体外受精-胚胎移植后异位妊娠29例临床分析

Clinical analysis of 29 cases of ectopic pregnancy after in vitro fertilization and embryo transfer

目的探讨体外受精胚胎移植(invitrofertilizationandembryotransfer,IVFET)后异位妊娠(ectopicpregnancy,EP)的发病因素、临床表现和早期诊治方法。方法回顾性分析我中心IVFET后29例EP的临床资料。结果IVFET妊娠634例,EP29例,其中宫内外同时妊娠(hesterotopicpregnancy,HP)5例,双侧输卵管妊娠1例。5例输卵管破裂(2例为HP),23例输卵管未破裂(3例为HP)。其临床表现主要是阴道不规则流血和下腹胀痛,发病因素主要是输卵管病变,其次为反复宫外孕和流产。结论输卵管病变、宫外孕、流产、盆腔炎是IVFET后EP的发病因素,阴道超声检查结合血HCG值测定是其最有效的诊断措施,腹腔镜下输卵管切除术是治疗未破裂EP的较好方法,阴道超声介导下经输卵管穿刺抽吸可作为未破裂HP治疗的一种有效选择。

Objective To analyze the etiological factors,clinical manifestation, early diagnosis and treatment of ectopic pregnancy(EP) after in vitro fertilization and embryo transfer(IVF-ET).Methods 29 patients with EP after IVF-ET were retrospectively studied.Results Of 634 pregnant women after IVF-ET,29 had EP, including 5 hesterotopic pregnancy(HP) and 1 double oviduct pregnancy.5 patients had rupture EP(2 HP),23 patients had unrupture EP(3 HP).The main clinical manifestation of EP were vagina abnormal bleeding and lower abdomen distending pain. Oviduct disease,EP and abortion were risk factors for EP.Conclusion Oviduct disease,EP, abortion and pelvic inflammation are main risk factors of EP after IVF-ET.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.