腹腔镜保守性手术治疗输卵管妊娠及对术后宫内妊娠的影响  

The influence of laparoscopic conservative surgery for treating women with tubal pregnancy on their postoperative intrauterine pregnancy

作　　者：陈丽鹃 陶萍 CHEN Lijuan;TAO Ping(The First People's Hospital of Chuzhou,Anhui Province,239001)

机构地区：[1]安徽省滁州市第一人民医院,239001

出　　处：《中国计划生育学杂志》2020年第9期1407-1411,共5页Chinese Journal of Family Planning

基　　金：安徽省自然科学基金项目(1708085MC83)。

摘　　要：目的:探讨腹腔镜保守性手术治疗输卵管妊娠患者临床效果及对术后宫内妊娠影响的可能因素。方法:选取本院收治的有生育要求的输卵管妊娠患者80例,根据患者意愿及输卵管情况选择手术方案,其中50例行保守性手术治疗(保守组),30例行输卵管切除术治疗(切除组),对比不同治疗方案临床效果并分析影响术后宫内妊娠的可能因素。结果:保守组手术时间(47.3±5.5min)、术中出血量(43.6±5.2ml)均高于切除组(37.2±6.0min、30.0±3.2ml)(P<0.05),术后尿管停留、肛门排气及术后住院时间两组无差异(P>0.05),血HCG转阴时间保守组(18.4±2.6d)长于切除组(9.26±3.87d)(P<0.05);术后输卵管碘油造影,保守组双侧通畅(60.0%),手术侧通畅(84.0%),对侧通畅(80.0%),切除组对侧通畅(83.3%)。术后随访宫内妊娠率、异位妊娠率及未孕比例两组无差异(P>0.05)。不同年龄、患侧输卵管破裂、对侧输卵管闭锁及术后对侧输卵管通畅者术后宫内妊娠未见差异(P>0.05),而术前不同HCG水平、盆腔黏连、异位妊娠史及术后患侧输卵管通畅者术后宫内妊娠存在差异(P<0.05);多因素分析显示,影响术后宫内妊娠的危险因素是术前患者血清高绒毛膜促性腺激素水平、有盆腔黏连、有异位妊娠史,而术后输卵管患侧通畅为术后宫内妊娠的保护因素(P<0.05)。结论:对盆腔黏连不严重及无重复同侧输卵管妊娠的患者,实施腹腔镜保守性手术,虽增加了手术时间和术中出血量,但手术创伤相对更小且未降低术后宫内妊娠几率。术前HCG水平>2000IU/L、有异位妊娠史、盆腔黏连严重是患者影响术后宫内妊娠的危险因素。Objective:To explore the clinical effect of laparoscopic conservative surgery for treating women with tubal pregnancy,and to study its influence on their postoperative intrauterine pregnancy.Methods:80 women with tubal pregnancy who had fertility requirement were selected in this study.According to wishes of these women and the condition of their fallopian tube,50 women in the study group were treated by laparoscopic conservative surgery and 30 women in the control group were treated by salpingectomy.The clinical effect of women were compared between the two groups,and the affect factors of their postoperative intrauterine pregnancy were analyzed.Results:The operation time and intraoperative blood loss of women in the study group were 47.3±5.5min and 43.6±5.2ml,which were significant higher than those(37.2±6.0min and 30.0±3.2ml)of the women in the control group,and the blood HCG turned to negative time of women in the study group was 18.4±2.6d,which was significant longer than that(9.26±3.87d)of the women in the control group(P<0.05),but there were no significant different in the Foley catheter kept time,anal exhaust time,and postoperative hospital stay between the two groups(P>0.05).In the study group,the results of postoperative lipiodol angiography showed that the rate of bilateral fallopian tube unobstructed was 60.0%,the rate of lesions fallopian tube unobstructed was 84.0%,and the rate of the contralateral fallopian tube unobstructed was 83.3%.There were no significant different in the intrauterine pregnancy rate,the ectopic pregnancy rate,and unpregnancy rate between the two groups(P>0.05).There was no significant difference in the intrauterine pregnancy rate among women with different age,with lesions fallopian tube ruptured,with contralateral fallopian tube obstructed,or with the contralateral fallopian tube unobstructed(P>0.05).There was significant difference in the intrauterine pregnancy rate among women with different HCG levels before operation,with pelvic adhesion,with ectopic pregnancy histo

关 键 词：输卵管妊娠 腹腔镜保守性手术治疗 宫内妊娠 影响因素 

分 类 号：R713.8[医药卫生—妇产科学]