未破裂输卵管妊娠腹腔镜保守手术治疗效果观察
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摘要
目的对比腹腔镜保守手术在未破裂输卵管妊娠的治疗效果和安全性。方法选择2015年4月-2016年6月在医院实施未破裂输卵管妊娠保守手术的患者为研究对象,其中68例为剖腹手术,75例为腹腔镜下手术,对比两种手术方式术中创伤程度、术后恢复速度以及术后输卵管再通率和妊娠率。结果两组患者手术时间、手术成功率差异无统计学意义(P>0. 05)。腹腔镜组术中失血量明显少于剖腹组,术后体温上升程度明显低于剖腹组,肛门排气时间、下床时间、住院时间均明显少于剖腹组,两组间差异均有统计学意义(P<0. 05)。术后腹腔镜组血β-h CG恢复正常时间略少于剖腹组,但差异无统计学意义(P>0. 05)。术后腹腔镜组镇痛率显著少于剖腹组,术后3个月患侧输卵管造影显示再通率86. 67%明显高于剖腹组的69. 12%,两组差异均有统计学意义(P<0. 05)。术后对两组患者中有生育要求并正常备孕的患者随访1年,腹腔镜组随访49例,妊娠率为69. 39%,其中2例为输卵管妊娠(4. 08%);剖腹组随访47例,妊娠率为46. 81%,其中4例为输卵管妊娠(8. 51%),两组妊娠率差异有统计学意义(P<0. 05)。结论腹腔镜保守手术在未破裂输卵管妊娠治疗中具有创伤小、恢复快、术后妊娠率高的优点,值得临床运用和推广。
Objective To compare the curative effect and security of laparoscopic conservative surgery for unruptured tubal pregnancy.Methods The patients of unruptured tubal pregnancy undergoing laparoscopic conservative surgery in Zunhua People's Hospital from April2015 to June 2016 were selected and divided into laparotomy group (68 patients) and laparoscopy group (75 patients). The degrees of intraoperative trauma,speeds of postoperative recovery,Fallopian tube recanalization rates,and pregnancy rates in the two groups were compared. Results There was no statistically significant difference in operation time and successful rate of operation between the two groups (P>0. 05). The amount of blood loss in laparoscopy group was statistically significantly less than that in laparotomy group (P<0. 05).The increasing degree of temperature after operation in laparoscopy group was statistically significantly lower than that in laparotomy group (P<0. 05). The anal exhausting time,the time of getting out of bed,and hospitalization time in laparoscopy group was statistically significantly shorter than that in laparotomy group (P<0. 05). The time of blood β-h CG recovery to normal after operation in laparoscopy group was slightly shorter than that in laparotomy group,but there was no statistically significant difference (P>0. 05). The rate of analgesia after operation in laparoscopy group was statistically significantly lower than that in laparotomy group (P< 0. 05). At 3 months after operation,the recanalization rate of affected side in laparoscopy group was 86. 67%,which was statistically significantly higher than that in laparotomy group (69. 12%) (P<0. 05). The patients with fertility requirements and preparing for normal pregnancy after operation in the two groups were followed up for one year,including 49 patients in laparoscopy group and 47 patients in laparotomy group,the pregnancy rate in laparoscopy group was 69. 39%,and the rate of tubal pregnancy was 4. 08% (2 patients); the pregnancy rate in laparotomy group was 46. 81%,and the rate of tubal pregnancy was 8. 51% (4 patients),there was statistically significant difference in pregnancy rate between the two groups (P<0. 05). Conclusion Laparoscopic conservative surgery has the advantages of small trauma,quick recovery,and high postoperative pregnancy rate in treatment of unruptured tubal pregnancy,which is worthy of clinical application and promotion.
