Comparison of three conservative laparoscopic procedures in treatment of tubal pregnancy / 中华全科医师杂志

ABSTRACT

Objective:To compare the clinical effects of three laparoscopic conservative surgical procedures for tubal pregnancy.Methods:From January 2016 to June 2017, 296 patients with tubal pregnancy who underwent laparoscopic fallopian tube window embryo retrieval in our hospital were included in the study. Ninety six patients received meshmental suture combined with tubal incision and suture (group A), 102 patients receive mesentery suture (group B) and 98 patients received conventional surgery (group C). All patients in the three groups were given methotrexate 25 mg injected to the mesentery of the fallopian tube after surgery. The general conditions, treatment effects and postoperative conditions of the three groups were compared. Statistical analysis was performed using analysis of variance or χ 2 test. Results:There was no significant difference in general conditions among the three groups ( P>0.05). The surgical success rate of groups A and B were significantly higher than that of the group C [99.0%(95/96),99.0%(101/102),93.9%(92/98);χ 2=6.52, P=0.04]; the intraoperative blood loss of groups A and B was significantly lower than that in the group C [(30.6±10.9)ml, (30.9±11.6)ml, (63.5±21.8)ml; F=144.18, P<0.01]. At three months after operation, the tubal patency (patency, tortuous, obstruction) of the affected side of the group A was significantly better than that of the groups B and C [group A81.1%(77/95),13.7%(13/95),5.3%(5/95); group B 62.4%(63/101),21.8%(22/101),15.8%(16/101);group C55.4%(51/92),26.1%(24/92),18.5%(17/92); χ 2=15.64, P<0.01]. Eighteen months after surgery, the fallopian pregnancy rate and secondary infertility rate of the affected side of the tubal in group A were significantly lower than those in groups B and C [group A7.3%(7/96) and 12.5%(12/96),group B 17.6%(18/102) and 21.6%(22/102), group C 19.4%(19/98) and 28.6%(28/98); χ 2=6.56, P=0.04; χ 2=7.60, P=0.02]. The intrauterine pregnancy rate of tree groups was similar [45.8%(44/96),35.3%(36/102),33.7%(33/98); χ 2=3.59, P=0.17]; none of the patients in the three groups had persistent ectopic pregnancy, and no serious adverse reactions occurred during treatment. Conclusions:Laparoscopic salpingotomy and tubal incision and laparoscopic suture combined with tubal incision suture are easy to be performed with less bleeding, high surgical success rate and high recanalization rate of fallopian tubes, which deserves clinical promotion.