胚胎移植术后17例宫内外同时妊娠分析及文献复习

Analysis of 17 cases of heterotopic pregnancies after embryo transfer and literature review

目的探讨胚胎移植术后宫内外同时妊娠的发生率、影响因素、诊断和治疗,以加强临床医生对宫内外复合妊娠的认识。方法回顾性分析我中心2011年1月1日至2014年12月31日胚胎移植术后发生宫内外同时妊娠的17例病例的临床资料。结果我中心2011年1月至2014年12月31日试管婴儿助孕中宫内外同时妊娠发生率为0.26%(17/6 623),全部17例宫内外同时妊娠均由阴道超声确诊。其中腹腔镜手术切除妊娠侧输卵管14例,腹腔镜下妊娠侧宫角楔形切除1例,经阴道穿刺减胎手术1例,宫内胎儿均存活;保守治疗1例,宫内胚胎停育。结论经阴道超声早期诊断、动态监测是提高宫内外同时妊娠诊断率的可行方法,腹腔镜手术是治疗宫内外同时妊娠的有效方法。

Objective： To explore the incidence rate, risk factors, diagnosis, treatment and prognosis of the he/erotopic pregnancy （HP） after embryo transfer in order to enhance the clinicians＇ understanding HP. Methods. The data of 17 patients with HP after embryo transfer between 1st January 2011 and 31st December 2014 were retrospectively analyzed. Results： The incidence rate of HP in our center was 0.26% （17/6 623） from 1st January 2011 to 31st December 2014. All the patients were identified by transvaginal ultrasound. Among them, fourteen patients were performed salpingectomy under the laparoscope;one had cornual pregnancy ectomy; and one had transvaginal embryo reducing operation. Their embryos in uterus were all alive after the operation. One patient had conservative treatment because of arrested intrauterine pregnancy. Conclusions： Early diagnosis by transvaginal ultrasound combined with dynamic monitoring is a feasible method to improve the diagnosis of HP. Laparoscopic operation is an effective method to treat HP.