腹腔镜保守性手术后持续性异位妊娠的有关因素分析

Risk Factors of Persistent Ectopic Pregnancy after Laparoscopic Conservative Surgery for Tubal Pregnancy

目的探讨腹腔镜保守性手术后持续性异位妊娠(persistent ectopic pregnancy,PEP)的有关因素。方法 2007年1月～2011年12月对2105例输卵管妊娠行腹腔镜保守性手术,27例术后发生PEP,发生率1.3%,对腹腔镜保守性手术后PEP的有关因素进行分析。结果 26例PEP甲氨蝶呤(MTX)药物治疗治愈,1例PEP因腹腔内出血急诊手术治愈。对有关因素进行单因素分析显示,PEP的发生与术前血清β-hCG≥4000 U/L、术前血清孕酮≥30 nmol/L和妊娠部位有关(χ2=66.512,P=0.000;χ2=85.093,P=0.000;χ2=9.918,P=0.019),其中间质部与峡部、壶腹部的PEP发生率有统计学差异(χ2=4.182,P=0.041;χ2=4.992,P=0.025);停经时间长短、患者年龄、包块大小、有无剖宫产史、有无异位妊娠史与PEP的发生无关(P>0.05)。结论 PEP的发生与术前血清β-hCG≥4000 IU/L、血清孕酮≥30 nmol/L和妊娠部位有关。

Objective To study the risk factors of persistent ectopic pregnancy （PEP） following laparoscopic conservative surgery for tubal pregnancy. Methods Since January 2007 to December 2011, we performed laparoscopic conservative surgery on 2105 patients with tubal pregnancy, 27 of them （ 1.3% ） developed PEP after the procedure. We analyzed the risk factors of PEP based on the data of these patients. Results Among the 27 patients, 26 were cured with MTX, and the other were cured after a emergency operation for abdominal hemorrhage. Univariate analysis showed that PEP is correlated with preoperative serum levels of ^- hCG （ ~〉 4000 U/L） and pregnendione （ ~〉30 nmol/L） , as well as the site of pregnancy （2,2 = 66. 512, P = 0. 000; X2 = 85. 093, P =0.000; X2= 9. 918, P = 0. 019）. There existed significant difference in the rate of PEP between the patients had the tubal pregnancy at the intramural oviduct and those at the isthmus and ampulla （X2 = 4. 182, P = 0. 041 ; X2 = 4. 992, P = 0. 025）. Length of menelipsis, age, size of lesion, history of cesarean section are not related to the incidence of PEP .（ P 〉 0. 05）. Conclusion Preoperative serum levels of β-hCG （ ≥ 4000 U/L） and pregnendione （ ≥30 nmol/L）, as well as the site of pregnancy are risk factors of PEP.