辅助生殖技术后输卵管间质部妊娠10例临床分析

Fallopian Interstitial Pregnancy after Assisted Reproductive Technology:10 Cases Report

目的:报道10例辅助生殖技术(ART)后输卵管间质部妊娠的临床案例。方法:回顾性分析南京医科大学第一附属医院生殖医学科2011年7月—2013年7月收治的10例体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)后输卵管间质部妊娠患者的临床资料。结果:10例输卵管间质部妊娠患者平均年龄(32.9±3.7)岁,均因输卵管因素行IVF/ICSI治疗,其中4例患者曾有异位妊娠史。所有患者既往均有输卵管相关手术史。9例患者胚胎移植数为2枚,1例为单胚胎移植后妊娠。在临床表现方面,6例患者因超声提示异位妊娠就诊,1例出现下腹痛,1例少量阴道出血,2例出现腹痛伴阴道出血。8例患者直接选择手术治疗,1例为药物(甲氨蝶呤)保守治疗,1例药物保守治疗失败后手术治疗。结论:IVF/ICSI后输卵管间质部妊娠发生率增高可能与患者既往输卵管功能异常行输卵管相关手术有关,特别是输卵管切除或者输卵管近端阻断的患者。因此有相关高危因素的患者在IVF/ICSI治疗过程中可适当控制胚胎移植数目,加强移植妊娠后早期超声监测和宣教,有利于减少输卵管间质部妊娠的不良结局。

Objective： This is ten cases report of the interstitial pregnancy after assisted reproductive technology （ART）. Methods：Ten cases of the interstitial pregnancy after IVF/ICSI-ET in our center, from July 2011 to July 2013, were retrospectively analyzed. Clinical features and related risk factors were summarized. Results：Ten patients aged （32.9±3.7）years, with the tubal-related operation history, accepted IVF/ICSI treatment due to their tubal factors. Four cases had a history of ectopic pregnancy. Nine patients had been transferred 2 embryos in their ART cycles,and only 1 case transfered a single embryo. As for clinical manifestations,6 cases were firstly suspected for ectopic pregnancy by B ultrasound, 1 case suffered from abdominal pain ,1 case had a small amount of vaginal bleeding,and the other 2 cases were complained of abdominal pain and vaginal bleeding. After diagnosed, eight patients underwent direct operation,one case successfully received MTX treatment while another one case underwent operation after her unsuccessful MTX treatment. Conclusions：The interstitial pregnancy after IVF/ICSI was possibly related to abnormal function of fallopian tube after the tubal-related operation,especially tube resection or the proximal tubal occlusion. The number of transferred embryos should be controlled in those IVF/ICSI patients with high-risk factors,while B ultrasound monitoring after transplantation and health education should be added so as to reduce the adverse outcome of the interstitial pregnancy after ART.