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目的通过与腹腔镜下输卵管取胚术比较,观察腹腔镜下输卵管妊娠取胚后重建术的临床疗效。方法 2007年5月-2010年5月,收治63例输卵管妊娠患者。30例行腹腔镜下输卵管妊娠取胚后重建术(试验组),33例行腹腔镜下输卵管妊娠取胚术(对照组)。两组患者年龄、妊娠时间、部位等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术中及术后1个月行通液检查,术后2个月行输卵管碘油造影(hysterosalpingography,HSG)观察输卵管通畅度,记录患者术后妊娠情况。结果试验组手术成功29例;1例因严重粘连无法施行重建术,排除统计学分析。术中通液检查示,试验组输卵管全程通畅26例,对照组2例,差异有统计学意义(Z=5.86,P=0.00)。术后1个月通液检查示,试验组全程通畅25例、对照组26例,差异无统计学意义(Z=0.48,P=0.63)。术后2个月HSG检查示,试验组全程通畅25例,对照组2例,差异有统计学意义(Z=5.35,P=0.00)。术后24个月内试验组有25例(86.20%)宫内妊娠,显著高于对照组的19例(57.58%)(χ2=7.72,P=0.01)。结论腹腔镜下输卵管妊娠取胚后重建术显著提高了宫内妊娠率,疗效优于腹腔镜下输卵管取胚术。
Objective To observe the clinical efficacy of laparoscopic tubal pregnancy after embryo reconstructive surgery through laparoscopic tubal embryo implantation. Methods From May 2007 to May 2010, 63 patients with tubal pregnancy were treated. Thirty patients underwent laparoscopic tubal pregnancy with embryo reconstruction (experimental group) and 33 underwent laparoscopic tubal pregnancy (control group). Two groups of patients age, gestational age, location and other general information, the difference was not statistically significant (P> 0.05), comparable. Intraoperative and postoperative 1 month line fluid inspection, 2 months after surgery tubal lipiodol contrast (hysterosalpingography, HSG) observation of tubal patency, record the patient’s postoperative pregnancy. Results The operation of the experimental group was successful in 29 cases. One case was unable to perform reconstruction due to severe adhesion, and the statistical analysis was excluded. Intraoperative fluid examination showed that the test group tubal full unobstructed in 26 cases, control group 2 cases, the difference was statistically significant (Z = 5.86, P = 0.00). One month after operation, there was no obvious difference between the two groups (P = 0.63). There were 25 cases in the test group and 26 cases in the control group. HSG examination 2 months after surgery showed that 25 cases in the test group were unobstructed and 2 cases in the control group, the difference was statistically significant (Z = 5.35, P = 0.00). Within 24 months after operation, 25 cases (86.20%) of intrauterine pregnancy in the test group were significantly higher than those in the control group (57.58%) (χ2 = 7.72, P = 0.01). Conclusion Laparoscopic tubal pregnancy and embryo reconstructive surgery significantly improve intrauterine pregnancy rate, and its efficacy is better than laparoscopic tubal embryo implantation.