近10年异位妊娠诊断及治疗的变化——附1970例分析

Advances in Diagnosis and Treatment of Ectopic Pregnancy during the Past Ten Years

目的 探讨近 10年异位妊娠发生率及诊断治疗方法的变化。方法 按每 2年为 1个时间段回顾分析我院 1987年 1月至 1996年 12月间 1970例异位妊娠的诊治情况。结果 (1)异位妊娠与同期分娩数之比由 1987至 1988年的 1.0∶42 .4上升为 1995至 1996年的 1.0∶6 .6。 (2 )诊断技术有改进 ,剖腹探查的比例下降 ,而经电视腹腔镜、超声结合血、尿绒毛膜促性腺激素 (β hCG)检测确诊者增多。确诊时间缩短 ,1987至 1988年平均为 (6 .5± 0 .7)d ,1995至 1996年平均为 (3.7± 0 .2 )d(P<0 .0 5 )。 (3)经腹输卵管切除术比例下降 ,腹腔镜手术、保守治疗比例上升。 (4)保守性手术成功率10 0 .0 %。药物保守治疗方式多样 ,成功率约 80 .0 %～ 85 .0 %左右。期待治疗成功率 10 0 .0 %。结论 异位妊娠发生率增高。腹腔镜技术的应用、超声结合敏感的 β hCG测定缩短了确诊时间。剖腹手术减少 。

Objective To investigate the changes of diagnosis and treatment of ectopic pregnancy (EP)during the past ten years. Methods Medical records of 1 970 cases with EP seen in our hospital from Jan.1987 to Dec.1996 were collected and analyzed retrospectively. Results (1) The incidence of EP increases from 1.0 per 42.4 labours during 1987 ～ 1988 to 1.0 per 6.6 labours in 1995～1996. (2) Diagnosis was confirmed more by television laparoscopy, transvaginal ultrasonography and sensitive human chorionic gonadotropin beta subunit assay rather than loparotomy and with a shorter period, (6.5 ±0.7) days in 1987～1988 versus (3.7±0.2)days in 1995～1996. (3) The choice of treatment was more conservative or through laparoscopic surgery than abdominal salpingectomy. (4) The success rate of conservative surgery expectant management reached 100.0% and medical treatment with a variety of choices around 80.0%～85.%. Conclusions Although the incidence of EP increased, with the improvement of diagnostic approaches, patients were detected at an earlier stage and possible to be treated more conservatively.