腹腔镜下输卵管壶腹部妊娠保守性手术输卵管不同切口的比较

摘要

Objective To explore the value of linear incision near the tubal mensengtary in laparoscopic salpingotomy for the treatment of tubal ampullary pregnancy. Methods Two different salpingian incisions were utilized in conservative surgery for ampullary tubal pregnancy.The control group ( n =63 ) was given traditional salpingotomy with a linear incision over the tubal mensentary, and the research group ( n=98) was given a salpingotomy with linear incision near the tubal mensentary.The operating time, hospitalization day, blood loss during and after operation, time of hCG value decreasing to normal, rate of persistent ectopic pregnancy and tubal unobstructed rate were retrospectively analyzed. Results All the operations were accomplished under laparoscopy.There were 2 failed cases in the control group.One developed a massive hemorrhage in tubal lesion and required a salpingectomy;another suffered from persistent ectopic pregnancy and was given systematic treatment.No failure occurred in the research group.The research group had significantly shorter operative time, less intraoperative blood loss, faster decreasing of serumβ-hCG on the first day of postoperation and higher unobstructed percentage of salpinx [(42.1 ±9.6) min vs.(68.2 ±12.5) min, t=-14.933, P=0.000;(15.3 ±5.8) ml vs.(61.2 ±11.2) ml, t=-34.111, P=0.000; (89.06 ±1.93)% vs.(80.58 ± 3.96)%, t=18.132, P=0.000;83.7% (82/98) vs.66.67% (42/63), χ2 =6.266, P=0.012]. Conclusion Improved laparoscopic salpingotomy with linear incision near the tubal mensentary is safe, effective, easy, and valuable.%目的 探讨腹腔镜下输卵管壶腹部妊娠保守性手术中采用在接近输卵管系膜处做输卵管线形切口的临床价值. 方法 腹腔镜输卵管壶腹部妊娠保守性手术采用2种不同输卵管切口:对照组63例,采用传统方法即在壶腹部病灶膨大处于输卵管系膜对侧电凝后沿输卵管长轴方向线形切开达病灶;观察组98例,在壶腹部病灶膨大处侧面接近输卵管系膜电凝后沿输卵管长轴方向线形切开达病灶,取出病灶后反复低压冲洗. 比较2组术中出血量、手术时间及术后β-hCG变化和输卵管通畅情况. 结果 均在腹腔镜下完成手术. 对照组2例失败,1例术后病灶区域大出血再次腹腔镜输卵管切除手术,1例持续性异位妊娠加用全身药物保守治疗;观察组无一例失败. 观察组手术时间(42.1 ±9.6)min,明显短于对照组(68.2 ± 12.5)min(t=-14.933,P=0.000);术中出血量(15.3 ±5.8)ml,明显少于对照组(61.2 ±11.2)ml(t=-34.111,P=0.000).观察组术后第1天血β-hCG下降(89.06 ±1.93)%,比对照组(80.58 ±3.96)%下降更明显(t=18.132,P=0.000);观察组术后输卵管通畅率83.7%(82/98),明显高于对照组66.67%(42/63)(χ2 =6.266,P=0.012). 结论 腹腔镜下输卵管壶腹部妊娠保守性手术在接近输卵管系膜处做输卵管线形切口不仅可降低操作难度和术中出血量,而且手术时间短,成功率高.