宫腹腔镜联合手术评价输卵管开窗取胚术临床意义的研究
发布时间：2018-12-21 13:19
【摘要】：目的：应用宫腹腔镜联合手术观察异位妊娠输卵管开窗取胚术后输卵管的形态及通畅性,了解输卵管功能状态,评价输卵管开窗取胚术的临床意义,同时比较不同手术方式、途径对再次妊娠的影响以及评价输卵管造影的符合率方法：1.选取2008年至2010年期间在山东省淄博市齐都医院及青岛大学附属医院就诊的229例输卵管妊娠手术病人作为研究对象进行回顾性的研究分析,对其术后进行为期4年的随访。按手术方法不同分为输卵管切除组及输卵管开窗取胚术组,比较两种手术方法术后的宫内妊娠率、再次异位妊娠率及不孕率。按手术途径不同分为开腹手术组与腹腔镜手术组,比较两种手术途径术后的宫内妊娠率、再次异位妊娠率及不孕率。再选取55例行输卵管开窗取胚术后不孕的病人作为研究对象进行回顾性研究分析,应用宫腹腔镜联合手术观察患侧输卵管的形态及通畅性,了解输卵管功能状态,从而评价输卵管开窗取胚术的临床意义,并对其输卵管造影符合率进行研究。结果：1.输卵管切除组术后的宫内妊娠率、不孕率与开窗取胚术组无明显差异,两者统计学上比较无差异(P0.05)；2.输卵管切除组术后的再次异位妊娠率较开窗取胚术组偏低,统计学比较有明显差异(P0.05； 3.术中见对侧输卵管异常组的患者术后宫内妊娠率明显低于对侧输卵管正常组,统计学上比较差异有显著性(P0.05),而再次输卵管妊娠和继发不孕的发生率明显高于对侧输卵管正常组,统计学差异有显著性(P0.05)；4.开腹组与腹腔镜组术后宫内妊娠率、再次输卵管妊娠率无明显差异(P0.05)；但腹腔镜组术后继发性不孕的发生率低于开腹组(P0.05)；5.宫腹腔镜联合手术直视下观察开窗取胚术后输卵管的功能状态较差；6.输卵管造影对输卵管功能状态诊断的准确性较宫腹腔镜联合手术差,统计学上比较有差异(P0.05)。结论：1.宫腹腔镜联合手术观察输卵管开窗取胚术后输卵管功能状态较差,输卵管妊娠患者术后的再次妊娠率取决于对侧输卵管的功能状态,故输卵管妊娠患者若术中发现对侧输卵管良好,手术方法宜为患侧切除,手术途径宜为经腹腔镜。2.输卵管妊娠行输卵管开窗术的患者术后6个月以上仍未孕者可直接选择宫腹腔镜联合手术评估其输卵管的功能状态,从而指导其选择合适的生育途径。
[Abstract]:Objective: to observe the shape and patency of fallopian tube after tubal fenestration in ectopic pregnancy by combined hysteroscopy and laparoscopy, to understand the functional status of fallopian tube, to evaluate the clinical significance of tubal fenestration and to compare different surgical methods. The effect of the method on re-pregnancy and the method of evaluating the coincidence rate of salpingography: 1. From 2008 to 2010 229 patients with tubal pregnancy who were treated in Qidu Hospital of Zibo City of Shandong Province and affiliated Hospital of Qingdao University were retrospectively analyzed and followed up for 4 years. The intrauterine pregnancy rate, ectopic pregnancy rate and infertility rate were compared between the two groups according to the different surgical methods: salpingotomy group and tubal fenestration group. The intrauterine pregnancy rate, ectopic pregnancy rate and infertility rate were compared between laparoscopy group and open operation group. Then 55 cases of infertility after oviduct fenestration were selected for retrospective analysis. The shape and patency of the affected fallopian tube were observed by hysteroscopy combined with laparoscopy to understand the functional status of the fallopian tube. The clinical significance of tubal fenestration was evaluated and the coincidence rate of salpingography was studied. Results: 1. The rate of intrauterine pregnancy and infertility in the salpingotomy group was not significantly different from that in the fenestration group, but there was no statistical difference between the two groups (P0.05); 2. The rate of ectopic pregnancy in the salpingotomy group was lower than that in the embryo extraction group (P 0.05; 3. 05; P < 0. 05; P 0. 05; P < 0. 05; P < 0. 05). The intraoperative pregnancy rate of the patients with abnormal fallopian tubes was significantly lower than that of the normal fallopian tubes (P0.05). The incidence of secondary infertility and secondary tubal pregnancy was significantly higher than that of the contralateral tubal normal group (P0.05). 4. There was no significant difference in intrauterine pregnancy rate and re-tubal pregnancy rate between laparoscopy group and laparoscopy group (P0.05), but the incidence of secondary infertility in laparoscopy group was lower than that in laparotomy group (P0.05). The functional state of oviducts after embryo extraction by laparoscopy combined with hysteroscopy was worse than that of oviducts after fenestration. 6. The accuracy of salpingography in the diagnosis of functional status of fallopian tube was worse than that in combined hysteroscopy and laparoscopy (P0.05). Conclusion: 1. The function of fallopian tube after tubal fenestration was observed by hysteroscopy combined with laparoscopy. The rate of repregnancy in patients with tubal pregnancy was determined by the functional status of the contralateral fallopian tube. Therefore, in patients with tubal pregnancy, if the contralateral fallopian tube is found to be good during the operation, the operative method should be resection of the affected side, and the operative route should be laparoscopic. 2. Patients with tubal pregnancy who have not been pregnant for more than 6 months can directly select hysteroscopy combined with surgery to evaluate the functional status of the fallopian tube, so as to guide them to choose the appropriate reproductive path.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R713.8
