CAJ | 학술논문

目的比较3种方法治疗未生育的年轻女性输卵管妊娠后对其生育能力的影响.方法回顾性分析我院2006至2011年收治,并能够系统随访的274例有生育要求的输卵管妊娠患者,其中55例行开腹输卵管切除术(切除组),120例行开腹输卵管开窗术(开窗组),99例行全身应用氨甲蝶呤保守治疗(药物组).治疗后平均随访4年.结果 180例(65.7％)治疗后自然宫内妊娠,16例(5.8％)再次异位妊娠.其中切除组的白然宫内妊娠37例(67％),再次异位妊娠1例(2.2％)；开窗组宫内妊娠96例(80％),再次异位妊娠2例(1.7％)；药物组宫内妊娠47例(47.4％),再次异位妊娠13例(13.1％).治疗后进行宫腔输卵管造影共55例,其中切除组13例,显示双侧输卵管不通3例(24％)；开窗组20例,双侧输卵管不通1例(5％)；药物组22例,双侧输卵管不通9例(43％).切除组和开窗组的宫内妊娠率较药物组高,再次异位妊娠率低.结论开腹输卵管开窗术在保留生育能力最好,其次是开腹输卵管切除术.而全身应用甲氨蝶呤治疗不仅保留生育能力较低,再次异位妊娠的发生率也高.
목적 비교3충방법치료미생육적년경녀성수란관임신후대기생육능력적영향.방법 회고성분석아원2006지2011년수치,병능구계통수방적274례유생육요구적수란관임신환자,기중55례행개복수란관절제술(절제조),120례행개복수란관개창술(개창조),99례행전신응용안갑접령보수치료(약물조).치료후평균수방4년.결과 180례(65.7％)치료후자연궁내임신,16례(5.8％)재차이위임신.기중절제조적백연궁내임신37례(67％),재차이위임신1례(2.2％)；개창조궁내임신96례(80％),재차이위임신2례(1.7％)；약물조궁내임신47례(47.4％),재차이위임신13례(13.1％).치료후진행궁강수란관조영공55례,기중절제조13례,현시쌍측수란관불통3례(24％)；개창조20례,쌍측수란관불통1례(5％)；약물조22례,쌍측수란관불통9례(43％).절제조화개창조적궁내임신솔교약물조고,재차이위임신솔저.결론 개복수란관개창술재보류생육능력최호,기차시개복수란관절제술.이전신응용갑안접령치료불부보류생육능력교저,재차이위임신적발생솔야고.
Objective To explore the effect of three different procedures on reproductive capacity in young women with tubal ectopic pregnancy.Methods The clinical data on 274 patients with tubal ectopic pregnancy who had been treated from 2006 to 2011 were retrospectively analyzed.55 of the patients underwent abdominal salpingectomy ( resection group ),120 patients underwent laparotomic oviduct fenestration ( fenestration group ),and 99 patients received conservative therapy with MTX ( medication group ) All the patients were followed up for four years,Results The rate of intrauterine pregnancy was found in 180 ( 65.7％ ) patients,while recurrent ectopic pregnancy was found in 16 ( 5.8％ ),Intrauterine pregnancy occurred in 37 ( 67％ ) patients and recurrent ectopic pregnancy developed in one ( 2.2％ ) in resection group:intrauterine pregnancy occurred in 96 ( 80％ ) patients and recurrent ectopic pregnancy developed in two ( 2.2％ ); and intrauterine pregnancy occurred in 47 ( 47.4％ ) patients and recurrent ectopic pregnancy developed in 13 ( 13.1％ ).The rate of intrauterine pregnancy was higher and the rate of recurrent ectopic pregnancy was lower in resection group and fenestration group than in medication group.Conclusions Laparotomic oviduct fenestration has the best effect in preservation of fertility,followed by abdominal salpingectomy.Conservative therapy with MTX not noly has lower fertility,but also has a higher rate of recurrent ectopic pregnancy.