不同处理方式在预防腹腔镜输卵管妊娠保守性手术后持续性异位妊娠中的效果比较  

Comparison of effect of different treatment methods in the prevention of persistent ectopic pregnancy after laparoscopic tubal pregnancy conservative operation

作　　者：秦月菊 俞碧霞 

机构地区：[1]宁波市北仑区人民医院妇科,浙江省宁波315800

出　　处：《中国基层医药》2017年第11期1601-1605,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医学会临床科研基金项目（2012zyc-a51）

摘　　要：目的 比较不同处理方式在预防腹腔镜输卵管妊娠保守性手术后持续性异位妊娠的效果,为输卵管妊娠有生育需求的患者临床治疗方案的选择提供参考.方法 选择204例输卵管妊娠需行腹腔镜保守手术治疗的患者,按照围手术期所采取的预防术后持续性异位妊娠的方式不同将其分为四组,分别为术中剔除孕囊后向输卵管注射甲氨蝶呤设为A组（48例）;剔除孕囊后,采用肌内注射甲氨蝶呤联合口服米非司酮预防术后持续性异位妊娠设为B组（56例）;剔除孕囊的同时剥除黄体设为C组（51例）;剔除孕囊后向输卵管注射甲氨蝶呤,同时剥除黄体为D组（48例）.比较四组临床手术指标（手术时间、术中出血量）,术后1 d、3 d、6 d及12 d的血β人绒毛膜促性腺激素（β-HCG）变化情况,术后持续性异位妊娠率,术后随访2年,比较四组术后再次正常妊娠时间,综合评价不同处理方式在预防腹腔镜输卵管妊娠保守性手术后持续性异位妊娠中的效果.结果 四组年龄、生育状况、停经时间、术前1 d出血量、患侧输卵管破裂例数、输卵管包块直径、孕囊在输卵管中的位置、血β-HCG水平、手术方式差异均无统计学意义（均P＜0.05）.四组手术指标比较,B组手术时间明显短于其他三组（F=5.305,P=0.037）;C组出血量与D组差异无统计学意义,明显高于A组和C组（F=7.483,P=0.005）,D组术后1 d、3 d、6 d及12 d血β-HCG明显低于其他三组（均P＜0.05）,B组在不同时间段β-HCG水平均明显高于其他三组（均P＜0.05）.术后D组发生持续性异位妊娠率明显低于其他三组（2.08%比14.58%、14.29%、11.54%,x2=7.406,P=0.040）,且D组再次正常妊娠率明显高于A、B、C组（58.33%比37.50%、32.14%、38.46%,x2=5.349,P=0.022）.结论 采用腹腔镜摘除输卵管孕囊的同时,向输卵管内注射甲氨蝶呤,同时剥除黄体,虽然增加了手术时间及出血量,但可明显降低持续Objective To compare the effect of different treatment methods in the prevention of persistent ectopic pregnancy after laparoscopic tubal pregnancy conservative operation, to provide reference to women＆#39;s clinical treatment planning needs of choice.Methods 204 patients underwent laparoscopic tubal pregnancy conservative surgery were selected.According to perioperative preventive postoperative persistent ectopic pregnancy in different ways, they were divided into four groups.After the removal of the gestational sac, the methotrexate injected into the fallopian tube was established as A group（48 cases）;methotrexate combined with mifepristone on the prevention of persistent ectopic pregnancy after laparoscopic cyst removal was established as B group（56 cases）;simultaneous removal of corpus luteum in laparoscopic cyst removal surgery was established as C group（51 cases）;after removal of the bursa, methotrexate injected into the fallopian tube in laparoscopic cyst removal surgery was established as D group（48 cases）.The operation indicators of four groups （operation time and intraoperative bleeding volume）,blood beta-HCG（β-HCG） changes of 1st,3rd,6th and 12th day after surgery, ectopic pregnancy rate continued after surgery, postoperative follow-up of 2 years were compared.Of the four groups, the normal pregnancy again time after operation, the comprehensive evaluation of different treatment methods for the effect of ectopic pregnancy in the prevention of laparoscopic tubal pregnancy conservative surgery were compared.Results Of the four groups, the age, reproductive status, menopause, preoperative 1st day bleeding, tubal rupture cases, tubal mass diameter, gestational sac in the fallopian tube in position, bloodβ-HCG levels, operation methods had no statistically significant differences（all P〈0.05）.Comparison of four groups of operation indicators, the operation time in B group was significantly shorter than that in the other three groups（F=5.305,P=0.037）.The amount of bleedin

关 键 词：妊娠 输卵管 腹腔镜检查 妊娠 异位 

分 类 号：R713.8[医药卫生—妇产科学]