| ObjectiveIn this artitle, we aims to analysis of partents’ ongoing outcome whether related to two different ways of conservative surgery,by comparing the laparotomy and laparoscopic conservative surgery patient general condition, surgery, postoperative recovery, postoperative pregnancies and pregnancy affecting factors.MethodsAll of the patients who from the First Affiliated Hospital of Kunming Medical University were selected in January 2009 to December 2011, the cases of 225 patients were retrospectively analyzed who with complete data and have fertility requirements after treated ectopic pregnancy conservative surgery. According to the operation method patients are divided into two groups, laparotomy group 119 cases, f laparoscopic group 106 cases, All of patients with ectopic pregnancy were diagnosed in the present study based on clinical suspicion aided with urine β human chorionic gonadotropic hormone and ultrasound (transabdominal and transvaginal), or underwent laparoscopy as a diagnostic procedure after vaginal vault puncture.Review of patients’ pre-operative, intraoperative situation;then follow-up of patients’ on-going outcome and the time about pregnancy by telephone.Finally use the statistical correlation analysis patients’ general condition, surgery, postoperative recovery, postoperative pregnancies and pregnancy affecting factors,comparing the laparotomy and laparoscopic conservative surgeryResults1、Laparoscopic surgery compared with laparotomy operation,have shorter postoperative urine tube pull time (1.2±0.5VS2.0±0.7), get out of bed earlier (1.1±0.3VS1.7±0.5) and shorter hospitalization days (5.3±1.5VS6.3±1.4),Less intraoperative hemorrhage (80.35±34.61VS288.7±105.69), less blood transfusion (2.8% VS11.8%).The difference was statistically significant (P<0.05).2、Pregnancies rate in patients with laparoscopy and laparotomy group has no obvious statistical significance difference (P>0.05), the surgical procedure itself has no obvious relation with intrauterine pregnancy rate again.But the laparoscopic group natural pregnancy rate of 65%(61.3%) than laparotomy group 65%(68/119) is higher, and in the 0 to 6 months after surgery, laparoscopic. group pregnancy rate 12.3% (38/106), higer than in the laparotomy group3.4%(4/119);But the laparoscopic group’s repeat ectopic pregnancy rate (23.6%VS29.4%) is lower.3、Age is a risk factor for pregnancy again(OR> 1), the pregnancy rate in three years, yongger than 25 patients was 76.9%,26 to 30 years old was 67.6%,31-35 years old was 36.8%,36 or older than 36 years old> 36 to 2.1%. So patients have more age the chance of infertility are lower;4、History of surgery are risk factors for ectopic pregnancy (OR> 1), patients who had a history of surgery, the risk of ectopic pregnancy was 8.123 times with no history of previous surgery;Blood HCG value is the protective factors of ectopic pregnancy (OR< 1), the patients who have a low blood HCG value.,the risk of patients with persistent ectopic pregnancy was 0.152 times with the patients who have a high blood HCG value.Conclusions1、If choice different ways of conservative surgery in patients whose ectopic pregnancy age, history of pelvic inflammatory disease, surgery, ultrasound tip with heart, blood HCG value, and so on various aspects condition had no statistical difference, the pregnancy outcome has no obvious statistical significance, in other words the way choice of laparoscopic conservative surgery or laparotomy itself has no effect on on-going outcomes.2、After Laparoscopic conservative surgery patients whose on-going pregrency rate within six months and three years of natural conception rate are higer than in laparotomy conservative surgery, and the repeat ectopic pregnancy rate are lower than in laparotomy conservative surgery. It is proved that after laparotomy patients with bilateral tubal damage is bigger, severe pelvic adhesion, may also haveinfluence to the contralateral fallopian tube function.3、Laparoscopic surgery in the treatment of ectopic pregnancy have a more important place account for many significant advantages,excemple its small trauma, less blood loss, pull the urine tube time early, rapid recovery, short hospital stay, postoperative wound beautiful and so on.But for patients with ectopic pregnancy who has broken, we select laparotomy is still higher than laparoscopic.So for us open operation is still the first selection for the patients whose blood are unstable.4、Patients have a older age, the lower the on-going pregnancy, age is the main influence factors of patients with postoperative pregnancy again.5、Parents who had a history of surgery or high blood HCG value have a higher incidence of postoperative persistent ectopic pregnancy, that always prove that both has a history of surgery in patients with pelvic adhesions and preoperative HCG value are easy to lead to higher residual nourish cells, resulting in persistent ectopic pregnancy. |
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