输卵管妊娠保守性手术后重复异位妊娠发生的多因素分析

Multifactorial Analysis of Repeated Ectopic Pregnancy after Conservative Surgical Treatment of Tubal Pregnancy

【目的】探讨输卵管妊娠保守性手术后重复异位妊娠发生的高危因素。【方法】回顾分析1999年1月至2004年1月,收治于广东省人民医院及中山大学附属第一医院经保守性手术治疗确诊为输卵管妊娠的有生育要求的330例患者,追踪生育结局18～72个月。据生育结局分为重复性异位妊娠组与非异位妊娠组,采用多重logistic回归分析13项临床变量与生育结局间的关系,探讨引起保守治疗术后重复性异位妊娠发生的危险因素。运用Pearson/Spearman相关性分析探讨两次异位妊娠发生部位的相关性。【结果】①70/330(21.2%)患者重复发生异位妊娠,经腹腔镜手术的43/249例(17.3%),经开腹手术的27/81例(33.3%)。②影响重复性异位妊娠发生的危险因素有:不孕史(OR=0.359)、盆腔炎史(OR=0.347)、异位妊娠史(OR=0.152)、输卵管手术史(OR=0.410)、输卵管粘连(OR=0.187)、输卵管伞端闭锁(OR=0.333)、开腹手术(OR=0.424)。P值均<0.05。尚未发现年龄、阑尾炎史、流产次数、输卵管妊娠部位、破裂与否、盆腔积血量对重复性异位妊娠结局有显著性影响。③Pearson/Spearman相关性分析显示P>0.05,表示两次异位妊娠部位无相关性。【结论】①重复性异位妊娠的发生受盆腔整体环境及患者特点影响,并不倾向于发生在原输卵管妊娠侧。②积极防治盆腔病变、治疗不孕症、选择腹腔镜手术是预防重复性异位妊娠发生的重要手段。

[ Objective ] To investigate the relative factors of recurrent ectopic pregnancy （REP） after conservative surgical treatment of tubal pregnancy. [ Methods ] A retrospective study were performed. This study was carded out in 330 patients who had been treated conservative surgical for tubal pregnancy from January 1999 to January 2004 and who desired future childbearing and who were followed up for a period of 18-72 months. Multiple logistic regression analysis was performed to determine the risk factors for the onset of REP. The Pearson/Spearman （P/S） correlative analysis was performed to assay the relation of the location between REP and the present tubal pregnancy. [Results] 1. The general REP rate was 21.2% （70/330）. 43/249 （17.3%） patients had been treated by laparoscopy, and 27/81 （33.3%） treated by laparotomy. 2. The risk factors influencing recurrent ectopic pregnancy were as follows： previous history of infertility （OR=0.359）, history of ectopic pregnancy （OR=0.152）, previous tube surgery （OR=0.410）, history of pelvis inflammation （OR=0.347）, pelvic adhesion （OR=0.187）, tubal distal occlusion （OR=0.333）, laparotomy （OR= 0.424） , P 〈0.05. But age, parity, previous history of appendicitis, location of EP, rupture tube and the volume of pelvic hematocele had no significant influence on the onset of REP. 3. The P/S correlative analysis showed no correlation of the location between the tubal pregnancy and REP. [Conclusion ] 1. The onset of REP depends more on the circumstance of pelvic cavity and the characteristics of patients, which is not tendency happen on the same side of the previous EP. 2. Aggressive management of infertility, prevention of pelvic infection and choose of laparoseopy are important strategy to prevent the onset of REP.