输卵管妊娠根治术后持续性异位妊娠6例临床分析

Clinical analysis of 6 cases of persistent ectopic pregnancy after salpingectomy for tubal pregnancy

目的探讨输卵管妊娠根治术后持续性异位妊娠的原因及诊治。方法分析2003年1月1日至2014年9月30日杭州师范大学附属医院输卵管妊娠根治术后发生的6例持续性异位妊娠病例的诊疗过程。结果输卵管妊娠根治术后持续性异位妊娠病例占同期输卵管妊娠根治病例的1.6%。患者平均年龄(27.4±5.7)岁,平均停经时间(45.3±6.7)天;6例均为流产型或破裂型;术前血人绒毛膜促性腺激素(hCG)平均(10 476.2±13 874.3)IU/L,术后3天血hCG降幅平均为(79.7%±17.9%),血hCG最低平均(493.1±891.4)IU/L,再次上升的时间平均为术后(18.5±5.9)天;6例中有4例单用甲氨蝶呤(MTX)药物治疗,另2例MTX联合米非司酮治疗,两种治疗方法均治愈患者,疗效上无显著性差异(t=0.298,P>0.05)。结论输卵管妊娠根治术后持续性异位妊娠的发生与术前血hCG的高低、输卵管妊娠的类型、手术方式等相关,术后严密监测血hCG非常必要。

Objective To investigate the causes and treatment of persistent ectopic pregnancy （ PEP ） after salpingectomy for tubal pregnancy. Methods Analysis was conducted on the clinical data of 6 cases with PEP after salpingectomy for tubal pregnancy at the Affiliated Hospital of Hangzhou Normal University from January 1st,2003 to September 30th,2014 . Results The cases with PEP accounted for 1. 6% of those with salpingectomy for tubal pregnancy. Mean age of these 6 patients was 27. 4 ± 5. 7years old, and the mean amenorrhea duration was 45. 3 ± 6. 7days. All of the cases were rupture type or abortion type. Mean level of human chorionic gonadotropin （hCG） before salpingectomy was 10 476. 2 ± 13 874. 3IU/L, and the average decreasing amplitude was 79. 7% ± 17. 9% at 3 days after surgery. The lowest mean level of hCG was 493. 1 ± 891. 4IU/L, and its rising occurred 18. 5 ± 5. 9days after surgery. Four of 6 cases were treated with MTX, and the other 2 were given MTX and mifepristone. Both therapies were effective and there was no significant difference between them. Conclusion The level of hCG, type of tubal pregnancy and surgery method are associated with PEP after salpingectomy for tubal pregnancy, so much attention should be paid on monitoring hCG after salpingectomy.