不同手术途径及方法对输卵管妊娠术后生育结局的影响

目的:探讨使用不同手术途径和手术方法治疗输卵管妊娠术后患者的生育结局及其影响因素。方法:回顾性分析382例输卵管妊娠妇女经手术治疗后的生育状况,比较开腹手术与腹腔镜手术、输卵管保守手术与切除手术之间的区别。结果:在无不良病史及输卵管病变的174例患者中,腹腔镜组较开腹组、输卵管保守手术组较输卵管切除术组均有更高的宫内妊娠几率及较低的重复性异位妊娠几率,差异均有显著性(P<0.01);而在有不良病史及输卵管病变的208例患者中,两种手术途径及两种手术方法对术后生殖状态的影响差异均无显著性(P>0.05)。结论:在影响输卵管妊娠手术治疗后生育结局的因素中,手术途径及方法对生殖能力的影响次要于患者的不良病史及输卵管状况的影响。如患者没有不良病史及输卵管病变,则其生殖预后良好,腹腔镜手术明显优于开腹手术,保留输卵管手术明显优于输卵管切除术。

Effect of different surgical pathway and methods of oviduct on reproductive outcome after tubal pregnancy

Objective:To explore the reproductive outcome and it's effect factors of different surgical pathway and methods of oviduct after tubal pregnancy.Methods:Reproductive outcomes of 382 women after different surgical pathway and methods of tube pregnancy were analysed retrospectively.The differences between laparotomy and laparoscopy,conservative tubal surgery and salpingectomy were compared.Results:Among 174 cases without undesirable history and oviduct lesions,the intrauterine pregnancy rates in laparoscopy group and conservative tubal surgery group were significantly higher than those in laparotomy group and salpingectomy(P<0.01),the recurent ectopic pregnancy rates in laparoscopy group and conservative tubal surgery group were significantly lower than those in laparotomy group and salpingectomy(P<0.01).But among 208 cases with undesirable history and oviduct lesions,there was no difference in the reproductive outcomes between the groups(P>0.05).Conclusion:Undesirable history and oviduct lesions are major effect factors of reproductive outcomes after tubal pregnancy.Laparoscopy is superior to laparotomy and conservative tubal surgery is superior to salpingectomy at preserving fertility especially in the patients without risk factor such as undesirable history and oviduct lesions.