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目的通过对输卵管妊娠的治疗进行分析和探讨,为生育健康保健工作提供科学依据。方法246例输卵管妊娠患者均详细收集病史,临床症状,体征,并选择以下辅助检查:后穹隆穿刺,超声检查,血β-HCG及血孕酮实验检测,必要时行诊断性刮宫或阴道排出物送病理确诊。开腹或腹腔镜下切除妊娠侧输卵管或保留输卵管的手术治疗195例,全身或局部的甲氨蝶呤(MTX)等药物治疗38例,期待疗法13例。结果195例行保守手术的输卵管异位妊娠病例,开腹手术后的宫内妊娠率和再次异位妊娠率分别为61.4%和15.4%,腹腔镜术后为61%和15.5%。50例保守手术后持续输卵管妊娠的患者随诊36个月,宫内妊娠率为59%,无再次异位妊娠发生。163例切除输卵管的患者和32例行保守手术的患者术后宫内妊娠率分别为49.3%和53.0%;再次异位妊娠率为9.9%和14.8%。输卵管切除与保留术后的宫内妊娠率分别为53.8%和60.0%;再次异位妊娠率为7.7%和18.3%。结论随着血β-hCG放射免疫测定敏感性的提高、阴道超声的广泛应用和腹腔镜技术的日趋成熟,异位妊娠的早期诊断和保守治疗成为趋势和发展。
Objective To analyze and discuss the treatment of tubal pregnancy and provide a scientific basis for reproductive health care. Methods 246 cases of tubal pregnancy patients were collected in detail history, clinical symptoms and signs, and select the following auxiliary examinations: after the fornix puncture, ultrasound, blood β-HCG and blood progesterone test, if necessary, diagnostic curettage or vaginal discharge Send pathological diagnosis. Laparoscopic or laparoscopic resection of the surgical fallopian tube or tubal surgery 195 cases of systemic or local methotrexate (MTX) and other drugs in 38 cases, expectant treatment in 13 cases. Results Of the 195 conservative cases of tubal ectopic pregnancy, the rates of intrauterine pregnancy and re-ectopic pregnancies after open surgery were 61.4% and 15.4%, respectively, and 61% and 15.5% after laparoscopic surgery. 50 patients with persistent tubal pregnancy after conservative surgery were followed up 36 months, intrauterine pregnancy rate was 59%, no recurrence of ectopic pregnancy. The intrauterine pregnancy rates were 49.3% and 53.0% in 163 patients with tubal resection and in 32 patients undergoing conservative surgery respectively. The rates of ectopic pregnancy were again 9.9% and 14.8%, respectively. The intrauterine pregnancy rates after tubal resection and reservation were 53.8% and 60.0% respectively; the rate of ectopic pregnancy was 7.7% and 18.3% respectively. Conclusion With the increase of the sensitivity of β-hCG radioimmunoassay, the wide application of vaginal ultrasound and the maturity of laparoscopic technique, the early diagnosis and conservative treatment of ectopic pregnancy have become the trend and development.