腹腔镜保守手术联合术中甲氨蝶呤和术后米非司酮治疗输卵管妊娠80例

目的观察腹腔镜保守手术联合甲氨蝶呤＋米非司酮治疗输卵管妊娠患者术后患侧输卵管通畅程度和宫内妊娠、再次输卵管妊娠状况。方法对2011年11月至2012年12月收治的腹腔镜保守治疗手术患者80例作为观察组,观察术中出血量、手术时间、血β-人绒毛膜促性腺激素（β-HCG）下降时间、住院天数,术后输卵管通畅程度,再次异位妊娠发生率、宫内妊娠率,并与同期接受惠侧输卵管切除术患者40例进行比较。结果术后输卵管通畅率观察组为95.00%,对照组为45.00%;再次异位妊娠发生率观察组为5.00%,对照组为12.50%;血β-HCG下降天数观察组为（16.3±0.6）d,对照组为（11.50±0.4）d;2年宫内妊娠率观察组为61.26%,对照组为25.00%。结论腹腔镜保守手术联合甲氨蝶呤＋米非司酮治疗输卵管妊娠具有微创、安全、再次宫内妊娠率高、再次输卵管妊娠率低等优点,适用于年轻有生育要求的患者。

Effect Comparison of Laparoscopic Conservative Operation Combined with Intraoperative Methotrexate and Postoperative Mifepristone for Treating Tubal Pregnancy

Objective To investigate the status of tubal patency, intrauterine pregnancy and re- tubal pregnancy in affected side after la- paroscopic conservative surgery combined methotrexate（MTX） plus mifepristone for treating tubal pregnancy, Methods 80 patients treat- ed by laparoscopic conservative surgery in our hospital from November 2011 to December 2012 were selected as the observation group. The intraoperative bleeding amount, operative time, blood 13- HCG decrease time, hospitalization duration, postoperative tubal paten- cy degree, occurrence rate of ectopic re- pregnancy and intrauterine pregnancy were observed and compared with those in 40 cases of salpingeetomy in affected side at the same period. Results The tubal patency rate after operation was 95.00% in the observation group and 45.00% in the control group; the occurrence rate of ectopic re-pregnancy was 5.00% in the observation group and 12.50% in the control group; the number of days of blood 13- HCG decline was （16. 3-＋ 0. 6）d in the observation group and （11.5 ＋ 0.4）d in the control group;the intrauterine pregnancy rate during the two years was 61.26% in the observation group and 25.00% in the control group. Conclusion Laparoscopic conservative surgery combined with MTX plus mifepristone for treating tubal pregnancy has the advantages of minimal invasion, safety, high intrauterine repregnancy rate, and low tubal re- pregnancy rate, which is suitable for the young patients with fertility requirement.