Fujishita Akira, Masuzaki Hideaki, Khan Khaleque Newaz, Kitajima Michio, Hiraki Koichi, Ishimaru Tadayuki
Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Hum Reprod. 2004 May;19(5):1195-200. doi: 10.1093/humrep/deh196. Epub 2004 Mar 25.
The study was carried out to clarify the incidence of post-operative tubal adhesions, patency rate and pregnancy outcome after laparoscopic salpingotomy with and without suturing for tubal pregnancy.
From May 1996 to December 2002, a total of 97 cases of tubal pregnancy were treated in our centre by laparoscopic conservative surgery. The successful salpingotomy cases were randomly assigned to undergo salpingotomy without suturing (group I; n = 43) or with suturing (group II; n = 32). We compared these patients and assessed their surgical and pregnancy outcome by second look laparoscopy (SLL) 3 months after the first operation.
Seventy-five cases (77%) were treated successfully by salpingotomy at initial laparoscopic surgery, and the remaining 22 cases were unsuccessful because of bleeding or complete tubal damage. Pelvic findings were assessed at SLL in 21 of 43 cases (49%) in group I and 17 of 32 (53%) in group II. There were no significant differences in gestational age, ectopic site, tubal diameter, tubal condition, intraperitoneal haemorrhage and pre-operative HCG levels between the two groups. Only the operation time was longer in group II than in group I (91 +/- 15 versus 69 +/- 15 min, P < 0.05). The tubal patency rate of the treated side was 90% (19/21) in group I and 94% (16/17) in group II. Also the peritubal adhesions were observed in 33% (7/21) in group I and 29% (5/17) in group II, and were mostly comprised of filmy adhesions. A tubal fistula occurred in two cases in each group. Pregnancy rate was 79% (15/19) in group I and 92% (12/13) in group II, and this did not reveal any significant difference of cumulative pregnancy rate between the groups.
We recommend laparoscopic linear salpingotomy as a useful method in the management of cases with tubal pregnancy who desire future pregnancy. This preliminary study emphasizes that the procedure involving suturing has no additional benefit over the non-suturing technique during salpingotomy.
本研究旨在明确输卵管妊娠行腹腔镜输卵管切开术（缝合与不缝合）后术后输卵管粘连的发生率、通畅率及妊娠结局。
1996年5月至2002年12月，本中心共对97例输卵管妊娠患者行腹腔镜保守手术治疗。成功行输卵管切开术的病例被随机分为不缝合输卵管切开术组（I组；n = 43）和缝合输卵管切开术组（II组；n = 32）。我们对这些患者进行比较，并在首次手术后3个月通过二次腹腔镜检查（SLL）评估其手术及妊娠结局。
初次腹腔镜手术时，75例（77%）患者通过输卵管切开术成功治疗，其余22例因出血或输卵管完全损伤而手术失败。I组43例中的21例（49%）和II组32例中的17例（53%）接受了二次腹腔镜检查以评估盆腔情况。两组在孕周、异位部位、输卵管直径、输卵管状况、腹腔内出血及术前HCG水平方面无显著差异。仅II组手术时间比I组长（91±15分钟对69±15分钟，P < 0.05）。I组治疗侧输卵管通畅率为90%（19/—21），II组为94%（16/17）。I组33%（7/21）和II组29%（5/17）观察到输卵管周围粘连，且大多为薄膜状粘连。每组各有2例发生输卵管瘘。I组妊娠率为79%（15/19），II组为92%（12/13），两组累积妊娠率无显著差异。
我们推荐腹腔镜线性输卵管切开术作为治疗希望未来妊娠的输卵管妊娠患者的一种有效方法。这项初步研究强调，在输卵管切开术中，缝合操作相较于不缝合技术并无额外益处。
