RESUMO
Objective To compare the effect of different treatment methods in the prevention of persistent ectopic pregnancy after laparoscopic tubal pregnancy conservative operation, to provide reference to women's clinical treatment planning needs of choice.Methods 204 patients underwent laparoscopic tubal pregnancy conservative surgery were selected.According to perioperative preventive postoperative persistent ectopic pregnancy in different ways, they were divided into four groups.After the removal of the gestational sac, the methotrexate injected into the fallopian tube was established as A group(48 cases);methotrexate combined with mifepristone on the prevention of persistent ectopic pregnancy after laparoscopic cyst removal was established as B group(56 cases);simultaneous removal of corpus luteum in laparoscopic cyst removal surgery was established as C group(51 cases);after removal of the bursa, methotrexate injected into the fallopian tube in laparoscopic cyst removal surgery was established as D group(48 cases).The operation indicators of four groups (operation time and intraoperative bleeding volume),blood beta-HCG(β-HCG) changes of 1st,3rd,6th and 12th day after surgery, ectopic pregnancy rate continued after surgery, postoperative follow-up of 2 years were compared.Of the four groups, the normal pregnancy again time after operation, the comprehensive evaluation of different treatment methods for the effect of ectopic pregnancy in the prevention of laparoscopic tubal pregnancy conservative surgery were compared.Results Of the four groups, the age, reproductive status, menopause, preoperative 1st day bleeding, tubal rupture cases, tubal mass diameter, gestational sac in the fallopian tube in position, bloodβ-HCG levels, operation methods had no statistically significant differences(all P<0.05).Comparison of four groups of operation indicators, the operation time in B group was significantly shorter than that in the other three groups(F=5.305,P=0.037).The amount of bleeding in C group and D group was similar, which was significantly higher than that of A group and C group(F=7.483,P=0.005).The β-HCG levels of D group of 1st,3rd,6th and 12th day were significantly lower than those of the other three groups(all P<0.05), which of B group at different time were significantly higher than those of the other three groups(all P<0.05).The persistent ectopic pregnancy rate of D group was significantly lower than that of the other three groups(2.08% vs 14.58%,14.29%,11.54%,x2=7.406,P=0.040),and the normal pregnancy again rate of D group was significantly higher than that of A,B and C groups(58.33% vs 32.14%,37.50%,38.46%,x2=5.349,P=0.022).Conclusion The laparoscopic removal of tubal pregnancy sac at the same time, to the fallopian tube injection of methotrexate, enucleation of corpus luteum, although increases operation time and bleeding volume, but can significantly reduce the harm to women of childbearing age of persistent ectopic pregnancy, and it has high clinical value.