重复异位妊娠的临床分析

Clinical analysis of recurrent ectopic pregnancy

目的:探讨重复异位妊娠的发生率、病因、临床特点、诊断、治疗方法及预防措施。方法:回顾性分析2001年1月至2004年6月我院353例异位妊娠中19例重复异位妊娠患者的资料。结果:重复异位妊娠的发病频率为1∶18.6(19/353);平均发病年龄31.70岁,19例患者中17例(对侧输卵管16例,同侧1例)行手术治疗;病理检查示13例伴有慢性输卵管炎。两次异位妊娠间隔时间最短为2个月,最长为6年,平均2.75年(33个月);10例间隔时间<36个月。最多1例发生3次异位妊娠。误诊率为5.26%。结论:盆腔粘连、输卵管炎以及保守性手术是重复异位妊娠的危险因素,预防和彻底治疗盆腔炎症性疾病是降低重复异位妊娠发生的重要手段,采取保守性手术治疗时应慎重权衡利弊。

Objective: To analyze the incidence, etiological factors, clinical characteristic, diagnosis, treatment method and the prevention measures of recurrent ectopic pregnancies in our hospital from January 2001 to June 2004. Methods:19 cases of recurrent ectopic pregnancy were analyzed retrospectively. Results: There were 19 recurrences in 353 cases of ectopic pregnancy with a incidence rate of 1∶ 18.6( 19/353). The average age was 31.7 years old. 17 were operated with lesions involving the contralateral oviduct in 16 cases and the homolateral oviduct in 1 case. Pathological examination revealed additional chronic salpingitis in 13 cases. The shortest interval between the recurrent ectopic pregnancies were 2 months to 6 years,with an average of 33 months. Among them, 10 patients recurred within 36 months. There was one patients suffering from 3 times of ectopic pregnancies. The misdiagnosis rate was 5.26%. And the disease of misdiagnosis was miscarriage of early pregnancy. Surgical treatment can be the first choice of treatment of recurrent ectopic pregnancy. Conclusion: Pelvic adhensions, inflamed salpinx and conservative treatment are risk factors of recurrent ectopic pregnancy. Effective treatment of pelvic inflammation and avoiding of the first heterotopic pregnancy are the important measures for prevention of recurrent ectopic pregnancy.