生殖医学杂志

目的 探讨不同切口腹腔镜输卵管切除术治疗输卵管妊娠的疗效差异。方法 收集2021年4月至2024年4月于上海大学附属南通医院接受腹腔镜下输卵管切除术治疗的89例输卵管妊娠患者，随机分为单切口组(采用经脐单切口手术，44例)和多切口组(采用三孔入路手术，45例)。比较两组患者手术指标、性激素水平、疼痛血清指标及卵巢截面积的差异，评估出院时及出院后6个月的卵巢窦卵泡计数(AFC)。结果 两组患者间手术时间、术中出血量比较均无统计学差异(P>0.05);相较于多切口组，单切口组住院时间更短、下床活动更早、切口满意度更高(P<0.05)。术前两组患者间性激素(FSH、LH、E₂)、AMH水平和疼痛相关血清指标(NPY、SP)比较均无统计学差异(P>0.05),出院时单切口组FSH、LH、E₂、AMH、NPY及SP水平均显著低于多切口组(P<0.05)。出院时和出院6个月后，单切口组的患侧卵巢AFC均显著高于多切口组(P<0.05),出院6个月后单切口组的健侧卵巢AFC显著低于多切口组(P<0.05)。两组患者间术后并发症总发生率比较无统计学差异(P>0.05)。结论 单切口腹腔镜下输卵管切除术治疗输卵管妊娠，与多切口方法相比，具有住院时间短、术后康复快、对卵巢功能影响小等优势，值得在临床上推广应用。

Objective:To investigate the efficacy, postoperative recovery, and complications of laparoscopic salpingectomy for tubal pregnancy using different incision approaches.Methods:A total of 89 patients with tubal pregnancy treated at Affiliated Nantong Hospital of Shanghai University from April 2021 to April 2024 were randomly divided into two groups as the single-incision group with transumbilical single-incision surgery(44 patients) and the multi-port group with a three-port approach(45 patients). The surgical indicators, sex hormone levels, serum markers related to pain, ovarian cross-sectional area, and antral follicle count(AFC) at discharge as well as six months after discharge were compared between the two groups.Results:There were no statistically significant differences in surgical duration and blood loss during operation between the two groups(P>0.05). The single-incision group showed shorter hospital stays, quicker mobilization, and higher incision satisfaction scores than the multi-port group(P<0.05). Before surgery, there were no statistically significant differences in the levels of sex hormone including FSH,LH,estradiol(E₂),anti-Müllerian hormone(AMH) and serum markers related to pain including both neuropeptide Y(NPY) and substance P(SP) between the two groups(P>0.05). At discharge and six months after discharge, AFC of the affected ovary was higher in the single-incision group than that in the multi-port group(P<0.05). Six months after discharge, AFC of the unaffected ovary in the single-incision group was lower than that of the multi-port group(P<0.05). There were no statistically significant differences in the incidence of postoperative complications between the two groups(P>0.05).Conclusions:Laparoscopic salpingectomy for tubal pregnancy via a single incision offers advantages over the multi-port approach, including shorter hospital stays, faster recovery, and less impact on ovarian function, making it a valuable technique for clinical application.