改良输卵管保守性手术对输卵管壶腹部妊娠患者生殖状态的影响

中华妇幼临床医学杂志（电子版)2018年8月第14卷第4期• 419 ••论著！改良输卵管保守性手术对输卵管壶腹部妊娠患者生殖状态的影响徐迅鲁春雁赵欣陶颖娜【摘要】目的探讨改良输卵管保守性手术对输卵管壶腹部妊娠患者的安全性、治疗效果及术后生殖状态的影响。

方法选择2015年1月1日至2016年3月31日，在上海市普陀区妇婴保健院确诊为输卵管壶腹部妊娠的）〇例患者为研究对象。

这）〇例患者均有生育要求，需保留输卵管。

按照随机数字表法，将其分为研究组（《= 36,采用改良输卵管保守性手术治疗）和对照组（《= 34,采用单纯腹腔镜下输卵管妊娠开窗取胚术治疗）。

采用回顾性分析方法，收集2组患者一般临床资料，包括年龄、孕次、停经天数等，以及2组患者治疗情况，包括手术时间、术中出血量，术后持续性异位妊娠(P E P)发生率，术后第6*2个月宫内妊娠和复发性异位妊娠（R E P)发生率，以及治愈率等-采用成组f检验，对2组患者年龄、停经天数、术前血#人绒毛膜促性腺激素（h C G)水平、手术时间、术中出血量等进行统计学分析。

采用W ilcoxon秩和检验，对2组患者孕次、术后疼痛持续时间等进行统计学分析。

采用f检验，对宫内妊娠率，P E P、R E P发生率及治愈率等进行统计学分析-采用Marni-W h itn e y U检验，对术后第3、天不同疼痛程度所占比例进行统计学分析。

本研究遵循的程序符合上海市普陀区妇婴保健院人体试验委员会所制定的伦理学标准，得到该委员会批准（批准编号：2014-18)，并与所有受试者签署临床研究知情同意书。

结果①2组患者的年龄、孕次、停经天数、术前血卩-h C G水平等一般临床资料比较，差异均无统计学意义（P>0. 05)。

②研究组患者手术时间为(58. 3±11. 2) m in，显著长于对照组的（30. 1±10. 7) m in，并且差异有统计学意义（= 10. 759，P<0.001)。

研究组术中出血量为（35. 2±6. 3) m L，显著高于对照组的（20. 4±5. 6) m L，并且差异亦有统计学意义（=10. 370，P<0. 001)。

③2组患者于术后第6个月的宫内妊娠率和R E P发生率比较，差异均无统计学意义（P>0. 05)。

但是，术后第12个月随访结果显示，研究组宫内妊娠发生率为25. 0%(9/36)，显著高于对照组的5. 9%(2/34)，2组比较，差异有统计学意义（f= 4. 825，P =0.028)(组R E P发生率比较，差异无统计学意义（P>0. 05)。

结论相对于单纯腹腔镜下输卵管妊娠开窗取胚术，改良输卵管保守性手术治疗输卵管壶腹部妊娠具有宫内妊娠率较高的优势，但是其手术时间较长、术中出血量较高-【关键词】妊娠，输卵管（生殖（输卵管妊娠开窗取胚术（宫腔镜（留置导丝（妇女Effects of modified tubal conservative operation on subsequent fertility outcomes of am pullary pregnancyX u X u n，L u C hunyan，Zhao X i n，Tao Y in gn a. D epartm ent o f Obstetrics and G ynecology，Shanghai Putuo M aternity and In fa n t H ealth H o sp ita l，Shanghai200060, ChinaCorresponding author：Zhao X i n，Email% bonbon_xu@【Abstract】Objective To evaluate the safety，efficacy and subsequent fertility outcom es ofmodified tubai conservative operation in treatm ent of am pullary pregnancy. M ethods From January1，2015 to June 31，2016，a total of 70 cases of patients who were diagnosed as am pullary pregnancyin Shanghai Putuo M aternity and Infant H ealth H ospital were chosen as study subjects，and those 70patients had fertility requirem ents to retain the fallopian tubes. According to random num ber tablem ethod，they were divided into study group (n=36，treated by modified tubal conservative operation)DOI： 10. 3877/cma. j. issn. 1673-5250. 2018. 04. 008基金项目：上海市卫生计生委中医药专项项目（2016LQ020)作者单位：200060上海市普陀区妇婴保健院妇产科通信作者：赵欣，Email:bonbon—xu@ 126. com• 420 •Chin. J Obstet Gynecol Pediatr (Electron. Ed) ^August 2018»V〇1. 14»No. 4 and control group (n=34, treated by laparoscopic salpingostom y). A retrospective analysis methodwas used to collect general clinical data of two groups, including age, gravidity，m enopause days,e tc.，and to collect treatm ent status of two groups，including operation duration，intraoperative bloodlo ss，incidence rates of persistent ectopic pregnancy (P E P) and intrauterine pregnancy12th m onths after operation，recurrent ectopic pregnancy (R E P) ra te，and cure ra te，etc. . T hem enopause days，preoperative blood #-hum an chorionic gonadotropin ( h C G) levels，operationduration，and intraoperative blood loss of two groups were statistically compared by independen--samples ' test. T he gravidity and postoperative pain duration of two groups were statistically compa by W ilcoxon rank sum test. T he incidence rates of intrauterine pregnancy，P E P，R EP and cure ratesof two groups were statistically compared by chi-square test. T he proportions of different pain levelsat the 3rd and 7th days after operation of two groups were statistically compared b y M ann-W hitn test. T he study protocol was approved by the Ethical Review Board of Investigation in H um an of Shanghai Putuo M aternity and Infant H ealth H ospital (A pproval No. 2014-18). Informed consen was obtained from each participant. Results $There were no significant differences betw een twogroups in the a g e，gravidity，m enopause days，and preoperative blood #-hCG levels (G>0. 05).②T he operative duration of study g ro upw as (58. 3±11. 2) m in，which was significantly longer thanthat of control group (30. 1110. 7) m in，and the difference was statistically significant ('= 10. 759,G〈0. 001). T he intraoperative blood loss of study group was (35. 2 ± 6. 3) m L，which wassignificantly higher than that of control group (20. 4 ± 5. 6) m L，and the difference also wasstatistically significant (=10. 370，P〈0. 001).③T here was no significant difference betw een two groups in the incidence rates of intrauterine pregnancy and R EP at the 6th m onth after operation (P#0.05). Follow-up results at the 12th m onth after operation showed th at the incidence rate ofintrauterine pregnancy in study group was 25. 0%(9/36)，which was significantly higher than that ofcontrol group 5. 9X(2/34)，and the difference was statistically significant (^2 =4. 825, P=0.028);how ever，there was no significant difference between two groups in the incidence rate of REP (#2 =2. 802，P = 0. 094). Conclusions M odified tubal conservative operation for am pullary pregnancy hasthe advantage of higher intrauterine pregnancy rate than that of laparoscopic salpingostom y，a longer operation duration and higher intraoperative blood loss.【Key w ords】Pregnancy，tu b al；R eproduction；Salpingostom y；H ysteroscopes；G uide-w ire，indw elling；W omenFund program：TCM Scientific Research Project of Shanghai M unicipal Commission of H ealth andFamily Planning (2016LQ020)异位妊娠（ectopic pregnancy)是指受精卵着床 于子宫体腔以外的任何部位，是妇产科常见疾病，也是妇产科常见急腹症之一，其发生率约为2%[1]，是导致孕产妇死亡的重要原因之一[2]。