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目的探讨未破裂型输卵管妊娠保守性手术治疗的最佳手术时机,以减少剥离面出血,减轻输卵管损伤,保留患侧输卵管功能。方法 69例未破裂型输卵管妊娠并有生育要求的患者,随机分为观察组37例和对照组32例。观察组术前予甲氨蝶呤(MTX)及米非司酮治疗并严密观察生命征、腹痛及β-人绒毛膜促性腺激素(β-HCG)的变化,在保证患者一般情况良好及生命征平稳正常的前提下,于血清β-HCG浓度停止上升或下降时行腹腔镜下开窗取胚;对照组患者诊断明确后,在腹腔镜下开窗取胚为对照组。两组患者术中均予垂体后叶素6 U+生理盐水10 ml(血压高患者予催产素10 U)行患侧宫角及输卵管系膜注射。比较两组术中出血量、手术时间、术后最高体温、输卵管通畅率及并发症发生率。结果观察组的手术时间、术中出血量均少于对照组,输卵管通畅率高于对照组,差异均具有统计学意义(P<0.05);术后两组最高体温及并发症生率比较,差异无统计学意义(P>0.05);对照组输卵管切除2例、持续性宫外孕3例,观察组无输卵管切除及持续性宫外孕患者。结论术前予MTX及米非司酮杀胚,血清β-HCG停止上升或下降,为未破裂型输卵管妊娠保守性手术的黄金时期。
Objective To investigate the optimal operation timing of conservative surgical treatment of unruptured tubal pregnancy in order to reduce bleeding in the peel surface, reduce tubal injury, and retain tubal function in the affected side. Methods Sixty-nine patients with unruptured tubal pregnancy who had fertility requirements were randomly divided into observation group (37 cases) and control group (32 cases). The patients in the observation group were treated with methotrexate (MTX) and mifepristone, and the changes of vital signs, abdominal pain and β-human chorionic gonadotropin (β-HCG) were observed. In order to ensure the general good condition and life Under the premise of normal and stable, the laparoscopic window was taken when the concentration of serum β-HCG stopped rising or falling; the control group patients were diagnosed, and the embryo was taken as the control group by laparoscopy. Two groups of patients were intraoperative pituitrin 6 U + saline 10 ml (high blood pressure to patients with oxytocin 10 U) ipsilateral uterine horn and tubal injection. Blood loss, operation time, postoperative maximal body temperature, tubal patency rate and complication rate were compared between the two groups. Results The operation time and intraoperative blood loss in the observation group were less than those in the control group, and the tubal patency rate was significantly higher than that in the control group (P <0.05). The highest body temperature and complication rate in the two groups were statistically significant There was no significant difference between the two groups (P> 0.05). In the control group, 2 cases of tubal resection and 3 cases of persistent ectopic pregnancy showed no tubal resection and persistent ectopic pregnancy in the observation group. Conclusion Preoperative MTX and mifepristone kill embryos, serum β-HCG stopped rising or falling, as a golden period of conservative surgery for unruptured tubal pregnancy.