重复异位妊娠的发生与防治

Etiologic Factors and Prevention of Repeated Ectopic Pregnancy

目的探讨重复异位妊娠(repeated ectopic pregnancy,REP)的发生特点,并提出预防和治疗措施。方法回顾性分析2009年9月—2011年9月我院收治的41例REP(观察组)与同期40例首次异位妊娠(ectopic pregnancy,EP)(对照组)的临床资料及治疗方法,并进行REP影响因素相关性分析。结果对照组与观察组孕次比较差异有统计学意义(P<0.01)。41例REP中26例(63.4%)发生在首次EP后两年内,且首次经手术切开取胚或药物治疗的EP患者两年内发生REP比例明显高于行输卵管切除术者(P<0.01)。发生REP的危险因素包括盆腔粘连和输卵管炎(OR=48.14,P=0.006),盆腔或宫腔手术史(OR=41.32,P=0.042),无或偶尔避孕(OR=13.78,P=0.002)及首次EP时输卵管发生破裂(OR=5.16,P=0.022);保护因素包括患侧输卵管切除加对侧输卵管绝育术(OR=0.05,P=0.002),长期药物避孕(OR=0.13,P=0.046)和首次EP时停经天数<45 d(OR=0.97,P=0.036)。结论输卵管损伤,急、慢性盆腔炎,盆腔粘连等是引起REP的主要原因,临床应积极治疗原发病,严密随访并正确指导患者避孕与妊娠。

Objective To explore etiologic factors and preventive measures of repeated ectopic pregnancy（REP） in order to improve the therapeutic measures.Methods Clinical data and therapeutic method of 41 patients with repeated ectopic pregnancy and 40 patients with the first time ectopic pregnancy（EP） during September 2009 and September 2011 were retrospectively analyzed.Results Comparison of two groups of pregnant difference was statistically signicant（P0.01）.Among 41 patients with repeated ectopic pregnancy there were 26 patients（63.4%） who experienced REP within two years.Those EP patients who underwent surgery or pharmacotherapy at the first time had a higher incidence rate of REP than those who underwent salpingectomy（P0.01）.Risk factors of repeated ectopic pregnancy included inflammation of the tube and pelvic adhesion（OR=48.14,P=0.006）,the history of pelvic and uterine operation（OR=41.32,P=0.042）,no or occasional use of contraception pills（OR=13.78,P=0.002） and tube rupture at first ectopic pregnancy（OR=5.16,P=0.022）;the protective factors included salpingectomy and oviductus lateralis sterilization operation（OR=0.05,P=0.002）,extended use of oral contraception pills（OR=0.13,P=0.046） and duration of amenorrheal at first ectopic pregnancy for less than 45 days（OR=0.97,P=0.036）.Conclusion The trauma of the tube,acute or chronic pelvic inflammatory disease and pelvic adhesion are the primary risk factors of repeated ectopic pregnancy.Intensive clinical measures should be taken to cure the primary disease of the patients with EP,who must be closely followed up and be given guidance in contraception and pregnancy.