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目的:回顾分析输卵管开窗术联合甲氨喋呤治疗异位妊娠的临床效果,评价腹腔镜下输卵管开窗术联合术中病灶局部注射甲氨喋呤(MTX)对提高异位妊娠后生育力的价值。方法:收集2002年1月～2007年12月在南昌大学第二附属医院住院诊断为异位妊娠的240例患者,按照手术方式及术后MTX的使用方案将其分为A组、B组、C组、D组。随访4组患者治愈后的生育力情况,随访时间为治疗后3年。结果:D组与A组、B组、C组术后1年内、2年内、3年内的宫内妊娠率、不孕率及异位妊娠再发率对照,经χ2检验,差异有统计学意义(P<0.01)。D组术后第1次宫内妊娠时间与A组、B组、C组对照,差异性显著(P<0.01)。结论:腹腔镜下输卵管开窗术联合术中病灶注射MTX治疗异位妊娠在治疗的同时可最大程度的保留患侧输卵管的功能,相对开腹行输卵管开窗术或术后予肌注MTX的治疗方法,对患者生育力的影响小。
OBJECTIVE: To retrospectively analyze the clinical effect of tubal fenestration combined with methotrexate in the treatment of ectopic pregnancy, evaluate the efficacy of laparoscopic tubal fenestration combined with local intraoperative injection of methotrexate (MTX) in improving the fertility after ectopic pregnancy the value of. Methods: A total of 240 patients diagnosed as ectopic pregnancy in the Second Affiliated Hospital of Nanchang University from January 2002 to December 2007 were enrolled in this study. They were divided into group A, group B according to the operation mode and the postoperative MTX protocol. Group C, Group D Follow-up 4 groups of patients after cure fertility, follow-up time of 3 years after treatment. Results: The intrauterine pregnancy rate, the rate of infertility and the rate of ectopic pregnancy recurrence within 1 year, 2 years and 3 years after operation in group D and group A, group B and group C were significantly lower than those in group A (P <0.01). The first intrauterine pregnancy time in group D was significantly different from that in group A, B and C (P <0.01). Conclusion: Laparoscopic tubal fenestration combined intraoperative injection of MTX treatment of ectopic pregnancy in the treatment of at the same time can maximize the retention of tubal function, relatively open abdominal tubal fenestration or postoperative intramuscular injection of MTX Treatment, the impact on the patient’s fertility small.