【摘要】 目的探讨腹腔镜手术治疗输卵管间质部或峡部妊娠的临床效果。方法对2015年1月～2017年6月江西省人民医院收治的95例腹腔镜手术治疗的异位妊娠(EP)患者进行回顾性研究,按照手术方式分为A(30例)、B(32例)、C组(33例)。A组腹腔镜下行患侧输卵管切开取胚;B组腹腔镜下行患侧输卵管全部切除;C组腹腔镜下仅切除包含有妊娠病灶的一段输卵管,保留远端输卵管。对三组的术中情况、住院时间,术后卵巢功能及再妊娠结局等进行比较。结果 A组的术中出血量多于B和C组,手术时间长于B和C组,差异有统计学意义(P<0.05);B组术后1个月的卵巢卵泡数(AFC)少于A、C组和术前患侧,差异均有统计学意义(P<0.05);B组术后1个月的卵泡刺激素(FSH)、促黄体生成素(LH)水平高于A和C组,雌二醇(E2)水平低于A和C组,差异均有统计学意义(P<0.05)。结论腹腔镜下输卵管切开取胚术可能增加术中出血量,延长手术时间,甚至导致再次EP。手术中是否保留含有妊娠病灶的输卵管,应根据患者意愿和实际情况进行选择。更多还原

【Abstract】 Objective To investigate the clinical effect of laparoscopic surgery in the treatment of interstitial or isthmic pregnancy of fallopian tubes. Methods From January 2015 to June 2017, 95 cases of ectopic pregnancy(EP)hospitalized in Jiangxi Provincial People′ s Hospital were retrospectively studyed. All these patients were selected for laparoscopic surgery. These patients were divided into three groups according to surgical methods: group A(30 cases),group B(32 cases), and group C(33 cases). In group A,these patients was only given fallopian tube incision to remove pregnancy lesions. In group B, all patients was underwent laparoscopic total salpingectomy of the affected side removal. In group C, only a segment of the fallopian tube containing the pregnancy lesion was removed, and the distal fallopian tube excluding the pregnancy lesion was retained. Intraoperative condition, length of hospital stay,postoperative ovarian function and outcome of second pregnancy were compared among the three groups. Results The amount of intraoperative blood loss in group A was more than that in group B and C, and the operation time was longer than that in group B and C, with statistically differences(P<0.05). The number of ovarian follicles(AFC) in the ovaries of patients in group B at 1 month after surgery was fewer than that in groups A and C and the affected side before surgery, and the differences were statistically significant(P<0.05). The levels of follicls stimalating hormore(FSH) and luteinizing hormore(LH) in group B were higher than those in group A and group C, and the level of estradiol(E2) was lower than that in group A and group C, the differences were statistically significant(P <0.05). Conclusion Laparoscopic fallopian tube incision and embryo extraction may increase intraoperative blood loss, prolong the operation time, and even lead to a second EP. Therefore, the choice of whether to retain fallopian tubes containing pregnancy lesions should be made according to patients′ wishes and actual conditions.更多还原