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56例输卵管妊娠治疗方法分析

【摘要】目的探讨输卵管妊娠的病因、诊断及治疗方法。方法回顾性分析2003年10月2007年12月收治的56例输卵管妊娠的临床资料。结果输卵管妊娠的病因有慢性输卵管炎、输卵管手术及IUD等。治疗采用以MTX和(或)米非司酮为主的药物治疗和手术治疗。结论输卵管妊娠的早期诊断为药物治疗和手术的选择提供了有利保证。

不同部位输卵管不孕的临床循证治疗

近年来，据WHO统计不育夫妇占已婚年龄夫妇的7%～15%，其中女方因素占40%，主要包括排卵障碍、输卵管因素、子宫因素及宫颈因素 ，输卵管疾病所致的不孕占25%～35%，其中输卵管阻塞占输卵管疾病的80%。根据阻塞部位的不同可分为近端输卵管不孕和远端输卵管不孕。近端输卵管不孕治疗方法包括选择性输卵管造影和经宫颈插管、输卵管子宫植入、绝育后复育者的输卵管吻合术、辅助生育技术；远端输卵管不孕治疗方法包括外科手术治疗、输卵管通液及辅助生育技术。此外，中医及物理治疗可作为输卵管不孕的辅助治疗。但近几年并无有关以上各种治疗方法妊娠率及临床疗效比较的报道，临床决策仍有一定困难。本文根据近年有关输卵管不孕不同治疗方法的相关临床研究证据，对其效果及妊娠率进行综述，以期全面了解各种治疗方案的优略。

输卵管壶腹部造孔法在复孕术中的应用

复孕术中,当输卵管的两个断端管径差异较大时,难以达到满意吻合,从而影响复孕效果。采用在壶腹部育端造一小孔,使远端孔径和近端管径大小一致,以达到满意吻合的改良方法。临床应用32例,随访1年以上,复通率100％,复孕率为93.7％。介绍了手术方法。

Clinical Analysis of Laparoscopic Operation for 36 Patients with Interstitial Tubal Pregnancy

Objective　To study the clinical value and surgical procedure of laparoscopic operation for interstitial tubal pregnancy. Methods　Clinical data of 36 patients of interstitial tubal pregnancy treated by laparoscopic operation were retrospectively analyzed. Results　All 36 patients were operated successfully, without conversions to laparotomy and intra- or post- operative complications. The operation time was 28-85 min(mean, 41min), and the length of stay in hospital postoperative was 3-6 d (mean, 4-5 d). Conclusion　Laparoscopic operation for interstitial tubal pregnancy is safe and feasible.

输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况调查

目的:了解输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况,以指导输卵管妊娠的临床治疗。方法:选择我院2004年至2007年因输卵管妊娠行开腹患侧输卵管切除术患者183例术后的生殖状况进行随访调查,回顾性分析其再次受孕及输卵管妊娠情况。结果: 在有生育要求的107位患者中,总的宫内妊娠率为64.5％(69/107例),8.7％复发输卵管妊娠(6/107例)。宫内受孕率以lt;30岁,术后1～2年最高,中重度贫血及盆腔中重度黏连导致宫内受孕机率下降;复发输卵管妊娠与年龄及术后时间无相关性,随贫血程度及盆腔黏连程度的加重进行性增加。结论: 开腹患侧输卵管切除术后生殖状况与年龄、术后时间、盆腔黏连程度、贫血程度密切相关。及时手术,减轻贫血程度,细致分黏,合理生殖健康指导,能有效提高宫内妊娠,降低复发输卵管妊娠。

Clinical Evidence of Tubal Infertility

Research of Pituitrin in Reducing Bleeding in Laparoscopy for Interstitial Pregnancy

