未破裂型输卵管妊娠的3种保守治疗方法对再次妊娠的影响

目的探讨未破裂型输卵管妊娠的3种保守治疗方法对再次妊娠的影响。方法93倒未破裂型输卵管妊娠患者分为3组，腹腔镜组33例和开腹组31例采用保守性手术，MTX组29例予以MTX20mg肌注，每天1次，连续5d，治愈后3个月行子宫输卵管碘油造影（HSG）比较3组输卵管通畅率，并统计两年内宫内孕、重复异位妊娠及继发不孕的发生率。结果腹腔镜组输卵管通畅率、宫内孕发生率与开腹组、MTX组比较差异均有统计学意义（P％0．05），开腹组与MTX组间差异无统计学意义（P〉0．05）。腹腔镜组继发不孕发生率与MTX组比较差异有统计学意义（P〈0．05）；与开腹组比较差异无统计学意义（P〉0．05）。重复异位妊娠发生率3组间差异无统计学意义（P〉0．05）。结论未破裂型输卵管妊娠行腹腔镜下保守性手术是对希望保留生育功能患者的首选治疗方式，且不增加重复异位妊娠的发生率。

Effect of 3 conservative therapies of unruptured tubal pregnancy on re-pregnancy

Objective To discuss the effect of 3 conservative therapies of unruptured tubal pregnancy on re-pregnancy.Methods The unruptured tubal pregnancy patients were divided into 3 groups.The laparoscopy group(33 cases)and the cesarean section group(31 cases) were taken conservative operation.MTX group(29 cases) was given MTX 20mg muscular injection,once a day,for successive 5d.HSG of uterus and oviduct was perfromed in 3 months after treatmnet.The oviduct unobstructed rate was compared among 3 goups.The intrauterine pregnancy rate,re-ectopic pregnancy rate and secondary infertility rate within 2 years were statisti- cally analyzed in 3 groups.Results There was statistical difference in the oviduct unobstructed rate and intrauterine pregnancy rate between the laparoscopy group and the cesarean section group,MTX group(P<0.05) and there was no statistical difference be- tween the laparoscopy group and MTX group(P<0.05).The secondary infertility rate had statistical difference between the lapa- roscopy group and MTX group(P<0.05) and had on statistical difference compared with the cesarean section group(P>0.05). The re-ectopie pregnancy rate had no statistical difference among 3 groups(P>0.05).Conclusion The conservative operation is first choice for the patient with unruptured tubal pregnancy,in the hoping to keeping the reproductive function,without increasing the re-heterotopic pregnancy rate.