本文编号：2388961
[Abstract]:Objective: to observe the shape and patency of fallopian tube after tubal fenestration in ectopic pregnancy by combined hysteroscopy and laparoscopy, to understand the functional status of fallopian tube, to evaluate the clinical significance of tubal fenestration and to compare different surgical methods. The effect of the method on re-pregnancy and the method of evaluating the coincidence rate of salpingography: 1. From 2008 to 2010 229 patients with tubal pregnancy who were treated in Qidu Hospital of Zibo City of Shandong Province and affiliated Hospital of Qingdao University were retrospectively analyzed and followed up for 4 years. The intrauterine pregnancy rate, ectopic pregnancy rate and infertility rate were compared between the two groups according to the different surgical methods: salpingotomy group and tubal fenestration group. The intrauterine pregnancy rate, ectopic pregnancy rate and infertility rate were compared between laparoscopy group and open operation group. Then 55 cases of infertility after oviduct fenestration were selected for retrospective analysis. The shape and patency of the affected fallopian tube were observed by hysteroscopy combined with laparoscopy to understand the functional status of the fallopian tube. The clinical significance of tubal fenestration was evaluated and the coincidence rate of salpingography was studied. Results: 1. The rate of intrauterine pregnancy and infertility in the salpingotomy group was not significantly different from that in the fenestration group, but there was no statistical difference between the two groups (P0.05); 2. The rate of ectopic pregnancy in the salpingotomy group was lower than that in the embryo extraction group (P 0.05; 3. 05; P < 0. 05; P 0. 05; P < 0. 05; P < 0. 05). The intraoperative pregnancy rate of the patients with abnormal fallopian tubes was significantly lower than that of the normal fallopian tubes (P0.05). The incidence of secondary infertility and secondary tubal pregnancy was significantly higher than that of the contralateral tubal normal group (P0.05). 4. There was no significant difference in intrauterine pregnancy rate and re-tubal pregnancy rate between laparoscopy group and laparoscopy group (P0.05), but the incidence of secondary infertility in laparoscopy group was lower than that in laparotomy group (P0.05). The functional state of oviducts after embryo extraction by laparoscopy combined with hysteroscopy was worse than that of oviducts after fenestration. 6. The accuracy of salpingography in the diagnosis of functional status of fallopian tube was worse than that in combined hysteroscopy and laparoscopy (P0.05). Conclusion: 1. The function of fallopian tube after tubal fenestration was observed by hysteroscopy combined with laparoscopy. The rate of repregnancy in patients with tubal pregnancy was determined by the functional status of the contralateral fallopian tube. Therefore, in patients with tubal pregnancy, if the contralateral fallopian tube is found to be good during the operation, the operative method should be resection of the affected side, and the operative route should be laparoscopic. 2. Patients with tubal pregnancy who have not been pregnant for more than 6 months can directly select hysteroscopy combined with surgery to evaluate the functional status of the fallopian tube, so as to guide them to choose the appropriate reproductive path.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R713.8
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