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目的比较腹腔镜下不同手术方式治疗输卵管妊娠后,宫内妊娠率和再次异位妊娠的风险差别。方法回顾分析118例输卵管妊娠行腹腔镜手术治疗且希望保留生育能力并有随诊条件的患者的临床资料,根据手术方式不同进行分组;A组行患侧输卵管开窗取胚术同时加患侧输卵管近端注射甲氨蝶呤(MTX)30mg的保留输卵管手术,共62例;B组在无法保留患侧输卵管或已有一子女,对侧卵管外观正常时行输卵管切除术,共56例。比较两组不同手术方式治疗输卵管妊娠后的生殖状态。结果术后1～3年宫内妊娠率:A组[19例(30.6%)]与B组[16例(28.6%)]比较无显著性差异(P﹥0.05);异位妊娠发生率:A组[11例(17.7%)]与B组[3例(5.3%)]比较有显著性差异(P﹤0.05)。结论输卵管妊娠行腹腔镜下保留患侧输卵管手术应慎用,宫内妊娠率虽然略高于切除者,但可增加再次宫外孕发生的危险。
Objective To compare the different risk of intrauterine pregnancy and repeat ectopic pregnancy after laparoscopic operation of different forms of tubal pregnancy. Methods Retrospective analysis of 118 cases of tubal pregnancy underwent laparoscopic surgery and hope to retain fertility and follow-up of patients with clinical data, according to different surgical methods were grouped; A group of ipsilateral tubal window embryo fetus plus the affected side Tubal proximal tubal injection of methotrexate (MTX) 30mg retained tubal surgery, a total of 62 cases; B group can not retain the affected tubal or have a child, the contralateral ovary normal appearance of tubal resection, a total of 56 cases. The reproductive status after tubal pregnancy was compared between two groups. Results The intrauterine pregnancy rate of 1 to 3 years after operation was not significantly different between group A and group B (19.6% and 16.6%, P <0.05). The incidence of ectopic pregnancy: There were significant differences (P <0.05) between group A [11 cases (17.7%)] and group B [3 cases (5.3%)]. Conclusion tubal pregnancy laparoscopic surgery to retain ipsilateral tubal surgery should be used with caution, while the intrauterine pregnancy rate slightly higher than the excision, but may increase the risk of ectopic pregnancy again.