腹腔镜输卵管妊娠开窗取胚术及切开缝合术后输卵管功能及妊娠结局分析  

Analysis of Fallopian Tube Function and Pregnancy Outcome after Laparoscopic Salpingostomy with and without Suturing

作　　者：张晓丹 刘艳[2] 刘欣[2] 任建蕾 张婷婷[1] 

机构地区：[1]潍坊医学院妇产科学教研室,山东潍坊261053 [2]潍坊市人民医院妇科

出　　处：《潍坊医学院学报》2017年第6期471-473,共3页Acta Academiae Medicinae Weifang

摘　　要：目的比较输卵管妊娠患者经腹腔镜下输卵管开窗取胚术与输卵管切开缝合术后的输卵管通畅率及妊娠结局。方法选取潍坊市人民医院2015年7月~2016年7月具有生育要求的输卵管妊娠患者197例,分为腹腔镜下输卵管开窗取胚组(109例)和输卵管切开缝合术组(88例),两组患者年龄、流产史、盆腔手术史及病灶直径比较,差异无统计学意义(P>0.05)。比较两组患者手术时间、术中出血量、术后β-HCG下降率、术后3个月输卵管功能与随访12个月再次受孕情况。结果两组患者术后3d、7dβ-HCG下降率比较,差异无统计学意义(P>0.05)。开窗组手术时间均小于缝合组,术后3个月缝合组输卵管通畅率高于开窗组,差异均有统计学意义(均P<0.05)。术中出血量两组无明显统计学意义(P>0.05)。术后随访12个月受孕结局,两组无明显统计学意义(P>0.05)。结论腹腔镜下输卵管开窗取胚术与切开缝合术都是治疗有生育要求的输卵管妊娠患者的有效术式,输卵管切开缝合术减少了输卵管阻塞及周围粘连率,但对妊娠结局无提高,且增加了手术时间,因此对于有生育要求的输卵管妊娠患者来说,缝合术并不是提高术后妊娠率的最佳有效方法。Objective To clarify the patency rate and pregnancy outcome after laparoscopic salpingostomy with and without suturing for tubal pregnancy. Methods A retrospective study was carried out on 197 patients of tubal pregnancy with fertility requirements in weifang people ＇s hospital from July 2015 to July 2016. The follow-up were 12 months. According to the types of procedures,all of the patients were divided into two groups： salpingostomy without suturing（ groupⅠ,n = 109） or with suturing（ group Ⅱ,n = 88）. Their operation time,the loss of blood,the decrease rate ofβ-HCG,the patency rate of the fallopian tube 3 months after the first operation and pregnancy outcome wereto compared and assessed. Results There was no significant difference in the decrease rate of β-HCG between the two groups at 3 d and 7 d after operation（ P〉0. 05）. The operation time was longer in groupⅡthan that in groupⅠ（ 50. 93 ± 3. 75） versus（ 39. 60 ± 5. 09） min,and the patency rate of the fallopian tube of the groupⅡwas higher than that of the groupⅠat 3 months after operation,the difference was statistically significant（ all P〈0. 05）. There was no statistically significant difference about the loss of blood and pregnancy outcome between the two groups（ P〉0. 05）. Conclusion Laparoscopic linear salpingotomy should be recommended as an useful method in the management of cases with tubal pregnancy who desire future pregnancy. The surgical procedure with suturing reduces the tubal obstruction and the surrounding adhesion rate,but the rate of pregnancy is not improved,and increase the operation time. Therefore,laparoscopic salpingostomy with suturing is not the best effective method to improve postoperative pregnancy rate in patients with fertility requirement.

关 键 词：腹腔镜手术 输卵管妊娠 开窗取胚术 切开缝合 妊娠结局 

分 类 号：R714.221[医药卫生—妇产科学]