输卵管妊娠手术后持续性异位妊娠的临床分析

Clinical analysis of persistent ectopic pregnancy after tubal pregnancy operation

目的：探讨输卵管妊娠术后并发症——持续性异位妊娠（persistent ectopic pregnancy,PEP）的高危因素、监测及诊治方法。方法：对我院2011年1月至2013年12月412例输卵管妊娠腹腔镜手术后出现的持续性输卵管妊娠共19例患者的资料进行分析,在输卵管妊娠术前预测PEP的高危因素,术后血β-绒毛膜促性腺激素（β-human chorionic gonadotropin,β-HCG）监测,治疗以甲氨蝶呤（MTX）1mg/kg单次肌肉注射为主,必要时给予米非司酮50mg,1次/d,5d或行再次手术。结果：发生PEP患者中保留输卵管手术比根治性的输卵管切除术发生PEP者高,输卵管伞部妊娠行妊娠产物挤出术又较其他术式高（P〈0.05）;术前高血β-HCG值、妊娠包块周边血流半环-环状、输卵管手术史、盆腔炎史者均明显高于未发生PEP患者（P〈0.05）。结论：手术前、中、后对发生PEP风险的评估、早期诊断、及时治疗是PEP防治的关键。

Objectives： To discuss the risk factors,diagnosis and treatment of complication of tubal pregnancy- persistent ectopic pregnancy（ PEP）. Methods： The 19 patients having PEP of the 412 patients in our hospital form January 2011 to December 2013 after tubal pregnancy laparoscopic surgery were studied. Risk factors of PEP were predicted before tubal pregnancy surgery,andβ- human chorionic gonadotropin（ β- HCG） was monitored after surgery. The treatment was mainly by 1mg / kg MTX a single Intramuscular injection,50 mg mifepristone once per day or reoperation if necessary. Results： The possibilities of having PEP in the retained tubal surgery group were higher than in the radical resection of fallopian tube group,while tubal fimbria pregnancy pregnant products extrusion surgery was of higher possibility than other surgical procedures（ P〈0. 05）. Before operation,the PEP patients had higher possibility of high blood beta- HCG,half ring - ring blood flow around pregnancy package,tubal surgery history,and pelvic inflammatory history than those did not have PEP（ P〈0. 05）. Conclusion：Risk assessments,early diagnosis and prompt treatment are the key points of PEP prevention and treatment.