Objective To compare the curative effect and security of laparoscopic conservative surgery for unruptured tubal pregnancy.Methods The patients of unruptured tubal pregnancy undergoing laparoscopic conservative surgery in Zunhua People's Hospital from April2015 to June 2016 were selected and divided into laparotomy group (68 patients) and laparoscopy group (75 patients). The degrees of intraoperative trauma,speeds of postoperative recovery,Fallopian tube recanalization rates,and pregnancy rates in the two groups were compared. Results There was no statistically significant difference in operation time and successful rate of operation between the two groups (P>0. 05). The amount of blood loss in laparoscopy group was statistically significantly less than that in laparotomy group (P<0. 05).The increasing degree of temperature after operation in laparoscopy group was statistically significantly lower than that in laparotomy group (P<0. 05). The anal exhausting time,the time of getting out of bed,and hospitalization time in laparoscopy group was statistically significantly shorter than that in laparotomy group (P<0. 05). The time of blood β-h CG recovery to normal after operation in laparoscopy group was slightly shorter than that in laparotomy group,but there was no statistically significant difference (P>0. 05). The rate of analgesia after operation in laparoscopy group was statistically significantly lower than that in laparotomy group (P< 0. 05). At 3 months after operation,the recanalization rate of affected side in laparoscopy group was 86. 67%,which was statistically significantly higher than that in laparotomy group (69. 12%) (P<0. 05). The patients with fertility requirements and preparing for normal pregnancy after operation in the two groups were followed up for one year,including 49 patients in laparoscopy group and 47 patients in laparotomy group,the pregnancy rate in laparoscopy group was 69. 39%,and the rate of tubal pregnancy was 4. 08% (2 patients); the pregnancy rate in laparotomy group was 46. 81%,and the rate of tubal pregnancy was 8. 51% (4 patients),there was statistically significant difference in pregnancy rate between the two groups (P<0. 05). Conclusion Laparoscopic conservative surgery has the advantages of small trauma,quick recovery,and high postoperative pregnancy rate in treatment of unruptured tubal pregnancy,which is worthy of clinical application and promotion.
引文
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[11]王晓平,徐金花,李开梅,等.腹腔镜下输卵管妊娠保守性手术的手术时机探讨[J].齐齐哈尔医学院学报,2016,37(14):1805-1806.
[12]胥银宇,顾江红.未破裂型输卵管妊娠的3种保守治疗方法对再次妊娠的影响[J].重庆医学,2007,36(24):2551-2552.
[13]陈芳芬.腹腔镜保守手术治疗未破裂型异位妊娠的疗效[J].中外医学研究,2013,12(4):29-30.
[2]赵丽娜.输卵管妊娠的流行病学调查分析[J].中国健康教育,2005,21(2):141-143.
[3]Saadati N,Najafian M,Masihi S,et al.Comparison of two different protocols of methotrexate therapy in medical management of ectopic pregnancy[J].Iran Red Crescent Med J,2015,17(12):759-796.
[4]李斌,华克勤.未破裂型输卵管妊娠腹腔镜保守性手术65例分析[J].中国实用妇科与产科杂志,2001,17(7):429-430.
[5]杨丽华,苏莹,冷天艳.未破裂型输卵管妊娠腹腔镜保守性手术和甲氨蝶呤治疗的比较研究[J].实用妇产科杂志,2012,28(11):985-986.
[6]Kim M.Unusually large,unruptured tubal ectopic pregnancy mass in a woman with bilateral tubal obstruction treated by laparoscopy:a case report[J].J Med Cases,2016,7(9):396-398.
[7]王亚琴.腹腔镜下保守性手术治疗未破裂型输卵管妊娠及对再次妊娠的影响[J].河北医药,2012,34(18):2793-2794.
[8]邹晖.未破裂型输卵管妊娠的腹腔镜下保守性手术的临床观察[J].深圳中西医结合杂志,2015,25(7):88-90.
[9]谢俊敏,王斌.腹腔镜手术治疗未破裂型输卵管间质部妊娠效果[J].中华实用诊断与治疗杂志,2015,29(2):206-206.
[10]刘爱民,陈枫.输卵管妊娠保守治疗方法探讨[J].中国当代医药,2016,23(26):61-63.
[11]王晓平,徐金花,李开梅,等.腹腔镜下输卵管妊娠保守性手术的手术时机探讨[J].齐齐哈尔医学院学报,2016,37(14):1805-1806.
[12]胥银宇,顾江红.未破裂型输卵管妊娠的3种保守治疗方法对再次妊娠的影响[J].重庆医学,2007,36(24):2551-2552.
[13]陈芳芬.腹腔镜保守手术治疗未破裂型异位妊娠的疗效[J].中外医学研究,2013,12(4):29-30.