腹腔镜两种术式及输卵管粘连评估对输卵管妊娠腹腔镜术后再次妊娠结局的影响

目的:探讨腹腔镜治疗输卵管妊娠手术方式及输卵管周围粘连等因素对术后再次妊娠结局的影响。方法:回顾性分析输卵管妊娠102例,根据手术方式分为输卵管切开组和切除组,随访48个月,观察术式对术后再次妊娠结局的影响;根据前次手术中输卵管粘连情况进行评分,评估输卵管粘连对再次妊娠结局的影响。结果:输卵管切开取胚术组再次妊娠54例(76.1%),其中宫内妊娠28例(39.4%),重复性异位妊娠26例(36.6%),继发不孕17例(23.9%)。输卵管切除术组术后再次妊娠23例(74.2%),其中宫内妊娠13例(41.9%),重复异位妊娠10例(32.3%),继发不孕8例(25.8%)。输卵管切开组与切除术组再次妊娠率,宫内妊娠率,重复异位妊娠率和继发不孕率差异均无统计学意义。重复异位妊娠组前次腹腔镜术中输卵管粘连评分明显高于宫内妊娠组,差异有统计学意义。结论:输卵管妊娠腹腔镜手术方式对再次妊娠的结局没有影响。前次异位妊娠手术中输卵管粘连评分可以作为预测术后重复异位妊娠的重要指标。

Effects of two kinds of laparoscopic operation methods and evaluation of fallopian tube adhesion on subsequent pregnancy outcomes of patients with tubal pregnancy after laparoscopic surgery

Objective:To explore the effects of different laparoscopic operation methods and fallopian tube adhesion on subsequent pregnancy outcomes of patients with tubal pregnancy after laparoscopic surgery.Methods:102 patients with tubal pregnancy were analyzed retrospectively,then they were divided into tubal incision group and tubal excision group according to laparoscopic operation methods;all the patients were followed up for 48 months,then the effects of different laparoscopic operation methods on subsequent pregnancy outcomes were observed;the patients were graded according to the adhesion conditions of fallopian tubes during the first operation,the effect of fallopian tube adhesion on subsequent pregnancy outcomes was evaluated.Results:54 patients(76.1%) in tubal incision group got pregnancy,including 28 patients(39.4%) with intrauterine pregnancy and 26 patients(36.6%) with recurrent ectopic pregnancy,17 patients(23.9%) were found with secondary infertility.23 patients(74.2%) in tubal excision group got pregnancy,including 13 patients(41.9%) with intrauterine pregnancy and 10 patients(32.3%) with recurrent ectopic pregnancy,8 patients(25.8%) were found with secondary infertility.There was no significant difference in subsequent pregnancy rate,intrauterine pregnancy rate,recurrent ectopic pregnancy rate and secondary infertility rate between the two groups.The score of fallopian tube adhesion during the first operation in recurrent ectopic pregnancy group was significantly higher than that in intrauterine pregnancy group,there was significant difference.Conclusion:The subsequent pregnancy outcomes are not affected by different laparoscopic operation methods;the score of fallopian tube adhesion during the first operation can be used as an important index to predict recurrent ectopic pregnancy after laparoscopy.