【作者】 徐丽；

【导师】 王言奎；

【作者基本信息】 青岛大学 ， 妇产科学， 2015， 硕士

【摘要】 目的：应用宫腹腔镜联合手术观察异位妊娠输卵管开窗取胚术后输卵管的形态及通畅性,了解输卵管功能状态,评价输卵管开窗取胚术的临床意义,同时比较不同手术方式、途径对再次妊娠的影响以及评价输卵管造影的符合率方法：1.选取2008年至2010年期间在山东省淄博市齐都医院及青岛大学附属医院就诊的229例输卵管妊娠手术病人作为研究对象进行回顾性的研究分析,对其术后进行为期4年的随访。按手术方法不同分为输卵管切除组及输卵管开窗取胚术组,比较两种手术方法术后的宫内妊娠率、再次异位妊娠率及不孕率。按手术途径不同分为开腹手术组与腹腔镜手术组,比较两种手术途径术后的宫内妊娠率、再次异位妊娠率及不孕率。再选取55例行输卵管开窗取胚术后不孕的病人作为研究对象进行回顾性研究分析,应用宫腹腔镜联合手术观察患侧输卵管的形态及通畅性,了解输卵管功能状态,从而评价输卵管开窗取胚术的临床意义,并对其输卵管造影符合率进行研究。结果：1.输卵管切除组术后的宫内妊娠率、不孕率与开窗取胚术组无明显差异,两者统计学上比较无差异(P>0.05)；2.输卵管切除组术后的再次异位妊娠率较开窗取胚术组偏低,统计学比较有明显差异(P<0.05； 3.术中见对侧输卵管异常组的患者术后宫内妊娠率明显低于对侧输卵管正常组,统计学上比较差异有显著性(P<0.05),而再次输卵管妊娠和继发不孕的发生率明显高于对侧输卵管正常组,统计学差异有显著性(P<0.05)；4.开腹组与腹腔镜组术后宫内妊娠率、再次输卵管妊娠率无明显差异(P>0.05)；但腹腔镜组术后继发性不孕的发生率低于开腹组(P<0.05)；5.宫腹腔镜联合手术直视下观察开窗取胚术后输卵管的功能状态较差；6.输卵管造影对输卵管功能状态诊断的准确性较宫腹腔镜联合手术差,统计学上比较有差异(P<0.05)。结论：1.宫腹腔镜联合手术观察输卵管开窗取胚术后输卵管功能状态较差,输卵管妊娠患者术后的再次妊娠率取决于对侧输卵管的功能状态,故输卵管妊娠患者若术中发现对侧输卵管良好,手术方法宜为患侧切除,手术途径宜为经腹腔镜。2.输卵管妊娠行输卵管开窗术的患者术后6个月以上仍未孕者可直接选择宫腹腔镜联合手术评估其输卵管的功能状态,从而指导其选择合适的生育途径。更多还原

【Abstract】 Objective:In uterine abdominal combined operation, we observe the shape and the unobstructed rate of oviduct after removal the embryo by doing the oviduct fenestration. To understand its function, evaluate oviduct fenestration’s clinical significance and the acuity of salpingography.Methods:We select 229 ectopic pregnancy surgery patients in Qidu Hospital of Zibo, Shandong and Qingdao Medical University Hospital from 2008 to 2010, and separated them into two groups (Salpingectomy Group and Oviduct fenestration Group), compared pregnancy rate, ectopic re-pregnancy rate and infertility rate. Then separate them by different operation method (open group and laparoscopic group), compare the effective of two operation methods to the ectopic re-pregnancy. Meanwhile, we select 55 patients in oviduct fenestration with infertility and observe the shape and the unobstructed rate of oviduct after removal the embryo by doing the oviduct fenestration in uterine abdominal combined operation. To understand its function, evaluate oviduct fenestration’s clinical significance and the acuity of salpingography in the oviduct fenestration patients with infertility.Results:There is no significant different in pregnancy rate and infertility rate between salpingectomy group and oviduct fenestration group (P>0.05). However, the ectopic re-pregnancy rate of salpingectomy group is significantly lower than that of oviduct fenestration group (P<0.05). The pregnancy rate of the contralateral oviduct normal group is dramatically higher than that of the contralateral oviduct abnormality group (P< 0.05).but the ectopic re-pregnancy rate and the infertility rate of the contralateral oviduct normal group is significantly lower than those of the contralateral oviduct abnormality group (P<0.05).There is no significant different in pregnancy rate between open group and laparoscopic group (P>0.05). The infertility rate of laparoscopic group is significantly lower than that of open group. The function of oviduct was poor during the oviduct fenestration. Salpingography is not better for diagnosis the function of oviduct than the uterine abdominal combined operation (P<0.05)Conclusion1. We observe the open state and function of oviduct during the oviduct fenestration of uterine abdominal combined operation. The function of oviduct was poor during the surgery, and the pregnancy rate of patients is depend on the oviduct function. If we found the contralateral oviduct function is good, the operation option should be only remove the affected side.2. If the patients after the oviduct fenestration with 6 months to 12 months have still not pregnant, then we can choose the uterine abdominal combined operation to evaluate the oviduct funtion for guide the patients a better way of pregnant.更多还原