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目的:对照分析腹腔镜下输卵管开窗术与输卵管切开缝合术治疗输卵管妊娠后的输卵管通畅率及再次妊娠结局。方法:输卵管妊娠126例依据不同术式分为腹腔镜下输卵管开窗术组(70例)和输卵管切开缝合术组(56例),术后3个月行输卵管造影术观察输卵管通畅率;随访48个月观察再次妊娠的结局。结果:开窗术组的手术时间(66.8±6.3)m in与缝合术组(45.5±4.6)m in比较差异有统计学意义(P<0.05)。两组术后治疗侧输卵管通畅率分别为84.3%和76.8%,输卵管周围粘连率分别为11.4%和21.4%;治疗侧输卵管完全梗阻率分别为4.3%和1.8%,两组间差异均无统计学意义。开窗术组再次妊娠54例(77.1%),其中宫内妊娠31例(44.3%),治疗侧重复性异位妊娠14例(20.0%),对侧重复异位妊娠9例(12.9%),继发不孕15例(21.4%)。切开缝合术组再次妊娠45例(80.4%),其中宫内妊娠24例(42.9%),治疗侧重复性异位妊娠12例(21.4%),对侧重复异位妊娠9例(16.1%),继发不孕10例(17.9%)。两组再次妊娠率、宫内妊娠率、重复异位妊娠率和继发不孕率差异均无统计学意义。结论:腹腔镜下输卵管切开缝合术和开窗术都是治疗有生育要求的输卵管妊娠患者的有效术式,输卵管切开缝合术不提高术后宫内妊娠率,也不增加术后重复异位妊娠及输卵管阻塞和输卵管周围粘连的风险。缝合术并不是输卵管切开术中所必需的手术步骤。
OBJECTIVE: To compare and analyze the success rate of tubal patency after tubal pregnancy and the pregnancy outcome after the laparoscopic tubal opening and tubal incision and suture. Methods: 126 cases of tubal pregnancy were divided into laparoscopic group (70 cases) and tubal incision suture group (56 cases) according to different surgical procedures. The tubal patency rate was observed by oviduct angiography at 3 months after operation. Follow-up of 48 months to observe the outcome of pregnancy again. Results: The operative time (66.8 ± 6.3) m in the fenestration group was significantly different from that of the suture group (45.5 ± 4.6) m in (P <0.05). The postoperative tubal patency rate was 84.3% and 76.8% respectively, and the rate of tubal adhesions was 11.4% and 21.4% respectively. The complete obstruction rate of the treatment side tubal was 4.3% and 1.8% respectively, with no statistical difference between the two groups Significance of learning. There were 54 cases (77.1%) of reoperation in the fenestration group, including 31 cases of uterine pregnancy (44.3%), 14 cases (20.0%) of repeat ectopic pregnancy and 9 cases (12.9%) of contralateral ectopic pregnancy , Secondary infertility in 15 cases (21.4%). Among 45 cases (80.4%) who underwent incision suture group, 24 cases (42.9%) had intrauterine pregnancy, 12 cases (21.4%) had repeat ectopic pregnancy and 9 cases (16.1% ), Secondary infertility in 10 cases (17.9%). There was no significant difference between the two groups in pregnancy rate, intrauterine pregnancy rate, repeated ectopic pregnancy rate and secondary infertility rate. Conclusion: Laparoscopic tubal incision suture and fenestration are both effective methods for the treatment of fertility tubal pregnancy. Tubal incision suture does not increase intrauterine pregnancy rate, and does not increase postoperative recurrence Pregnancy and tubal occlusion and the risk of adhesions around the fallopian tube. Suturing is not a surgical procedure necessary for tubal incision.