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目的:探讨腹腔镜保守治疗异位妊娠的临床应用。方法:回顾性分析本院178例保守治疗异位妊娠的病历资料,比较不同治疗方法的住院时间、治疗效果以及对未来妊娠的影响。所有资料根据治疗方法分为两组:A组米非司酮(MTX)保守治疗73例;B组腹腔镜输卵管切开取胚105例,其中腹腔镜单纯切开取胚34例(B1组),腹腔镜切开取胚术前给予MTX(25 mg每天两次×3天)预处理48例(B2组),腹腔镜切开取胚术中使用小剂量MTX(20 mg)输卵管系膜局部注射23例(B3组)。结果:A组住院时间长,持续性宫外孕发生率较高,对改善治疗后正常妊娠无优势,并且有比较明显的药物不良反应;B组住院时间短,其中B1组有发生持续性宫外孕的风险,但风险较A组低(P<0.05),B2及B3组均无持续性宫外孕发生,无明显药物不良反应。结论:腹腔镜治疗异位妊娠有手术时间短、创伤小、术中出血少、术后恢复快的明显优势,对于有生育要求的女性,腹腔镜输卵管切开取胚术可能是更好的治疗方法。
Objective: To investigate the clinical application of laparoscopic conservative treatment of ectopic pregnancy. Methods: A retrospective analysis of our hospital 178 cases of conservative treatment of ectopic pregnancy medical records, compared the different treatment methods of hospital stay, the treatment effect and the impact on future pregnancy. All the data were divided into two groups according to the treatment: A group of 73 patients with conservative treatment of mifepristone (MTX); B group of laparoscopic tubal incision and embryo retrieval in 105 cases, of which laparoscopic simple excision embryos in 34 cases (B1 group) , 48 patients (group B2) were pretreated with MTX (25 mg twice daily x 3 days) before laparoscopic embryo implantation, and a small dose of MTX (20 mg) Injection in 23 cases (B3 group). Results: A group of hospitalized for a long time, persistent higher incidence of ectopic pregnancy, to improve the treatment of normal pregnancy no advantage, and there are more obvious adverse drug reactions; B group hospitalization time is short, which group B1 have the risk of persistent ectopic pregnancy , But the risk was lower than that in group A (P <0.05). There was no persistent ectopic pregnancy in groups B2 and B3, with no apparent adverse drug reactions. Conclusions: Laparoscopic treatment of ectopic pregnancy with shorter operative time, less trauma, less intraoperative bleeding, postoperative recovery of the obvious advantages for women with reproductive requirements, laparoscopic tubal embryo surgery may be a better treatment method.