宫角妊娠的治疗及对术后生育能力的影响分析

摘要

目的:分析比较宫角妊娠不同治疗方案的临床效果及对术后生育能力的影响.方法:对我院2012年1月—2015年12月收治的95例宫角妊娠患者进行回顾性分析,按照治疗方法将其分为5组:清宫术组(n=21)、开腹探查手术组(n=27)、腹腔镜手术组(n=33)、减胎术组(n=5)、药物治疗组(n=9).分析比较不同治疗方案的临床效果及对术后生育能力的影响.结果:手术患者均获得成功,术后均未发生明显不良反应.开腹探查手术组的术中出血量最多,清宫术组最少,差异有统计学意义(P<0.05);清宫术组手术时间短于开腹探查手术组和腹腔镜组,差异有统计学意义(P<0.05),而腹腔镜手术组与开腹探查手术组的手术时间比较,差异无统计学意义(P>0.05);术后3 d人绒毛膜促性腺激素β亚单位(β-hCG)下降程度清宫术组显著优于开腹探查手术组和腹腔镜组,差异有统计学意义(P<0.05);术后住院时间比较,清宫术组最短,开腹探查手术组最长,差异有统计学意义(P<0.05).药物治疗组的9例患者中,有8例孕囊完全排出,孕囊排出时间3~5.5 h,平均(4.1±1.2)h;阴道出血时间5~8 d,平均(7.2±1.4)d;其余1例因不完全流产转行清宫术.随访至治疗后1年,除减胎术组5例成功分娩外,其余90例患者中,计划妊娠81例,再次宫内妊娠者41例,药物治疗组再妊娠率最高,开腹探查手术组最低,差异有统计学意义(P<0.05).结论:对于宫角妊娠应根据患者的病情,妊娠包块大小、位置及是否破裂,患者的意愿,以及医师的实践经验和手术技巧综合考虑,力求对患者创伤程度最低,对术后再生育能力影响最小.%Objective:To analyze the clinical effect of different treatment regimens of cornual pregnancy and its effect on postoperative fertility. Methods: 95 cases of cornual pregnancy patients admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed. They were divided into 5 groups according to the treatment methods: uterine curettage group (n=21), laparotomy group (n=27), laparoscopic surgery group (n=33), reduction group (n=5), drug treatment group (n=9). To analyze the clinical effect of different treatment regimens and the effect on postoperative fertility. Results:All surgical patients were treated successfully an no adverse reactions occurred after surgery. The bleeding volume in the laparotomy group was the largest and the uterine curettage group was the smallest (P<0.05). The operation time of the uterine curettage group was shorter than that of laparotomy group and laparoscopic surgery group (P<0.05), but there was not statistical difference between laparotomy group and laparoscopic surgery group (P>0.05). The decline of postoperative 3 dβ-hCG of uterine curettage group was significantly more than that of laparotomy group and laparoscopic group (P<0.05). The hospitalization days of uterine curettage group was the shortest and the laparotomy group was the longest ( P<0 . 05 ) . In the 9 patients of drug treatment group, 8 cases of gestational sac were completely discharged and the discharge time of the gestational sac was 3-5.5 h, averaged (4.1±1.2) h; the vaginal bleeding time was 5-8 d, averaged (7.2±1.4) d. The remaining 1 case treated by uterine curettage due to incomplete miscarriage of labor. After following-up for 1 year after treatment, 5 cases of reduction group delivered successfully. 41 cases in another planned pregnancy 81 cases were intrauterine pregnancy. The re-pregnancy rate in the drug treatment group was the highest and the laparotomy group was the lowest (P<0.05). Conclusions:In the development of treatment programs, we should give full consideration to the patient′s condition, the size of the gestational sac, the location and whether rupture, the patients′ wishes and physicians′ practical experience and surgical techniques. Minimally invasive surgery is the development trend of cornual pregnancy treatment.