腹腔镜下输卵管壶腹部妊娠切开取胚术中输卵管创面不同止血方法的疗效比较

李开颜 沈慧敏

【摘要】 目的 研究腹腔镜下输卵管壶腹部妊娠切开取胚术中输卵管创面出血点电凝止血与缝合止血的近期、远期疗效， 以期为腹腔镜下行输卵管壶腹部妊娠切开取胚术中输卵管创面出血的处理提供依据。方法 96例输卵管壶腹部妊娠患者， 随机分为观察组和对照组， 各48例。两组患者均接受腹腔镜下输卵管壶腹部妊娠切开取胚术， 观察组输卵管创面出血部位予4/0 Vicryl可吸收缝线缝合止血， 对照组输卵管创面出血部位予双极电凝止血， 觀察比较两组患者治疗效果。结果 观察组手术时间长于对照组， 术中出血量多于对照组， 差异具有统计学意义（P<0.05）；两组患者盆腔积血、术后β-人绒毛膜促性腺激素（β-hCG）下降至正常时间比较， 差异无统计学意义（P>0.05）。观察组患者术后患侧输卵管通畅率为100.00%， 明显高于对照组的91.67%， 差异具有统计学意义（P<0.05）。两组患侧输卵管通畅患者于输卵管造影后随访1年， 观察组宫内自然妊娠率高于对照组， 再次异位妊娠率低于对照组， 差异具有统计学意义（P<0.05）。结论 腹腔镜下输卵管壶腹部妊娠切开取胚术中输卵管创面出血点使用可吸收缝线缝合止血， 可有效提高术后患侧输卵管通畅率和自然妊娠率， 但较电凝止血耗时稍长、术中出血稍多。

【关键词】 输卵管壶腹部妊娠；腹腔镜；电凝止血；缝合止血

DOI：10.14163/j.cnki.11-5547/r.2018.10.003

【Abstract】 Objective To study the short-term and long-term efficacy of electrocoagulation hemostasis and suture hemostasis on the oviduct wound during laparoscopic tubal ampullary pregnancy incision and embryo extraction， so as to provide basis for processing for oviduct wound bleeding during laparoscopic tubal ampullary pregnancy incision and embryo extraction. Methods A total of 96 tubal ampullary pregnancy patients were randomly divided into observation group and control group， with 48 cases in each group. Both groups received laparoscopic tubal ampullary pregnancy incision and embryo extraction， and the observation group received 4/0 Vicryl absorbable suture for hemostasis of oviduct wound bleeding site， and the control group received bipolar electrocoagulation for hemostasis for hemostasis of oviduct wound bleeding site. The treatment effect in two groups was observed and compared between the two groups. Results The observation group had longer operation time than the control group， and more intraoperative bleeding volume than the control group， and the difference was statistically significant （P<0.05）. Both groups had no statistically significant difference in pelvic hemorrhage， postoperative β-human chorionic gonadotropin （β-hCG） decreased to normal time （P>0.05）. The observation group had obviously higher patency rate of affected oviduct after operation as 100.00% than 91.67% in the control group， and the difference was statistically significant （P<0.05）. Two groups with affected oviduct patency were followed up for 1 year after salpingography， and the observation group had higher intrauterine natural pregnancy rate than the control group， and lower ectopic re-pregnancy rate than the control group. Their difference was statistically significant （P<0.05）. Conclusion Application of absorbable suture for hemostasis on oviduct wound bleeding sites during laparoscopic tubal ampullary pregnancy incision and embryo extraction can effectively improve the patency rate of affected oviduct and natural pregnancy rate， but it takes much longer time and a little more bleeding during operation than electrocoagulation hemostasis.

【Key words】 Tubal ampullary pregnancy； Laparoscope； Electrocoagulation hemostasis； Suture hemostasis

异位妊娠是妇科常见急症， 而输卵管妊娠为最常见的异位妊娠类型， 发生率占异位妊娠的95%， 其中又以输卵管壶腹部妊娠最为常见， 其发生率占输卵管妊娠的78%[1]。随着超声设备的分辨率日益提高、经阴道超声检查的普及及β-hCG检测的广泛开展， 使得未破裂输卵管妊娠、流产型输卵管妊娠早期诊断率得到显著提升[2， 3]， 从而为有生育要求患者实施保留患侧输卵管手术治疗的几率获得极大的提高。腹腔镜下行患侧输卵管线形切开取胚术， 因具有创伤小、对输卵管损伤轻微、可保留患侧输卵管等优势， 已成为治疗输卵管妊娠的首选[4， 5]。但对术中取出妊娠组织物后输卵管创面出血的处理方法， 尚存争议， 主要集中于使用电凝止血对输卵管功能及后期生育的影响。……