腹腔镜下不同术式治疗输卵管妊娠后的生育结局分析

发布时间：2018-04-18 17:18

本文选题：输卵管妊娠 + 腹腔镜手术　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：对腹腔镜下不同术式治疗输卵管妊娠后的生育结局进行分析评价。方法：选取自2005年7月至2009年7月间在我院行腹腔镜下手术治疗的输卵管妊娠病例，按照入选标准共选取了98例，并将所选取的98例患者根据不同的手术方式分为两组，即把行腹腔镜下保守手术的患者归为A组，共有42例；把行腹腔镜下输卵管切除术的患者归为B组，共有56例。分别评价两组病例的一般资料、术中情况、术后持续性异位妊娠发生情况、术后输卵管碘油造影输卵管通畅情况及术后3年内的宫内妊娠情况、重复性异位妊娠情况和不孕情况。结果: 1.一般资料选取的98名患者在入院时均生命体征平稳，无急性腹腔内出血及失血性休克等症状，适宜行腹腔镜下手术治疗。两组患者的一般资料在年龄、孕次、产次、停经天数、包块大小、血β-hCG值、腹部手术史及人流史这几个方面没有明显差异，经统计学分析提示P＞0.05。但在既往不孕史方面两组患者的结果经统计学分析P＜0.05，差异有意义，具体为A组有7人有不孕史，B组有2人有不孕史。 2.术中情况两组患者的平均盆腔积血量没有差异，但在妊娠包块是否破裂、手术时间和手术失血量三个方面差异有统计学意义。具体为A组患者的盆腔积血量平均值为120.25±50.02ml，B组患者为138.02±64.56ml；A组患者有20例出现输卵管妊娠囊破裂，B组有45例出现孕囊破裂；A组患者在手术过程中的平均失血量为56.25±20.80ml，B组患者为30.12±16.83ml，；A组的平均手术时间为53.23±16.23min，B组为48.32±15.86min。 3.术后持续性异位妊娠发生情况 A组患者术后有5例出现持续性异位妊娠，所占比率为11.9%，B组患者术后有1例出现持续性异位妊娠，所占比率为1.8%，经统计学分析均P＜0.05，差异有统计学意义，说明保守手术比输卵管切除术具有更高的持续性异位妊娠发生率。 4.部分患者的术后输卵管碘油造影（HSG）结果在术后3~6个月内共有56人于门诊行HSG检查，其中A组有26人，B组有30人。结果显示两组患者的对侧输卵管通畅率分别为76.9%和73.3%，差异无统计学意义。而保守手术的患侧输卵管通畅率为42.3%，因此比输卵管切除术的患者增加了受孕几率。 5.术后3年内的生育结局 98名患者在术后3年内有54人成功宫内妊娠，，有11人发生重复性异位妊娠，有33人未怀孕。具体为宫内妊娠方面A组有28人（66.7%），B组有26人（46.4%）；重复性输卵管妊娠方面A组有8（19.1%），B组3（5.3%）；在不孕方面A组有6人（14.2%），B组有27人（48.3%）。以上两组患者间的生育结局数据经统计学分析均P＜0.05，差异有统计学意义。在成功宫内妊娠的54例患者中有26人在术后的前半年内怀孕，且随着时间的延长宫内妊娠率逐渐下降，术后3年以后的宫内妊娠率极低。因此，应鼓励输卵管妊娠患者在术后尽早怀孕，在一次月经恢复后就可以妊娠。结论：腹腔镜下保守性手术治疗输卵管妊娠的术后宫内妊娠率要高于输卵管切除术的患者，但同时也增加了持续性异位妊娠和重复性异位妊娠的发生。在临床上，对于有生育要求的异位妊娠患者，应根据患者的血流动力学情况、包块的大小和位置、患者的年龄、既往的不孕史和输卵管损伤史等情况来综合判断，以决定患者的手术方式，尽可能的保留患者的生育能力。术后应鼓励患者尽早怀孕，在一次月经恢复后就可以妊娠。
[Abstract]:Objective: To evaluate the reproductive outcome of tubal pregnancy after different laparoscopic surgery.
Methods: from July 2005 to July 2009 for pregnancy cases between surgery in our hospital underwent laparoscopic tubal, according to inclusion criteria to select a total of 98 cases, and 98 cases of the patients selected according to the different surgical methods were divided into two groups, which underwent laparoscopic conservative surgery were classified as group A, a total of in 42 cases; the laparoscopic tubal resection were classified as group B, a total of 56 cases. The general data were evaluated two groups of patients, intraoperative conditions, persistent ectopic pregnancy after operation, 3 years of pregnancy hysterosaltingograty tubal patency rate and postoperative fallopian tube postoperative recurrent ectopic pregnancy and infertility.
Result:
1. general information
98 patients were selected with stable vital signs at admission, no acute abdominal bleeding and hemorrhagic shock and other symptoms, suitable for laparoscopic surgery. The general data of the two groups in age, gravidity, parity, menopause duration, mass size, serum -hCG value, and there is no significant difference in the abdomen art history and history of abortion in these areas, the statistical analysis indicated that P, 0.05. but in the past history of infertility patients in the two groups the results of the statistical analysis of P < 0.05, the difference was significant, specific for the A group of 7 people have a history of infertility, B group of 2 people have a history of infertility.
2. in the operation
