腹腔镜保守手术和血管介入治疗输卵管妊娠疗效和术后生育状况分析

目的比较输卵管妊娠腹腔镜保守手术和血管介入治疗疗效和术后生育状况,为有生育要求选择微创手术治疗输卵管妊娠者提供理论依据。方法对2005年12月至2008年12月在惠阳人民医院诊断输卵管妊娠,有生育要求患者68例采用腹腔镜保守手术治疗（腹腔镜组）,58例采用子宫动脉灌注栓塞术治疗（血管介入组）,观察其疗效和术后输卵管通畅程度,再次妊娠时间,宫内妊娠率,异位妊娠再发等情况。结果腹腔镜组成功率100%,血管介入组成功率89.7%。腹腔镜组无论双侧输卵管再通率、手术侧输卵管通畅率、对侧输卵管通畅率均较血管介入组高（P〈0.05）;随访0.5～3年,腹腔镜组和血管介入组受孕平均时间（356.76±121.68）d、（437.88±142.75）dL,再次宫内妊娠率分别为（63.2%、46.5%）,再次异位妊娠率（14.7%、22.4%）,2组比较差异均有统计学意义（P〈0.05）。结论输卵管妊娠腹腔镜保守手术和血管介入均为微创、安全、有效的方法,腹腔镜手术成功率高,血管介入有一定的适应证,对于有生育要求的输卵管妊娠患者,腹腔镜保守手术是首选。重复同侧输卵管妊娠者,不建议行保守手术。

Analysis on the Therapeutic Effect and Procreation State of Oviductal Pregnancy after Laparoscopic Conservative Operation and Vascular Interventional Therapy

Objective To compare the curative effect and procreation state of oviductal pregnancy patients after laparoscopic conservative operation and vascular interventional therapy, and provide theoretical evidence for patients desiring procreation to choose minimally invasive surgery to cure oviductal pregnancy. Methods 126 cases of tubal pregnancy diagnosed in huiyang renmin hospital between June, 2005 and December,2008 were collected and divided into two groups.68cases were adopted laparoscopic conservative operation and 58 cases adopted intra-uterine artery infusing embolization operation.To observe the curative effect, oviduct unobstruction sequence, next gestation time, intrauterine pregnancy rate ,ectopic pregnancy relapse and so on. Results The achievement ratio was 100% in laparoscopy group and 89.7% in vascular intervention group. The recanalization rates of the bilateral, operation lateral and opposite side oviduct in laparoscopy group overweighted those in vascular intervention group（P〈0.05）,After 0.5～3years’follow-up visit,the mean conceiving time was（356.76121.68）days in laparoscopy group and（437.88142.75）days in vascular intervention group, the next intrauterine pregnancy rate was 63.2% and 46.5% respectively while the ectopic pregnancy rate was14.7% and 22.4% respectively, all the differeces were statistically significant（P〈0.05）.Conclusion Both laparoscopic conservative operation and vascular interventional therapy are minimally invasive, safe and effective.The achievement ratio of laparoscopy is high, vascular intervention requires some indicatons. Laparoscopic conservative operation is first choice for oviductal pregnancy patients desiring procreation. Laparoscopic conservative operation is not recommended for the repeated ipsilateral tubal pregnancy.