持续性异位妊娠的诊断及治疗

Persistent ectopic pregnancy, report of seven cases

目的 探讨持续性异位妊娠的发生机理和诊治。方法 回顾了 1995～ 2 0 0 0年 5年间经腹、经腹腔镜手术的 411例异位妊娠患者 ,用logistic回归分析将手术成功与不成功发生持续性异位妊娠患者的两组临床情况进行了比较。结果 7例持续性异位妊娠患者均发生在经腹腔镜手术后 ,发生率为 3 5 %。 7例中 6例发生在输卵管造口等保守性手术后 ,1例发生在输卵管切除术后。 7例中 2例因再次出现腹痛、腹腔内出血 ,5例因血 β人绒毛膜促性腺激素 ( hCG)下降停滞而被诊断。 7例中 2例再次经腹腔镜手术 ,5例经用氨甲蝶呤药物治疗。异位妊娠包块大小、病理有无绒毛组织与是否会发生持续性异位妊娠有关系。结论 对异位妊娠包块越小、停经时间越短及病理无绒毛患者要高度警惕此症发生。血 β hCG监测对于及时诊断和处理是至关重要的。

Objective To investigate and evaluate the occurrence, diagnosis and treatment of persistent ectopic pregnancy. Methods 411 patients with ectopic pregnancy treated via laparoscopy or laparotomy between July 1995 and June 2000 were reviewed. The clinic manifestations of patients who were successfully treated by laparoscopic surgery and those with persistent ectopic pregnancy were analyzed by multivariate stepwise logistic regression. Results Seven cases with persistent ectopic pregnancy occurred after laparoscopic surgery with an incidence rate of 3.5%. Six cases had been treated by conservative approach and one case by tubectomy. Persistent ectopic pregnancy was diagnosed in two cases because of abdominal pain and intra abdominal hemorrhage and in five cases because of plateauing β hCG titers. Two of the seven cases underwent a second time laparoscopic surgery and five were treated with methotrexate. The size of ectopic mass and the absence of villi by pathologic finding were relevant factors of persistent ectopic pregnancy. Conclusion Small mass of ectopic pregnance, short amenorrheal time, and biosy specimens in which no villi are found are all warning indicators of persistent ectopic pregnancy. Close postoperative β hCG surveillance is critical for diagnosis and treatment.