不同方法治疗输卵管妊娠后生育结局的调查分析

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1、目录中文摘要„„„„„„„„„„„„„„„„„„„„„„„„„„„„„1英文摘要„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„2前言„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„4资料与方法„„„„„„„„„„„„„„„„„„„„„„„„„„„„5结果„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„6讨论„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„10结论„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„15致谢„„„

2、„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„16参考文献„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„17附录1临床病例观察表„„„„„„„„„„„„„„„„„„„„„„„„„„„20附录2综述„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„22摘要中文摘要目的：观察比较药物治疗、开腹保守性手术、开腹根治性手术、腹腔镜保守性手术、腹腔镜根治性手术治疗输卵管妊娠后患者的生育结局，评价出最有利于保护生殖能力的治疗方法。方法：本文回顾性分析河南中医学院第一附属

3、医院妇产科自2005年3月～2008年2月间确诊为输卵管妊娠并接受治疗且有生育要求的患者276例，对患者进行电话、门诊或信件随访，以了解再生育情况。比较药物、手术治疗输卵管妊娠后的生育结局，并应用SPSS16.0统计学软件对所得的数据进行统计学分析。结果：①药物治疗与手术治疗后的宫内妊娠率分别为72.3％、65.5％，继发不孕率分别为6.4％、19.4％，差异无统计学意义（P>0.05）；前者的输卵管妊娠再发率高于后者，差异有统计学意义（P<0.05）。②比较药物治疗与保守性手术的生育结局显示，两组的宫内妊

4、娠率分别为72.3％、65.9％，继发不孕率分别为6.4％、19.5％，差异无统计学意义（P>0.05）；重复性输卵管妊娠率分别为21.3％、14.6％，差异有统计学意义（P<0.05）。③腹腔镜手术与开腹手术后的宫内妊娠率分别为66.7％、62.7％，继发不孕率分别为21.1％、15.7％，差异无统计学意义（P﹥0.05），开腹手术后重复性输卵管妊娠率较腹腔镜手术高（P<0.05）。④宫内妊娠率、重复性输卵管妊娠率和继发不孕率在输卵管妊娠保守性手术后分别为58.5％、26.8％和14.6％，在输卵管切除手

5、术分别为67.7％、11.3％和21.0％，差异无统计学意义（P>0.05）。⑤调查结果显示输卵管妊娠经保守性治疗后重复性输卵管妊娠患者21例，其中同侧输卵管妊娠率达76.2％，对侧输卵管妊娠率为23.8％。⑥术中视对侧输卵管正常患者的宫内妊娠率明显高于对侧输卵管受损者（P<0.05），而对侧输卵管受损患者的重复性输卵管妊娠率和继发不孕率均明显高于对侧输卵管正常者，差异有统计学意义（P<0.05）。结论：输卵管妊娠患者治疗后的生育结局与治疗方法关系不大，经保守性治疗后重复性输卵管妊娠多发生在同侧输卵管；对侧

6、输卵管状况是预计生育力的重要指标，当对侧输卵管解剖形态及功能正常的情况下，宜行腹腔镜切除患侧输卵管，其重复性异位妊娠率较其他各组明显降低；在对侧输卵管受损的情况下经腹腔镜手术可一并给予相应处理，有利于改善盆腔内生殖环境，提高妊娠率。关键词：不同方法；输卵管妊娠；治疗；生育结局1不同方法治疗输卵管妊娠后生育结局的调查分析AstudyofthereproductiveoutcomeafterdifferenttreatmentoftubalpregnancyLiXiaohua(GynecologyofTCM)D

7、irectedby:WangLinaAbstractObjective：Theobjectiveofthisstudywastocompareandtoevaluatethereproductiveoutcomeandit'spossibleinfluencingfactorsafterdifferenttreatmentmanagementoftubalpregnancyatHenancollegefirstofTraditionalChineseMedicine.Methods：Retrospectiv

8、ecohortstudyof276consecutivepatientswhowerediagnosedtubalpregnancyandwisedtokeepreproductiveabilitybetweenMarch2005andFebruary2008inHenancollegefirstofTraditionalChineseMedicine.Forcasefollowup,thewomenwerein