腹腔镜下输卵管开窗术与输卵管切开缝合术治疗输卵管妊娠对照分析

目的:对照分析腹腔镜下输卵管开窗术与输卵管切开缝合术治疗输卵管妊娠后的输卵管通畅率及再次妊娠结局。方法:输卵管妊娠126例依据不同术式分为腹腔镜下输卵管开窗术组(70例)和输卵管切开缝合术组(56例),术后3个月行输卵管造影术观察输卵管通畅率;随访48个月观察再次妊娠的结局。结果:开窗术组的手术时间(66.8±6.3)m in与缝合术组(45.5±4.6)m in比较差异有统计学意义(P<0.05)。两组术后治疗侧输卵管通畅率分别为84.3%和76.8%,输卵管周围粘连率分别为11.4%和21.4%;治疗侧输卵管完全梗阻率分别为4.3%和1.8%,两组间差异均无统计学意义。开窗术组再次妊娠54例(77.1%),其中宫内妊娠31例(44.3%),治疗侧重复性异位妊娠14例(20.0%),对侧重复异位妊娠9例(12.9%),继发不孕15例(21.4%)。切开缝合术组再次妊娠45例(80.4%),其中宫内妊娠24例(42.9%),治疗侧重复性异位妊娠12例(21.4%),对侧重复异位妊娠9例(16.1%),继发不孕10例(17.9%)。两组再次妊娠率、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。结论:腹腔镜下输卵管切开缝合术和开窗术都是治疗有生育要求的输卵管妊娠患者的有效术式,输卵管切开缝合术不提高术后宫内妊娠率,也不增加术后重复异位妊娠及输卵管阻塞和输卵管周围粘连的风险。缝合术并不是输卵管切开术中所必需的手术步骤。

Laparoscopic salpingotomy for tubal pregnancy: comparison of linear salpingotomy with and without suturing

Objective:To clarify the patency rate and pregnancy outcome after laparoscopic salpingotomy with and without suturing for tubal pregnancy.Methods:A retrospective study was carried out on 126 patients of tubal pregnancy.The follow-up were 48 months.According to the types of procedures,all of the patients were divided into two groups: salpingotomy without suturing(group Ⅰ;n=70) or with suturing(group Ⅱ;n=56) to compare and assess their surgical and pregnancy outcome by HSG 3 months after the first operation.Results:There were not significant differences in gestational age,ectopic site,tubal diameter,tubal condition,haemorrhage and preoperative HCG levels between the two groups.Only the operation time was longer in group Ⅱ than that in group Ⅰ((86.8±6.3) versus(65.5±4.6)min,P<0.05).The tubal patency rate of the treated side was 84.3%(59/70) in group Ⅰ and 76.8%(43/56) in group Ⅱ.Also the peritubal adhesions were observed in 11.4%(8/70) in group Ⅰ and 21.4%(12/56) in group Ⅱ,and were mostly comprised of filmy adhesions.A tubal fistula occurred in two cases in group Ⅰ and a tubal fistula occurred in one cases in group Ⅱ.Pregnancy rate was 77.1%(54/70) in group Ⅰ and 80.4%(45/56) in group Ⅱ,and this did not reveal any significant difference of cumulative pregnancy rate between the groups.Of 70 women after laparoscopic salpingotomy without suturing,31(44.3%) of them were intrauterine,14(20%) in treated tube and 9(12.9%) in contralateral tube were undergone repeat ectopic pregnancy(REP),and 15(21.4%)were endured secondary infertility.Of 56 women after salpingectomy with suturing,24(43%) of them was intrauterine,12(21.4%) in treated tube and 9(16.1%) in contralateral tube were undergone REP,and 10(17.9%)were endured secondary infertility.There was not significant difference between the two groups in the percentages of postoperative pregnancy,intrauterine pregnancy,REP and secondary infertility.Conclusion:Laparoscopic linear salpingotomy should be recommended as an useful method in the management of cases with tubal pregnancy who desire future pregnancy.This preliminary study emphasizes that the procedure involving suturing has no additional benefit over the nonsuturing technique during salpingotomy.