發(fā)布時(shí)間：2018-12-21 13:19

【摘要】：目的：應(yīng)用宮腹腔鏡聯(lián)合手術(shù)觀察異位妊娠輸卵管開窗取胚術(shù)后輸卵管的形態(tài)及通暢性,了解輸卵管功能狀態(tài),評價(jià)輸卵管開窗取胚術(shù)的臨床意義,同時(shí)比較不同手術(shù)方式、途徑對再次妊娠的影響以及評價(jià)輸卵管造影的符合率方法：1.選取2008年至2010年期間在山東省淄博市齊都醫(yī)院及青島大學(xué)附屬醫(yī)院就診的229例輸卵管妊娠手術(shù)病人作為研究對象進(jìn)行回顧性的研究分析,對其術(shù)后進(jìn)行為期4年的隨訪。按手術(shù)方法不同分為輸卵管切除組及輸卵管開窗取胚術(shù)組,比較兩種手術(shù)方法術(shù)后的宮內(nèi)妊娠率、再次異位妊娠率及不孕率。按手術(shù)途徑不同分為開腹手術(shù)組與腹腔鏡手術(shù)組,比較兩種手術(shù)途徑術(shù)后的宮內(nèi)妊娠率、再次異位妊娠率及不孕率。再選取55例行輸卵管開窗取胚術(shù)后不孕的病人作為研究對象進(jìn)行回顧性研究分析,應(yīng)用宮腹腔鏡聯(lián)合手術(shù)觀察患側(cè)輸卵管的形態(tài)及通暢性,了解輸卵管功能狀態(tài),從而評價(jià)輸卵管開窗取胚術(shù)的臨床意義,并對其輸卵管造影符合率進(jìn)行研究。結(jié)果：1.輸卵管切除組術(shù)后的宮內(nèi)妊娠率、不孕率與開窗取胚術(shù)組無明顯差異,兩者統(tǒng)計(jì)學(xué)上比較無差異(P0.05)；2.輸卵管切除組術(shù)后的再次異位妊娠率較開窗取胚術(shù)組偏低,統(tǒng)計(jì)學(xué)比較有明顯差異(P0.05； 3.術(shù)中見對側(cè)輸卵管異常組的患者術(shù)后宮內(nèi)妊娠率明顯低于對側(cè)輸卵管正常組,統(tǒng)計(jì)學(xué)上比較差異有顯著性(P0.05),而再次輸卵管妊娠和繼發(fā)不孕的發(fā)生率明顯高于對側(cè)輸卵管正常組,統(tǒng)計(jì)學(xué)差異有顯著性(P0.05)；4.開腹組與腹腔鏡組術(shù)后宮內(nèi)妊娠率、再次輸卵管妊娠率無明顯差異(P0.05)；但腹腔鏡組術(shù)后繼發(fā)性不孕的發(fā)生率低于開腹組(P0.05)；5.宮腹腔鏡聯(lián)合手術(shù)直視下觀察開窗取胚術(shù)后輸卵管的功能狀態(tài)較差；6.輸卵管造影對輸卵管功能狀態(tài)診斷的準(zhǔn)確性較宮腹腔鏡聯(lián)合手術(shù)差,統(tǒng)計(jì)學(xué)上比較有差異(P0.05)。結(jié)論：1.宮腹腔鏡聯(lián)合手術(shù)觀察輸卵管開窗取胚術(shù)后輸卵管功能狀態(tài)較差,輸卵管妊娠患者術(shù)后的再次妊娠率取決于對側(cè)輸卵管的功能狀態(tài),故輸卵管妊娠患者若術(shù)中發(fā)現(xiàn)對側(cè)輸卵管良好,手術(shù)方法宜為患側(cè)切除,手術(shù)途徑宜為經(jīng)腹腔鏡。2.輸卵管妊娠行輸卵管開窗術(shù)的患者術(shù)后6個月以上仍未孕者可直接選擇宮腹腔鏡聯(lián)合手術(shù)評估其輸卵管的功能狀態(tài),從而指導(dǎo)其選擇合適的生育途徑。
[Abstract]:Objective: to observe the shape and patency of fallopian tube after tubal fenestration in ectopic pregnancy by combined hysteroscopy and laparoscopy, to understand the functional status of fallopian tube, to evaluate the clinical significance of tubal fenestration and to compare different surgical methods. The effect of the method on re-pregnancy and the method of evaluating the coincidence rate of salpingography: 1. From 2008 to 2010 229 patients with tubal pregnancy who were treated in Qidu Hospital of Zibo City of Shandong Province and affiliated Hospital of Qingdao University were retrospectively analyzed and followed up for 4 years. The intrauterine pregnancy rate, ectopic pregnancy rate and infertility rate were compared between the two groups according to the different surgical methods: salpingotomy group and tubal fenestration group. The intrauterine pregnancy rate, ectopic pregnancy rate and infertility rate were compared between laparoscopy group and open operation group. Then 55 cases of infertility after oviduct fenestration were selected for retrospective analysis. The shape and patency of the affected fallopian tube were observed by hysteroscopy combined with laparoscopy to understand the functional status of the fallopian tube. The clinical significance of tubal fenestration was evaluated and the coincidence rate of salpingography was studied. Results: 1. The rate of intrauterine pregnancy and infertility in the salpingotomy group was not significantly different from that in the fenestration group, but there was no statistical difference between the two groups (P0.05); 2. The rate of ectopic pregnancy in the salpingotomy group was lower than that in the embryo extraction group (P 0.05; 3. 05; P < 0. 05; P 0. 05; P < 0. 05; P < 0. 05). The intraoperative pregnancy rate of the patients with abnormal fallopian tubes was significantly lower than that of the normal fallopian tubes (P0.05). The incidence of secondary infertility and secondary tubal pregnancy was significantly higher than that of the contralateral tubal normal group (P0.05). 4. There was no significant difference in intrauterine pregnancy rate and re-tubal pregnancy rate between laparoscopy group and laparoscopy group (P0.05), but the incidence of secondary infertility in laparoscopy group was lower than that in laparotomy group (P0.05). The functional state of oviducts after embryo extraction by laparoscopy combined with hysteroscopy was worse than that of oviducts after fenestration. 6. The accuracy of salpingography in the diagnosis of functional status of fallopian tube was worse than that in combined hysteroscopy and laparoscopy (P0.05). Conclusion: 1. The function of fallopian tube after tubal fenestration was observed by hysteroscopy combined with laparoscopy. The rate of repregnancy in patients with tubal pregnancy was determined by the functional status of the contralateral fallopian tube. Therefore, in patients with tubal pregnancy, if the contralateral fallopian tube is found to be good during the operation, the operative method should be resection of the affected side, and the operative route should be laparoscopic. 2. Patients with tubal pregnancy who have not been pregnant for more than 6 months can directly select hysteroscopy combined with surgery to evaluate the functional status of the fallopian tube, so as to guide them to choose the appropriate reproductive path.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R713.8

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