腹腔镜下输卵管壶腹部妊娠保守性手术的临床研究

目的探讨输卵管妊娠腹腔镜下行保守性手术的临床效果。方法回顾性分析我院2008年1月至2012年12月收治的204例经腹腔镜证实为输卵管壶腹部妊娠未破裂的患者．根据手术方案不同随机分为3组：A组：腹腔镜胚胎吸出联合甲氨蝶呤注射组（75例）；B组：单纯腹腔镜胚胎吸出组（69例）；C组：单纯甲氨蝶呤注射组（60例）。观察3组患者治疗前后血β—HCG水平、持续性异位妊娠发生率、包块消失时间及住院时间、治疗后输卵管通畅情况。结果A、B两组患者术前血清β—HCG水平无显著性差异（P〉0．05），术后A组下降较B组显著，有统计学差异（P〈0．05）。术前C组血清β-HCG水平较A、B组低，有统计学差异（P〈0．05），接受治疗后下降速度缓慢，下降幅度小，与A、B组比较，差异显著（P〈0．05）：A组持续性异位妊娠发生率0％，B和C-组持续性异位妊娠发生率分别为2．8％和5．0％。A、B两组患者附件区包块消失的平均时间及住院时间比较，差异无统计学意义（P〉0．05），但均优于C组（P〈0．05）。三组术后输卵管通畅情况：A、B组比较，无明显差异（P〉0．05），C组与A、B两组比较，差异有统计学意义（P〈0．05）。结论腹腔镜胚胎吸出联合甲氨蝶呤注射治疗输卵管壶腹部妊娠术后血HCG下降显著，持续异位妊娠发生率低，住院时间短，输卵管通畅率高，为有生育要求的输卵管壶腹部妊娠患者的首选治疗方案，值得在临床推广应用。

Clinical Research on Tubal Ampulla Pregnancy Treated by Laparoscopy Conservative Surgery

Objective To explore the clinical effect of tubal pregnancy treated by laparoscopy conservative surgery. Methods 204 cases of pregnancy patients with unruptured tubal ampulla treated by laparoscopy from January 2008 to December 2012 were analyzed retrospectively. According to the different operation scheme, they were randomly divided into three groups, including laparoscopic embryo aspiration combined with methotrexate injection （group A, 75 cases）, laparoscopic embryo aspiration （group B, 69 cases）, methotrexate injection alone （group C, 60 cases）. The blood fl-HCG levels of three groups before and after treatment, the incidence of persistent ectopic pregnancy, mass disappearance time and hospital stay were observed. Results Preoperative serum HCG levels had no significant difference between group A and group B （P 〉0.05）. Group A declined more significantly than group B at the postoperative period with statistical significant difference （P 〈0.05）. The preoperative blood fl-HCG level of group C was lower than that of group A and group B with statistical significant difference （P 〈0.05） despite its slow and small decline after treatment. The incidence of persistent ectopic pregnancy in group A was 0.0%, and group B and group C were 2.8% and 5.0%, respectively. The average time of extinction mass in adnexa and length of hospital stay had no statistical significant difference between group A and B （P 〉0.05）, but better than group C （P 〈0.05）. The condition of tubal patency after operation had no obvious difference between group A and B （P〉0.05）, but had statistical significant difference in group C compared with group A and group B（P〈0.05）. Conclusions Laparoscopic embryo aspiration combined with methotrexate injection in the treatment of pregnancy patients with unruptured tubal ampulla has the advantages such as significant decrease of postoperative serum HCG, lower incidence of persistent ectopic pregnancy, short hospital stay and high rate of tubal patency, which is the preferred treatment option for fertility requirements of women with tubal ampulla pregnancy and deserves clinical application.