【作者】 邓新粮； 肖松舒；

【Author】 DENG Xin - liang, XIAO Song - shu(Department of Gynecology and Obstertrics , the Third Xiangya Hospital, Central South University, Changsha, Hunan 410013 , P. R. China)

【机构】 中南大学湘雅三医院妇产科；

【摘要】 目的探讨腹腔镜与开腹输卵管妊娠病灶清除术后血β-hCG恢复正常的时间及持续性异位妊娠的处理方法。方法对149例确诊为输卵管妊娠、包块直径<5 cm、且有生育要求的患者,行腹腔镜或开腹保守手术,并对其术前、后血β-hCG水平及术后β-hCG降至正常的时间进行对比观察。结果腹腔镜组与开腹组术前血β-hCG水平差异无显著性(P>0.05)。腹腔镜组118例中血β-hCG在14 d内降至正常者94例(79.66%),>14 d降至正常者24例(20.34%),其中经期待观察缓慢下降至正常者9例(37.5%),用MTX后下降至正常者15例(62.5%),开腹组31例中血β-hCG 14 d内恢复正常者30例(96.77%),>14 d者1例(3.23%),经注射MTX后降至正常,两组差异有显著性(P<0.05)。149例患者中无1例行第2次手术,月经均于1-3个月内恢复正常。结论输卵管妊娠保守性手术是未育妇女保留生育功能最常用的手术方法,术后密切监测血β-hCG及恰当地预防和处理持续性异位妊娠是保守手术成功的关键。更多还原

【Abstract】 [Objective] To investigate and evaluate the time for serum β- hCG descending to normal after salpingostomy laparoscopicly or laparotomicly, and the treatment methods for persistent ectopic pregnancy (PEP). [ Methods] Compared with the level of β - hCG before or postoperation and the time of serum β - hCG descend to normal, 149 patients who were diagnosed tubal pregnancy and mass diameters less than 5cm and had birth demand, were selected to perform conservative operation by laparoscopy and laparotomy respectively. [Results] The serum β - hCG level of two groups was no statistically significant before operation (P >0.05). .In laparoscopy group, out of 118 cases, the serum β - hCG of 94 cases (79.66%) descended to normal within 14 days, that of 24 cases (20.34%) for more than 14 days, 9 cases (37.5%) descended to normal slowly by observation expectively, 15 cases (62.5% ) descended to normal by MTX injection. Out of 31 cases in laparotomy group, the serum β - hCG of 30 cases (96. 77% ) descended to normal in 14 days, 1 case( 3. 23% ) get to normal after by injected MTX, the difference of β- hCG level for two groups was statistically significant(P <0.05). No one had operated again in all 149 patients, and menstruation restored in 1 - 3 months. [Conclusion] Conservative operation of tubal pregnancy is a most usual method for women who had birth demand. Monitoring serum β - hCG closely and preventing or treating persistent ectopic pregnancy appropriately is the key of conservative operation.更多还原