Application of laparoscopic tubal core-pulling resection combined with uterine horn suture in treatment of tubal pregnancy
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摘要:目的 探讨腹腔镜下输卵管切除术联合宫角缝扎对输卵管妊娠患者的效果。方法 采用随机分组法将符合条件的100例输卵管妊娠患者分为2组，对照组50例患者行腹腔镜下保留输卵管妊娠病灶清除手术，观察组50例患者行腹腔镜下输卵管抽芯切除术+宫角缝扎治疗，评估并比较2组手术时间、术中出血量、住院时间、术后血β-人绒毛膜促性腺激素(β-HCG)下降情况、宫内受孕情况、再次宫外孕、卵巢功能情况。结果 2组手术时间、住院时间无显著差异(P>0.05), 对照组出血量显著多于观察组(P < 0.05); 与对照组相比，观察组血β-HCG水平下降更显著(P < 0.05); 治疗1、3、6个月后, 2组血清黄体生成素(LH)、卵泡刺激素(FSH)、抗缪勒管激素(AMH)和雌二醇(E2)水平无显著差异(P>0.05); 随访18个月后，观察组患者异位妊娠发生率4.00%低于对照组的12.00%, 而2组间宫内受孕率无显著差异(P>0.05)。结论 腹腔镜下输卵管抽芯切除术联合宫角缝扎术应用于输卵管妊娠能有效降低再次异位妊娠的发生率，且并未对卵巢功能造成不良影响。Abstract:Objective To investigate the effect of laparoscopic salpingectomy combined with uterine horn suture for patients with tubal pregnancy.Methods A total of 100 patients with tubal pregnancy were randomly divided into 2 groups, the control group(n=50) underwent laparoscopic preservation of tubal pregnancy lesions, and 50 patients in the observation group underwent laparoscopic tubal core-pulling resection combined with uterine horn suture. Operation time, intraoperative blood loss, hospital stay, decrease situation of postoperative blood human chorionic gonadotropin (HCG), intrauterine pregnancy, ectopic pregnancy, ovarian function of two groups were compared.Results There was no significant difference in operation time and hospital stay between the control group and the observation group (P>0.05), and the blood loss in the control group was significantly more than that in the observation group (P < 0.05). Compared with the control group, the blood HCG level in the observation group decreased more significantly (P < 0.05). At 1, 3 and 6 months after treatment, there were no significant differences in serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), AMH and estradiol (E2) levels between the two groups (P>0.05). After 18 months of follow-up, the incidence of ectopic pregnancy in the observation group was lower than that in the control group (4.00% vs. 12.00%), and there was no significant difference in intrauterine pregnancy rate between the two groups.Conclusion Laparoscopic salpingectomy combined with cornual suture can effectively reduce the incidence of second ectopic pregnancy and has no effect on ovarian function.
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表 1 2组治疗情况比较(x±s)
组别 手术时间/min 出血量/mL 住院时间/d 对照组(n=50) 42.81±12.09 29.96±19.95 3.10±1.00 观察组(n=50) 38.76±12.58 18.74±15.22* 2.94±1.16 与对照组比较, *P < 0.05。 
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表 2 2组术后血β-HCG下降情况比较(x±s)
% 组别 术后2 d 术后7 d 对照组(n=50) 67.10±8.76 83.40±5.41 观察组(n=50) 70.54±6.87* 85.56±5.16* β-HCG: β-人绒毛膜促性腺激素。与对照组比较, *P < 0.05。
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表 3 2组手术治疗后激素水平情况比较(x±s)
组别 时点 AMH/(ng/mL) FSH/(IU/L) LH/(IU/L) E2/(IU/L) 对照组(n=50) 治疗1个月后 2.83±0.75 5.39±1.48 4.74±1.27 79.20±21.30 治疗3个月后 2.91±0.75 5.48±1.43 4.78±1.24 80.92±20.94 治疗6个月后 2.91±0.72 5.58±1.37 4.82±1.20 80.40±20.14 观察组(n=50) 治疗1个月后 2.72±0.64 5.72±1.56 4.58±1.24 74.58±16.80 治疗3个月后 2.81±0.65 5.77±1.52 4.61±1.23 76.40±16.53 治疗6个月后 2.79±0.62 5.74±1.50 4.59±1.23 79.10±15.49 AMH: 抗缪勒管激素; LH: 黄体生成素; FSH: 卵泡刺激素; E2: 雌二醇。
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表 4 2组患者随访妊娠情况对比[n(%)]
组别 宫内妊娠 宫外孕 未受孕 对照组(n=50) 30(60.00) 6(12.00) 14(28.00) 观察组(n=50) 29(58.00) 2(4.00)* 19(38.00)* 与对照组比较，*P < 0.05。
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