体外受精-胚胎移植后异位妊娠9例临床分析

Clinical Analysis of 9 Cases of Ectopic Pregnancy after in vitro Fertilization and Embryo Transfer

目的 :分析体外受精 胚胎移植 (IVF ET)后异位妊娠 (EP) ,包括宫内宫外同时妊娠 (HP)的发病率及好发因素 ,并评价其各种诊断和处理方法的临床效果。方法 :回顾性分析 9例IVF ET后EP病例临床资料。结果 :IVF ET妊娠 16 8例中 ,发生EP 9例 (5 .36 % ) ,其中HP 6例 (3.5 7% )。在 9例EP病人中 ,7例有明显的输卵管或盆腔疾患史 ;ET后 12dHP患者HCG值高于单纯EP患者 ;超声检查发现 8例 ,漏诊 1例。 3例输卵管破裂的患者 (包括 2例HP)行开腹输卵管切除术 ,2例HP术后宫内妊娠自然流产 ;5例输卵管未破裂的患者 (1例单纯EP ,4例HP)行腹腔镜下输卵管切除术 ,4例HP术后宫内妊娠继续 ,1例流产 ;1例早期发现的EP患者在阴道超声介导下穿刺抽吸治疗 ,取得满意疗效。结论 :既往输卵管或盆腔疾患、宫外孕、输卵管手术是IVF ET后EP发生的常见原因 ,超声检查结合HCG值测定是其最有效的诊断方法 ,腹腔镜下输卵管切除术是治疗HP的较好方法 ,阴道超声介导下穿刺抽吸可作为未破裂EP治疗的一种选择。

Objective: To analyze the incidence and risk factors of ectopic pregnancy (EP), including hesterotopic pregnancy(HP),after in vitro fertilization and embryo transfer(IVF-ET) and to evaluate the efficiency of different methods of diagnosis and treatment. Methods: 9 patients with EP after IVF-ET were retrospectively studied. Results: Of 168 pregnant women after IVF-ET, 9 had EP and 6 had HP. The rate of EP was 5.36% and HP was 3.57%. Seven patients had history of tubal or pelvic disease, four had previous EP and one had previous tubal surgery. Serum HCG measurement at 12 days after ET in patients with HP was higher than in thoes with sole EP. 8 patients were initially diagnosed correctly with sonography at 30 days after ET, one were confirmed at secondary examination. Salpingectomy was performed to 3 patients with severe pain and intra abdominal bleeding. 4 patients with unrupture HP were treated with laparoscopic salpingectomy. Reduction of ectopic pregnancy with transvaginal sonography-guided puncture was made to one patient with unrupture EP. 4 patients with HP preserved the intrauterine gestation. Conclusion: Previous tubal or pelvic disease, EP and tubal surgery are risk factors for EP. The combination of sonograph and serum HCG measurement is reliable in the diagnosis of EP. Transvaginal reduction of ectopic pregnancy may be allowed if an early diagnosis of EP is made, but careful patient selection and follow up is necessary. Laparoscopic salpingectomy is still considered to be the best method for the treatment of HP.