腹腔镜下输卵管切开取胚联合输卵管通液术对远期妊娠的影响

目的 探讨异位妊娠患者腹腔镜下行输卵管切开取胚术联合输卵管通液术对远期妊娠结局的影响。方法 选择2015年1月~2016年7月在我院妇科治疗的输卵管妊娠患者138例，依据手术方式不同分为实验组70例和对照组68例，实验组行腹腔镜下患侧输卵管切开取胚术及子宫输卵管通液术，对照组单纯行患侧输卵管切开取胚术，比较两组手术时间、术中出血量、术后排气时间、住院天数，及术后2年内妊娠情况。结果 两组患者术中出血量，手术时间、术后排气时间、住院天数比较，差异无统计学意义（P＞0.05）。实验组术后2年内再次异位妊娠率为4.23%，3例再次异位妊娠再次行腹腔镜手术，46例宫内妊娠，8例继发性不孕，6例失访。对照组的再次异位妊娠率为16.18%，11例再次异位妊娠再次行腹腔镜手术，30例宫内妊娠，13例继发性不孕，7例失访。实验组的再次异位妊娠率低于对照组，再次宫内妊娠率高于对照组，差异有统计学意义（P＜0.05）。结论 腹腔镜下切开取胚术联合输卵管通液术可同时在术中判断对健侧输卵管通畅度，还可指导通而不畅甚至堵塞输卵管术中同时治疗，可能有助于降低再次异位妊娠的概率。

Effect of Embryo Extraction by Laparoscopic Oviduct Incision Combined with Hydrotubation on Long-term Pregnancy

Objective To investigate the effect of Embryo Extraction by Laparoscopic oviduct incision combined with Hydrotubation on the long term pregnancy outcome in patients with ectopic pregnancy. Methods 138 cases of tubal pregnancy treated in our hospital from January 2015 to July 2016 were divided into experimental group (n = 70) and control group (n = 68). The patients in the experimental group were treated with laparoscopic oviductal incision and Hydrotubation, while the control group were treated with oviductal oviduct incision alone.The time of operation, the amount of blood lost during operation, the time of exhaust after operation, the days of hospitalization, and the pregnancy in two years after operation were compared between the two groups. Results There was no significant difference in blood loss, operative time, postoperative exhaust time and hospital stay between the two groups(P > 0.05).In the experimental group, the rate of re-ectopic pregnancy was 4.23% within 2 years after operation. Three cases of ectopic pregnancy were followed by laparoscopic surgery, 46 cases of intrauterine pregnancy, 8 cases of secondary infertility, and 6 cases were lost to follow-up. The re-ectopic pregnancy rate of the control group was 16.18%. 11 cases of ectopic pregnancy were followed by laparoscopic surgery, 30 cases of intrauterine pregnancy, 13 cases of secondary infertility, and 7 cases were lost to follow-up. The rate of re-ectopic pregnancy in the experimental group was lower than that in the control group, and the intrauterine pregnancy rate was higher than that in the control group,the difference was statistically significant(P<0.05). Conclusion Embryo Extraction by Laparoscopic oviduct incision combined with Hydrotubation can simultaneously determine the patency of the unobstructed fallopian tube and may be helpful to reduce the probability of ectopic pregnancy.