不同腹腔镜手术方式在输卵管妊娠中的应用

目的探讨腹腔镜不同手术方式对输卵管妊娠患者的影响。方法选择2008年2月至2010年8月入住重庆市万州区妇幼保健院的输卵管妊娠患者127例,按入组要求随机抽取38例进入A组,36例进入B组。A组行腹腔镜下输卵管开窗取胚或伞端妊娠物清除术(保守治疗),B组行腹腔镜下输卵管大部分切除术。术后比较两组患者手术时间与出血量,随访2年,比较两组患者的宫内妊娠和异位妊娠情况。结果 A组患者的手术时间长于B组,A组的出血量多于B组,差异均统计学意义(P<0.05);经2年随访,A组宫内妊娠17例(44.74%),B组12例(33.33%),两组差异无统计学意义(P>0.05);A组异位妊娠4例(10.53%),B组11例(30.56%),两组差异有统计学意义(P<0.05)。结论与腹腔镜下输卵管部分切除术相比,行腹腔镜下保守手术者再次宫内妊娠率稍高,异位妊娠率低,但具体术式应根据患者自身情况决定。

Application of two laparoscopic surgical methods for tubal pregnancy

Objective To discuss the influence of two laparoscopic Surgical methods for tubal pregnancy.Methods 127 patients with tubal pregnancy in department of gynaecology,Maternal and Child Health Care Hospital of Wanzhou District during february 2008 to august 2010 were Selected,randomly extracted 38 cases to group A and 36 cases to group B according to the selected demand.group A received laparoscopic tubal windowing fetching embryo or fimbriating pregnancy tissue removal（conservative treatment）,and group B received laparoscopic salpingectomy.the operation time and bleeding volume between the two groups after operation was compared,the intrauterine pregnancy and ectopic pregnancy between two groups were compared after followed up for 2 years.Results Operation time in group A was significantly longer than that in group B,and the amount of bleeding in group A was significantly much than that in group B（P0.05）.Followed up of 2 years,there were 17 cases（44.74%） of intrauterine pregnancy in group A,12 cases（33.33%） in group B,the difference was not statistically significant（P0.05）.Only 4 cases（10.53%） of ectopic pregnancy in group A,but group B had 11 cases（30.56%）,the difference was statistically significant（P0.05）.Conclusion The repregnancy rate of laparoscopic conservative surgery might be higher than laparoscopic tubal partial nephrectomy,ectopic pregnancy rate might be lower,but the specific operation procedure should be based on the patient′s own situation.