腹腔镜下输卵管切除术及开窗术对输卵管壶腹部妊娠术后生育结局的影响  

Effect of laparoscopic tubal resection and fenestration on posoperative fertility outcome of tubal ampulla pregnancy

作　　者：甄宗慧[1] ZHEN Zong-hui.(Department of Obstetrics and Gynecology, Shandong Province Tengzhou City Worker＇ s Hospital, Tengzhou 277500, Chin)

机构地区：[1]山东省滕州市工人医院妇产科,277500

出　　处：《中国实用医药》2017年第29期26-28,共3页China Practical Medicine

摘　　要：目的对比分析腹腔镜下输卵管切除术与开窗术对输卵管壶腹部妊娠患者术后生育结局的影响。方法 178例输卵管壶腹部妊娠患者均行腹腔镜手术治疗,根据患者意愿选择手术方式将患者分为切除术组(76例,采用腹腔镜下输卵管切除术治疗)及开窗术组(102例,采用腹腔镜下输卵管开窗术治疗),统计并比较两组患者手术情况,术后定期随访2年,统计并比较两组随访患者生育情况。结果切除术组及开窗术组患者手术时间分别为(50.8±9.9)、(53.3±10.4)min,术中出血量分别为(27.5±11.2)、(29.2±12.7)ml,排气时间分别为(18.7±8.9)、(20.3±8.4)h,术后住院时间分别为(3.8±1.6)、(4.1±1.7)d,两组患者手术时间、术中出血量、排气时间及术后住院时间比较差异无统计学意义(t=1.619、0.928、1.225、1.194,P>0.05)。术后切除术组符合随访条件的患者71例,开窗组符合随访条件的患者93例。随访2年内,切除术组随访患者中宫内妊娠率为64.8%(46/71),异位妊娠率为16.9%(12/71),继发不孕率为18.3%(13/71),与开窗术组的68.8%(64/93)、16.1%(15/93)、15.1%(14/93)比较差异无统计学意义(χ2=0.296、0.017、0.310,P>0.05)。结论相比于腹腔镜下输卵管切除术,腹腔镜下输卵管开窗术与其手术情况相当,且其并不能明显改善输卵管壶腹部妊娠患者的生育结局,因此在患者没有强烈要求保留输卵管的情况下,可优先选择输卵管切除术。Objective To compare and analyze the effect of laparoscopic tubal resection and fenestration on posoperative fertility outcome of patients with tubal ampulla pregnancy.Methods A total of 178 patients with tubal ampulla pregnancy all treated with laparoscopic surgery,and they were divided by different surgical methods into resection group（76 cases,laparoscopic tubal resection） and fenestration group（102 cases,laparoscopic tubal fenestration）.The surgical conditions in two groups was compared,and after 2 years regular followed-up,the fertility conditions in two groups was compared.Results The resection group and fenestration group had operation time respectively as（50.8±9.9） min and（53.3±10.4） min,intraoperative bleeding volume respectively as（27.5±11.2） ml and（29.2±12.7） ml,exhaust time respectively as（18.7±8.9） h and（20.3±8.4） h and postoperative hospitalization time respectively as（3.8±1.6） d and（4.1±1.7） d.Both groups had no statistically significant difference in operation time,intraoperative bleeding volume,exhaust time and postoperative hospitalization time（t=1.619,0.928,1.225,1.194,P〉0.05）.After operation,the resection group had 71 cases eligible for follow-up,which was 93 cases in the fenestration group.Within 2 years of follow-up,the resection group had no statistically significant difference in intrauterine pregnancy rate as 64.8%（46/71）,ectopic pregnancy rate as 16.9%（12/71） and secondary infertility rate as 18.3%（13/71）,comparing with 68.8%（64/93）,16.1%（15/93） and 15.1%（14/93） in fenestration group（χ^2=0.296,0.017,0.310,P〉0.05）.Conclusion Laparoscopic tubal fenestration shows surgical conditions with laparoscopic tubal resection,and it can not obviously improve fertility outcome of patients with tubal ampulla pregnancy.Therefore,tubal hysterectomy may be preferred if the patient does not have a strong desire to retain the fallopian tube.

关 键 词：输卵管壶腹部妊娠 腹腔镜 输卵管切除术 输卵管开窗术 生育结局 

分 类 号：R713.8[医药卫生—妇产科学]