【摘要】 目的探究输卵管异位妊娠应用腹腔镜输卵管切开取胚术治疗的效果及对输卵管和生殖潜能的影响。方法回顾性分析2014年1月—2016年1月收治的301例输卵管异位妊娠患者的临床资料。根据实行的不同术式将301例患者分为腹腔镜输卵管切开取胚术组(研究组,n=155)和腹腔镜输卵管切除术组(对照组,n=146)。比较两组患者手术时间、术中出血量、留置导尿时间、肛门排气时间、住院时间、β-人绒毛膜促性腺激素(β-HCG)降至正常时间等围手术期指标差异,观察手术前后血清β-HCG、孕酮水平变化情况;随访2年后,比较持续性异位妊娠(PEP)、重复异位妊娠(REP)、宫内妊娠(IUP)发生情况。结果研究组手术时间、β-HCG降至正常时间均长于对照组(P<0.05);两组患者术中出血量、留置导尿时间、肛门排气时间、住院时间比较,差异无统计学意义(P>0.05);术后24 h,两组患者血清β-HCG、孕酮水平均较术前降低,且研究组高于对照组(P<0.05);随访2年后,两组患者PEP、REP发生率比较,差异无统计学意义(P>0.05);研究组IUP发生率高于对照组(P<0.05)。结论与腹腔镜输卵管切除术比较,输卵管异位妊娠行腹腔镜输卵管切开取胚术治疗效果相当,术后恢复时间差异不大,虽所需手术时间稍长,激素恢复正常较慢,但宫内妊娠情况较好,更有利于保护患者生育能力。更多还原

【Abstract】 Objective To investigate the treatment effect of laparoscopic salpingotomy and embryo extraction on tubal ectopic pregnancy and its influence on fallopian tube and reproductive potential. Methods Clinical data of 301 patients with tubal ectopic pregnancy admitted to our hospital from January 2014 to January 2016 were analyzed retrospectively. The patients were assigned into the laparoscopic salpingotomy and embryo extraction group( n = 155,the study group) and laparoscopic salpingotomy group( n = 146,the control group) according to different surgical means. Perioperative indexes between the two groups( operative time,intraoperative bleeding amount,indwelling catheterization time,anal exhaust time,hospitalization time and the time of β-human chorionic gonadotropin( β-HCG) reducing to the normal level) were compared,and the levels of serum β-HCG and progesterone were observed before and after operation. After 2 years of follow-up,the occurrence of persistent ectopic pregnancy( PEP),repeated ectopic pregnancy( REP) and intrauterine pregnancy( IUP) were compared. Results The operative time and the time of β-HCG reducing to the normal level in the study group were longer than those in the control group( P < 0. 05). There was no statistically significant difference in intraoperative bleeding amount,indwelling catheterization time,anal exhaust time and hospitalization time between the two groups( P > 0. 05). 24 h after operation,the levels of serum β-HCG and progesterone in the two groups were significantly lower than those before operation,and the levels in the study group were significantly higher than those in the control group( P < 0. 05). After 2 years of follow-up,there was no significant difference in the occurrence rates of PEP and REP between the two groups( P >0. 05),and the incidence of IUP in the study group was higher than that in the control group( P < 0. 05). Conclusion Laparoscopic salpingotomy and embryo extraction for tubal ectopic pregnant patients has quite similar treatment effect with laparoscopic salpingotomy,except in postoperative recovery time. Although operation time is longer and hormones take more time to assume to the normal level,the former is better in intrauterine pregnancy condition andprotection of reproductive function.更多还原