腹腔镜输卵管异位妊娠切开取胚术后输卵管通畅情况的探讨

摘要

Objective To explore the tubal patency after laparoscopic salpingotomy and embryo removal for tubal ectopic pregnancy. Methods A retrospective analysis was made on 28 patients receiving laparoscopic salpingotomy at other hospitals from September 2013 to September 2014.Within their 6 postoperative months, these patients were given hysterosalpingography in this gynecological minimally invasive center to evaluate the tubal patency. Results There were 6 cases of ipsilateral tubal patency (21.4%) and 22 cases of tubal obstruction or dropsy (78.6%), while 19 cases of contralateral tubal patency (67.9%) and 9 cases of tubal obstruction or dropsy (32.1%).Bilateral tubal embryo removal was carried out in 3 cases, with hysterosalpingography showing bilateral tubal obstruction in 2 cases and bilateral tubal dropsy in 1 case.One patient had ipsilateral tubal obstruction after tubal embryo patency and developed contralateral tubal patency after conservative treatment.Follow-up of the 28 cases for 6-15 months showed 4 cases of intrauterine pregnancy, 4 cases of examination of ovulation, 7 cases of preparation of assisted reproduction, 3 cases of laparoscopic salpingoplasty 1-2 months after hysterosalpingography, 1 case of endocrine regulation monitoring ovulation, 1 case of abnormal uterine bleeding 13 months later ( hysteroscopic examination showed endometritis and diagnostic curettage found proliferative phase endometrium that consistent with the menstrual cycle), and 8 cases without further treatment. Conclusion Laparoscopic salpingotomy for tubal ectopic pregnancy does not improve patient’ s tubal patency.%目的：探讨腹腔镜输卵管异位妊娠切开取胚术后输卵管通畅情况。方法回顾分析2013年9月～2014年9月28例在外院行腹腔镜输卵管异位妊娠切开取胚术后6个月在我院妇科微创中心门诊行子宫输卵管碘水造影的临床资料，评价输卵管通畅情况。结果患侧输卵管通畅6例（21.4％），阻塞或积水22例（78.6％）；对侧输卵管通畅19例（67.9％），阻塞或积水9例（32.1％）。3例双侧输卵管均分别行切开取胚术，碘水造影显示2例双侧输卵管均阻塞，1例双侧输卵管均积水；1例右侧输卵管异位妊娠切开取胚术后碘水造影显示阻塞，左侧输卵管异位妊娠药物保守治疗后碘水造影显示通畅。28例随访6～15个月：4例宫内妊娠；4例正在监测排卵；7例正在准备辅助生育；3例输卵管碘水造影后1～2个月行腹腔镜下输卵管积水切开整形术；1例内分泌调节监测排卵；1例碘水造影13个月后出现异常子宫出血行宫腔镜检查，宫腔镜镜下诊断子宫内膜炎，诊断性刮宫子宫内膜病理为增殖期子宫内膜，与月经周期相符合；8例未进一步治疗。结论腹腔镜输卵管异位妊娠切开取胚术并不能完全改善输卵管通畅情况。