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目的探讨药物保守治疗与腹腔镜保守性手术治疗对异位妊娠所保留输卵管形态及功能的影响。方法对北京市朝阳区妇幼保健院2013年1月至2015年6月间异位妊娠经药物保守治疗成功患者40例与腹腔镜保守性手术治疗20例的输卵管复通情况与再次妊娠情况及结局进行分析。治愈3个月后行子宫输卵管碘油造影检查,了解患侧输卵管通畅情况。结果药物保守治疗组患侧输卵管复通率为72.5%(29/40),而手术治疗组复通率为70.0%(14/20),两组比较差异无统计学意义(P>0.05)。药物保守治疗组40例中,16例于随访期内再次妊娠,2例为重复性异位妊娠,14例宫内妊娠,其中1例行辅助生殖技术,足月分娩8例;手术治疗组20例患者中,再次妊娠8例(其中3例行体外受精-胚胎移植术),1例为自然受孕后重复性异位妊娠,足月分娩5例。药物保守治疗组再次自然宫内妊娠率为32.5%(13/40),手术组自然宫内妊娠率20%(4/20),两组比较差异有统计学意义(P<0.05)。药物保守治疗组住院费用显著低于手术组,但住院时间明显长于手术组(P<0.05)。结论传统中药方剂联合甲氨蝶呤药物治疗与腹腔镜保守性手术治疗有异曲同工的效果,临床实践中,如何选取具体治疗方法,还需要对满足两种保守治疗条件的患者进行具体分析,做到个体化治疗。
Objective To investigate the effects of conservative treatment and laparoscopic conservative surgery on the morphology and function of fallopian tubes retained by ectopic pregnancy. Methods 40 cases of patients with conservative treatment of ectopic pregnancy and 20 cases of laparoscopic conservative surgery in 20 cases of ectopic pregnancy from January 2013 to June 2015 in Chaoyang District, Beijing Maternal and Child Health Hospital were retrospectively analyzed. Analyze. Cure 3 months after the line of hysterosalpingography to understand the tubal patency. Results The conservative rate of tubal recuperation was 72.5% (29/40) in the conservative group and 70.0% (14/20) in the surgical group. There was no significant difference between the two groups (P> 0.05). Among the 40 cases of drug conservative treatment group, 16 cases were re-pregnant in the follow-up period, 2 cases were repeated ectopic pregnancy and 14 cases were intrauterine pregnancy. One case received assisted reproductive technology and 8 cases were given full-term labor. Surgical treatment group 20 Among the patients, there were 8 cases of pregnancy again (3 cases of in vitro fertilization and embryo transfer), 1 case of recurrent ectopic pregnancy after spontaneous conception and 5 cases of term delivery. The rate of intrauterine pregnancy in the conservative treatment group was 32.5% (13/40), and the intrauterine pregnancy rate in the operation group was 20% (4/20). There was significant difference between the two groups (P <0.05). The cost of hospitalization in the conservative treatment group was significantly lower than that in the operation group, but the hospitalization time was significantly longer than that in the operation group (P <0.05). Conclusion Traditional Chinese medicine prescription combined with methotrexate drug treatment and laparoscopic conservative surgery have similar effects, clinical practice, how to select the specific treatment methods, but also need to meet the two conservative treatment conditions in patients with specific analysis, so Individualized treatment.