The average of two groups of patients with pelvic hematocele but no difference in pregnancy mass is broken, blood loss between the three aspects of operation time and the operation was statistically significant. The average volume was 120.25 + 50.02ml for A group of patients with pelvic, patients in group B was 138.02 + 64.56ml; group A patients in 20 cases capsular rupture of tubal pregnancy, B group had 45 cases of gestational sac rupture; A group patients in the operation process of the average blood loss was 56.25 + 20.80ml, B + 16.83ml group was 30.12, the average operation time; A group was 53.23 + 16.23min, B + 15.86min. group was 48.32
The occurrence of persistent ectopic pregnancy after 3. operation
The patients of the A group had 5 cases of persistent ectopic pregnancy, accounting for 11.9%, the patients of the B group had 1 cases of persistent ectopic pregnancy, the proportion is 1.8%, by statistical analysis of P < 0.05, the difference was statistically significant, indicating conservative surgery than salpingectomy has higher the incidence of persistent ectopic pregnancy.
The results of postoperative oviduct lipiodol contrast (HSG) in the 4. part of the patients
After 3~6 months, a total of 56 people in the outpatient department for HSG examination, 26 of them in A group, B group of 30 people. The results showed that the two groups of patients with fallopian tube patency rates were 76.9% and 73.3%, the difference was not statistically significant. While the fallopian tube patency for conservative surgery 42.3%, the ratio of tubal resection patients increases the chance of pregnancy.
5. birth outcome within 3 years after operation
98 patients in the postoperative 3 years there were 54 successful pregnancy, 11 had recurrent ectopic pregnancy, 33 were not pregnant. The intrauterine pregnancy has 28 A group (66.7%), B group of 26 people (46.4%); the repeatability of tubal pregnancy group A 8 (19.1%), B group (5.3%); 3 in A infertility group of 6 people (14.2%), B group of 27 people (48.3%). The birth outcomes data above between the two groups were P < 0.05, the difference was statistically significant. In 54 cases of patients with intrauterine pregnancy success 26 people in the first half after surgery in pregnancy, and with the time prolonged the intrauterine pregnancy rate decreased gradually after 3 years after the intrauterine pregnancy rate is very low. Therefore, we should encourage tubal pregnancy in patients with postoperative pregnancy as soon as possible, in the recovery time after menstruation can be pregnant.
Conclusion: after laparoscopic conservative surgery for tubal pregnancy in the pregnancy rate is higher than that of tubal resection, but also increase the persistent ectopic pregnancy and recurrent ectopic pregnancy. Clinically, the patients with ectopic pregnancy fertility requirements, should be based on the hemodynamics of patients, the size of the location and mass of the patient's age, previous history of infertility and tubal damage history to comprehensive judgment, the surgical approach to determine the patients, the patients may preserve fertility. Postoperative patients should be encouraged as early as possible in pregnancy, recovery time after menstruation can be pregnant.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.5

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