全凭静脉麻醉下腹腔镜手术对宫内外同时妊娠结局的影响

Effect of laparoscopic surgery under total intravenous anesthesia on postoperative pregnancy outcomes of heterotopic pregnancies

目的探讨全凭静脉麻醉下腹腔镜手术对体外受精-胚胎移植（IVF-ET）后宫内外同时妊娠者妊娠结局的影响。方法回顾性分析北京大学第三医院生殖医学中心2010年1月至2014年7月收治的宫内外同时妊娠并于全凭静脉麻醉下行腹腔镜手术的患者48例为手术组。随机选取同期IVF—ET后正常妊娠者60例为对照组。比较两组孕妇自然流产率、孕期合并症发生率、早产率、活产率、分娩周数、剖宫产率差异，同时比较新生儿体重、男婴率、Apgar评分等指标的差异。结果手术组自然流产率、妊娠合并症发生率、早产率、剖宫产率、男婴比例分别为14．6％、16．7％、4．2％、82．9％、51．2％，对照组分别为15．0％、18．3％、6．7％、84．3％、52．9％，差异均无统计学意义（χ2=-0．072、-0．241、-0．569、-0．442、-0．163，均P〉0．05）。手术组分娩周数、新生儿体重分别为（38．3±1．7）周、（3394．9±460．7）g，对照组分别为（37．9±1．5）周、（3406．3±512．6）g，差异均无统计学意义（t=1．083、-0．111，均P〉0．05）。手术组新生儿1minApgar评分、5minApgar评分分别为9．6（9．0～10．0）、10（10～10）分，对照组新生儿1minApgar评分、5minApgar评分分别9．5（9．0～10．0）、10（10-10）分，差异均无统计学意义（Z=-0．418、0．000，均P〉0．05）。手术组和对照组活产率均为100％，出生缺陷率均为0。结论全凭静脉麻醉下腹腔镜手术对宫内外同时妊娠结局未见明确的影响。

Objective To evaluate the effects of laparoscopic surgery under total intravenous anesthesia （TIVA） on outcomes of heterotopic pregnancies which need to receive laparoscopie procedures. Methods The data of 108 cases of pregnant women in Center of Reproductive Medicine, Peking University Third Hospital were retrospectively analyzed, and divided into two groups according to whether received surgery. Surgery group ： 48 pregnant women after in vitro fertilization-embryo transfer （IVF-ET） were diagnosed as heterotopic pregnancies and received laparoscopic procedures under TIVA. Control group： 60 normal pregnant women after IVF-ET. The miscarriage rate, pregnant complications rate, premature birth rate, live birth rate, delivery weeks and cesarean section rate of two groups were compared. Meanwhile, the newborn＇s weight, male rate, birth defect rate and Apgar score in 1 min and 5 min of the two groups were compared. Results The miscarriage rate, pregnant complications rate, premature birth rate, cesarean section rate, male rate of surgery group were 14.6% , 16.7% ,4.2% ,82. 9% ,51.2% respectively,which were 15.0% , 18. 3% , 6. 7%, 84. 3%, 52. 9% in control group respectively. There were no significant difference between the two groups （ χ2 = - 0. 072, - 0. 241, - 0. 569, - 0. 442, - 0. 163, P 〉 0. 05 ）. The delivery weeks and newborn＇s weight of surgery group were （ 38.3 ± 1.7 ） weeks and （ 3 394. 9 ± 460. 7 ） g respectively ,which were （37.9 ±1.5 ） weeks and （ 3 406. 3 ±512. 6 ） g in control group. There were no significant difference between the two groups （ t = 1. 083, - 0. 111, P 〉 0. 05 ）. The 1 min Apgar score and 5 min Apgar score of surgery group were 9. 6 （ 9. 0 - 10. 0）, 10 （ 10 - 10 ） scores and were 9. 5 （ 9.0 - 10. 0 ）, 10（10- 10） scores in control group. There were no significant difference between the two groups （Z =-0. 418,0. 000, P〉0.05）. The live birth rate of two groups were both 100%, and the birth defect rate were both 0. Conclusion Laparoscopic surgery under TIVA has no effect on the outcome of heterotopic pregnancies.