输卵管妊娠患者腹腔镜保守性手术后发生持续性异位妊娠的相关因素及其防治

Influencing Factors and Prevention of Persistent Ectopic Pregnancy After Laparoscopic Oviduct-Sparing Surgical Treatment of Tubal Pregnancy

目的探讨输卵管妊娠患者腹腔镜保守性手术治疗后发生持续性异位妊娠(persistent ectopic pregnancy,PEP)的相关因素及其防治方法。方法回顾性分析2004年1月至2006年12月在本院接受腹腔镜保守性手术治疗的470例输卵管妊娠患者的临床资料,采用logistic回归分析法分析患者术前血HCG水平及术后递降率等因素与发生持续性异位妊娠的相关性,并应用受试者工作特征曲线(receiver operating characteristic curve,ROC)确定发生持续性异位妊娠的相关因素最佳临界点。结果470例患者中,共计发生持续性异位妊娠33例(7.02%,33/470)。单因素logistic回归分析发现,持续性异位妊娠的发生与同侧输卵管妊娠史、术前血HCG水平、术后第9、第12天血HCG递降率相关(P<0.05),而与患者的停经时间、非同侧输卯管妊娠史、输卵管完整性、腹腔内出血、附件包块大小、下腹部手术史、盆腔粘连、妊娠部位、术后第3、第6天血HCG递降率无相关性(P>0.05)。在多因素分析中,持续性异位妊娠的发生与患者术前血HCG水平、术后第9、第12天血HCG递降率仍呈相关关系(P<0.05)。以术前血HCG水平大于3 390 mIU/ml结合术后第9天血HCG水平递降率小于41%为阈值,预测持续性异位妊娠发生的敏感度和特异度分别为76.97%和85.91%。结论持续性异位妊娠的发生与患者术前血HCG水平及术后第9、第12天血HCG递降率相关,当术前血HCG水平大于3 390 mIU/mL,并术后第9天血HCG递降率小于41%时,应及时应用甲氨蝶呤(MTX)等预防持续性异位妊娠的发生。

Objective To explore influencing factors and prevention of persistent ectopic pregnancy after laparoscopic oviduct sparing surgical treatment. Methods A retrospective logistic regression analysis was carried out on 470 cases （from January 2004 to December 2006）after laparoscopic oviduct- sparing surgical treatment of tubal pregnancy in the Department of Gynecology 8. Obstetrics, the First People＇s Hospital of Foshan to find out the relationship between the occurrence of persistent ectopic pregnancy and factors, like HCG level before the operation and descending rate after the operation. Receiver operating characteristic curve （ROC） was used to determine the best critical point of the persistent ectopic pregnancy related factors. Results Among 470 patients, 33 （7. 02%） patients were diagnosed with persistent ectopic pregnancy. Univariate logistic regression analysis showed that persistent ectopic pregnancy was significantly associated with the pre-operative serum level of HCG, homolateral tubal pregnancy history and the fall rate of serum HCG on the 9th day,12th day after the operation （P〈 0.05）, but not with duration of menolipsis amenorrhea, non-ipsilateral tubal pregnancy history, the size of adnexal mass, pelvic adhesion, rupture of affected oviduct, hemoperitoneum, previous lower abdominal surgery history and the fall rate of serum HCG on the 3rd and the 6th day after the operation （P〈0. 05）. Multivariate logistic regression analysis revealed that persistent ectopic pregnancy was related with the prc-operative HCG serum level and the fall rate of serum HCG on the 9th and the 12th day on alternate 3 days after the operation （P〈20.05）. Taking pre-operative serum HCG 〉3 390 mlU/mL and descending rate 〈41% on the 9th day post peratively as the cutoff value, the sensitivity and specificity of the test were 76. 97% and 85.91% respectively. Conclusion The occurance of persistent ectopic pregnancy was related witb the pre-operative serum level of HCG and fall rate of serum HCG after surgery on the 9th and the 12th day. Pre-operative serum HCG〉3 390 mlU/mL and descending rate 〈41% at the 9th day after operation are indicators for methotrexate injection to prevent persistent ectopic pregnancy in time.