【摘要】　目的　探讨减少输卵管间质部妊娠腹腔镜术中失血的方法。　方法　选择2007年1月-2010年6月49例诊断为输卵管间质部妊娠的患者随机分成观察组（24例）和对照组（25例）。观察组在腹腔镜切开异位妊娠病灶前于宫角注射垂体后叶素6 U，待子宫收缩后手术；对照组直接切开异位妊娠病灶进行手术。比较两组手术时间、术中出血量、血压、术后肛门排气时间、体温等方面的差异以及随访患者月经恢复时间。　结果　观察组和对照组手术时间分别为（34.29±7.96）、（53.68±10.48） min，术中出血量为（48.04±9.49）、（85.52±15.24） mL，差异有统计学意义（Plt;0.05）；两组在术后肛门排气时间、术后体温、术前血压、妊娠病灶切开后5 min的血压以及观察组使用垂体后叶素前后的血压差异均无统计学意义（Pgt;0.05）。两组患者在术后30～41 d月经复潮。　结论　输卵管间质部妊娠腹腔镜术中使用垂体后叶素能明显缩短手术时间和减少术中出血量，不增加持续性宫外孕的发生。【Abstract】　Objective　To explore the method of reducing bleeding in laparoscopy for interstitial pregnancy. 　Methods　Forty-nine patients diagnosed to have interstitial pregnancy between January 2007 and June 2010 were randomly divided into observation group (24 cases) and control group (25 cases). Patients in the observation group were given an injection of 6 U pituitrin in the horn of uterus before the incision of lesions in laparoscopy, and operation was performed after uterine contraction; while the lesions of patients in the control group were directly incised. The differences between the two groups in operation time, blood loss during the operation, blood pressure, exhaust time and temperature were studied and the recovery time of menstrual period was followed up.　Results　The operation time of the observation group and the control group was (34.29±7.96) minutes and (53.68±10.48) minutes; the blood loss was (48.04±9.49) mL and (85.52±15.24) mL, respectively. The difference in the operation time and blood loss between the two groups was significant (Plt;0.05). The difference in other indexes between the two groups such as the exhaust time, postoperative body temperature, the blood pressure before operation and within five minutes after the incision of the lesion was not statistical (Pgt;0.05). The recovery time of menstrual period in the two groups was 30 to 41 days.　Conclusion　Using pituitrin in laparoscopy for interstitial pregnancy can significantly shorten operation time and reduce blood loss, and will not increase the incidence rate of persistent ectopic pregnancy.

输卵管绒癌一例

The Short-term Influence of Oviduct Suture after Laparoscopic Embryo Removal Fenestration

目的　探讨腹腔镜下输卵管妊娠开窗取胚术后缝合与否对输卵管再通、宫内妊娠率的近期影响。方法　回顾分析2008年4月－2010年4月112例有保留生育功能意愿且具备随访条件的输卵管妊娠患者行腹腔镜手术的临床资料。根据手术方法将患者分为两组：A组54例，行患侧输卵管开窗取胚术，术后缝合输卵管；B组58例，行患侧输卵管开窗取胚术，术后不予缝合输卵管。两组术毕均予甲氨喋呤20 mg注射于病变输卵管处系膜，并行通液了解患侧输卵管通畅情况（对侧输卵管均通畅）。3个月后比较两组患侧输卵管的再通情况，并随访其近期（12个月内）宫内妊娠率、重复性异位妊娠率情况。 结果　A组54例患者术中患侧输卵管通畅48例，通而不畅6例；术后3个月B型超声监测下通液43例通畅，10例通而不畅，1例不通，通畅率79.63%。B组58例患者术中患侧输卵管通畅54例，4例通而不畅；术后3个月B型超声监测下通液37例通畅，13例通而不畅，8例不通，通畅率63.79%。近期（12个月内）宫内妊娠率、重复性异位妊娠率情况：A组54例，实访42例，宫内妊娠29例，占69.05%；重复性异位妊娠6例，占14.29%。B组58例，实访44例，宫内妊娠18例，占40.91%，重复性异位妊娠12例，占27.27%。A组术后患侧输卵管通畅率、宫内妊娠率高于B组，而重复性异位妊娠率明显降低，两组差异有统计学意义（P＜0.05）。 结论　腹腔镜下输卵管妊娠开窗取胚术后行输卵管缝合，可以减少对患侧输卵管损伤并恢复其正常的解剖结构，从而有效地保留患者生育功能。术后患侧输卵管通畅率、宫内妊娠率明显高于术后不缝合者，而重复性异位妊娠率明显降低。

CLINICAL APPLICATION OF TUBAL RECONSTRUCTION AFTER LAPAROSCOPIC TUBAL PREGNANCY OPERATION

ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.