CAJ | 학술논문

目的探讨腹腔镜不同术式治疗输卵管妊娠的结局、术后再妊娠情况及其影响因素。方法56例输卵管妊娠患者中，28例行腹腔镜下保守性手术（保守组），28例行腹腔镜下输卵管大部分切除术（切除组），对比分析两组围手术期情况和术后再次宫内妊娠率、异位妊娠率；采用单因素Logistic回归分析盆腔粘连情况等因素对保守性手术后妊娠的影响。结果保守组术中出血量和手术时间均大于切除组(P＜0.05)。随访6个月至6年，保守组和切除组再次宫内妊娠率分别为46.4％(13/28)、32.1％ (9/28)，两组比较差异无统计学意义(P＞0.05)；再次发生异位妊娠率分别为10.7％(3/28)、28.6％( 8/28)，两组比较差异有统计学意义(P＜0.05)。单因素Logistic回归分析表明，腹腔镜下保守性手术治疗输卵管妊娠术后宫内妊娠率与盆腔粘连、对侧输卵管通畅情况相关(P＜Q.05)。结论输卵管妊娠腹腔镜下保守性手术再次宫内妊娠率高于腹腔镜下输卵管大部分切除术。盆腔粘连情况、对侧输卵管闭锁与否是术后宫内妊娠率的相关因素。对于严重盆腔粘连或患侧输卵管破坏严重而对侧输卵管正常者，不建议行保守性手术。
목적탐토복강경불동술식치료수란관임신적결국、술후재임신정황급기영향인소。방법56례수란관임신환자중，28례행복강경하보수성수술（보수조），28례행복강경하수란관대부분절제술（절제조），대비분석량조위수술기정황화술후재차궁내임신솔、이위임신솔；채용단인소Logistic회귀분석분강점련정황등인소대보수성수술후임신적영향。결과보수조술중출혈량화수술시간균대우절제조(P＜0.05)。수방6개월지6년，보수조화절제조재차궁내임신솔분별위46.4％(13/28)、32.1％ (9/28)，량조비교차이무통계학의의(P＞0.05)；재차발생이위임신솔분별위10.7％(3/28)、28.6％( 8/28)，량조비교차이유통계학의의(P＜0.05)。단인소Logistic회귀분석표명，복강경하보수성수술치료수란관임신술후궁내임신솔여분강점련、대측수란관통창정황상관(P＜Q.05)。결론수란관임신복강경하보수성수술재차궁내임신솔고우복강경하수란관대부분절제술。분강점련정황、대측수란관폐쇄여부시술후궁내임신솔적상관인소。대우엄중분강점련혹환측수란관파배엄중이대측수란관정상자，불건의행보수성수술。
Objective To investigate the outcome and repregnancy after different laparoscopicsurgical treatments for tubal pregnancy,and analyse the influential factors. Methods In 56 tubal pregnancypatients,28 cases performed laparoscopic salpingostomy (group A) and 28 cases peoformed laparoscopicsalpingectomy (group B). The perioperative condition, the rate of repregnancy and re-ectopic pregnancy was compared and analyzed. Logistic regression analysis was used to detect the effect on subsequent repregnancyof influential factors such as pelvic adhesion. Results More bleeding and longer operative time were needed in group A than group B, there were significant differences between two groups (P ＜ 0.05 ). In follow-up of 6months to 6 yeats,the rate of repregnancy in group A and group B was 46.4％(13/28) and 32.1％(9/28)respectively,there was no significant difference between two groups (P ＞0.05). The rate of re-ectopic pregnancy in group A and group B was 10.7％ (3/28) and 28.6％ (8/28) respectively,there was significant difference between two groups (P ＜0.05). In the single factor analysis,the repregnancy in group A was significantly associated to pelvic adhesion and patency of the contralateral oviduct (P ＜ 0.05 ). Conclusions The rate of repregnancy of laparoscopic salpingostomy is higher than laparoscopic salpingectomy for tubal pregnancy. Each of pelvic adhesion and the patency of the contralateral oviduct is a factor that affects the postoperative fertility. The conservation operation is not recommended for those patients with extensive pelvic adhesion or seriously destroyed tube but normal contralateral oviduct.