比较腹腔镜下输卵管妊娠部分切除+端端吻合术与输卵管切开取胚术的临床效果及生育预后。

回顾性收集2020年1月~2023年1月于西北妇女儿童医院就诊、有强烈再生育需求并接受手术治疗的输卵管妊娠患者69例。其中29例行腹腔镜下输卵管妊娠部分切除+端端吻合术（A组），40例行腹腔镜下输卵管切开取胚+缝合术（B组）。2组术中均于妊娠输卵管系膜注射甲氨蝶呤20 mg，术后3个月行碘油子宫输卵管造影评估术侧输卵管通畅情况。比较2组患者术前一般资料、术中出血量、手术时间、术后肠道功能恢复时间、术后1 d疼痛视觉模拟评分（VAS）、术后2周持续性异位妊娠发生率、术后3个月患侧输卵管通畅性（分为梗阻、通而不畅、通畅），以及术后24个月内经超声确诊的宫内妊娠率和患侧重复性异位妊娠率。

2组患者术前一般资料、术后肠道功能恢复时间及术后1 d VAS评分差异均无统计学意义（P＞0.05）。术中出血量A组为（39.1±9.4）ml，B组为（35.2±13.1）ml，差异无统计学意义（F=1.87，P=0.176）。A组手术时间为（58.7±18.0）min，显著长于B组的（43.6±17.3）min（F=12.34，P=0.001）。术后2周持续性异位妊娠率A组为0%，B组为7.5%，差异无统计学意义（χ²=2.27，P=0.132）。术后3个月A组患侧输卵管通畅率为89.7%，显著高于B组的65.0%（χ²=6.24，P=0.044）。术后24个月A组宫内妊娠率为89.7%，显著高于B组的70.0%（χ²=4.09，P=0.043）；2组再次异位妊娠率分别为3.4%和12.5%，差异无统计学意义（χ²=1.74，P=0.188）。所有手术均顺利完成，未见严重不良反应。

与输卵管切开取胚术相比，腹腔镜下输卵管妊娠部分切除+端端吻合术虽然手术时间较长，但安全可靠，能显著提高术后输卵管通畅率及宫内妊娠率，且术后持续性异位妊娠及重复性输卵管妊娠风险有降低趋势，可作为有强烈再生育意愿的适龄女性的手术新选择。

To compare the clinical efficacy and fertility outcomes of laparoscopic segmental tubal resection with end-to-end anastomosis versus laparoscopic salpingotomy in patients with tubal pregnancy.

A retrospective analysis was conducted on 69 patients with tubal pregnancy who had a strong desire for future fertility and underwent surgical treatment at our hospital between January 2020 and January 2023. Among them, 29 patients underwent laparoscopic segmental tubal resection with end-to-end anastomosis (Group A), while 40 patients underwent laparoscopic salpingotomy with suture repair (Group B). Both groups received a 20 mg methotrexate injection into the mesosalpinx during surgery. Tubal patency was assessed via lipiodol hysterosalpingography 3 months postoperatively. Parameters compared included preoperative baseline characteristics, intraoperative blood loss, operative time, postoperative bowel recovery time, visual analog scale (VAS) pain score on postoperative day 1, incidence of persistent ectopic pregnancy within 2 weeks post-surgery, tubal patency status (classified as obstructed, partially patent, or patent) at 3 months, and rates of ultrasonographically confirmed intrauterine pregnancy (IUP) and recurrent ipsilateral ectopic pregnancy within 24 months postoperatively.

No significant differences were observed in preoperative baseline data, postoperative bowel recovery time, or VAS score on day 1 between the two groups (P＞0.05). Intraoperative blood loss was also comparable between the two groups (Group A: 39.1± 9.4 ml vs Group B: 35.2±13.1 ml; F=1.87, P=0.176). However, the mean operative time was significantly longer in Group A (58.7±18.0 min) than in Group B (43.6±17.3 min) (F=12.34, P=0.001). The incidence of persistent ectopic pregnancy was 0% in Group A and 7.5% in Group B, which showed no statistically significant difference (χ²=2.27, P=0.132). At the 3-month follow-up, the tubal patency rate was significantly higher in Group A (89.7%) compared to Group B (65.0%) (χ²=6.24, P =0.044). The IUP rate within 24 months was also significantly higher in Group A (89.7%) than in Group B (70.0%) (χ²=4.09, P=0.043). The recurrent ectopic pregnancy rates were 3.4% and 12.5% in Groups A and B, respectively, with no statistically significant difference (χ²=1.74, P=0.188). All procedures were completed successfully without severe adverse events.

Compared to salpingotomy, laparoscopic segmental tubal resection with end-to-end anastomosis, although requiring a longer operative time, is safe and effective. It significantly improves postoperative tubal patency and intrauterine pregnancy rates, with a trend towards reduced risks of persistent and recurrent ectopic pregnancy. This procedure can be considered a new surgical option for women of reproductive age with a strong desire for future fertility.