腹腔镜与开腹手术治疗宫角妊娠的效果分析

徐州栋

[摘要]目的 探讨腹腔镜下宫角楔形切除联合患侧输卵管切除治疗宫角妊娠的临床价值。方法 选择2013年1月～2016年3月本院收治宫角异位妊娠患者80例，按照随机数字表法分为观察组与对照组，每组各40例。对照组行开放手术，观察组则行腹腔镜手术。比较手术相关情况及术后3个月两组性激素水平；观察随访1年两组宫内妊娠情况及术后性生活开始时间与恢复规律性生活时间。结果 观察组手术时间短于对照组（P<0.05），术中出血少于对照组（P<0.05），术后下床时间早于对照组（P<0.05）；术后3个月，观察组E2水平显著高于对照组（P<0.05），PRL水平显著高于对照组（P<0.05），宫内自然妊娠率显著高于对照组（P<0.05），宫外妊娠比例显著低于对照组（P<0.05），观察组术后恢复性生活时间及存在恢复规律性生活时间均早于对照组（P<0.05）。结论 腹腔镜下宫角楔形切除联合患侧输卵管切除术对宫角妊娠患者的内分泌影响较小，术后较快恢复规律性生活，且有效减少再发宫外孕概率。

[关键词]腹腔镜；开腹手术；宫角妊娠；宫角楔形切除；输卵管切除

[中图分类号] R713.8 [文献标识码] A [文章编号] 1674-4721（2017）07（b）-0100-03

[Abstract]Objective To investigate the clinical value of laparoscopic uterine wedge resection combined with ipsilateral salpingectomy in the treatment of uterine horn pregnancy.Methods Eighty cases with uterine ectopic pregnancy from January 2013 to March 2016 in our hospital were divided into observation group and control group by random number table method，with 40 cases in each group.The control group was used routine open surgery，the observation group was used laparoscopic surgery.The surgical situation and levels of hormones 3 months after operation；intrauterine pregnancy during 1 year follow-up；time of sexual life regain postoperation，time of recover regular sexual life were observed.Results The time of operation in the observation group was shorter than control group （P<0.05），the hemorrhage during operation in the observation group was less than control group （P<0.05），the time of getting out of bed in the observation group was earlier than control group （P<0.05）；the level of E2 in the observation group was significantly higher than control group （P<0.05），and the PRL level was significantly higher than control group （P<0.05），the time of sexual life regain postoperation，time of recover regular sexual life of the observation group was earlier than that of the control group （P<0.05）.Conclusion Laparoscopic cholecystectomy combined with ipsilateral salpingectomy has little influence on the endocrine and it is quickly restore regular sexual life and it can reduce the risk of recurrent ectopic pregnancy.

[Key words]Laparoscopy；Laparotomy；Uterine horn pregnancy；Palace wedge resection；Fallopian tube resection

宫角妊娠临床上主要指受精卵定植于近子宫及输卵管口交叉部位的宫角处[1]，临床发生率相对较少[2]，但其一旦发生，随着孕囊的增大时刻存在宫角或输卵管破裂导致大出血甚至威胁患者生命的可能[3]，同时该部位妊娠亦是早孕、流产以及滋养细胞性疾病的高发因素[4]，临床上多漏诊及误诊。宫角妊娠作为异位妊娠中最凶险的一种类型，一旦病灶破裂导致大出血，极易出现失血性体克甚至威胁患者生命安全[5]。以往針对此类患者多行开腹患侧宫角楔形切除联合患侧输卵管切除[6]。近年随着腹腔镜技术的发展，以及医师临床操作技能的提高，腹腔镜下宫角楔形切除联合患侧输卵管切除手术越来越多的在临床得到开展[7]。以往研究证实腹腔镜手术相对开腹手术，其创伤小、术后恢复快、并发症少等优点[8]。但目前极少有研究针对腹腔镜宫角楔形切除联合患侧输卵管切除术术后患者性生活质量、妊娠方式及相关性激素变化进行研究，为弥补以上不足，本研究主要探讨腹腔镜与开腹手术下行宫角楔形切除患侧输卵管切除的差异，现报道如下。……