腹腔镜输卵管妊娠保守性手术后发生持续性异位妊娠的多因素分析

Multivariate Analysis on Persistent Ectopic Pregnancy After Laparoscopic Conservative Surgery for Tubal Pregnancy

目的探讨腹腔镜输卵管妊娠保守性手术后发生持续性异位妊娠（persistent ectopic pregnancy,PEP）的相关危险因素。方法回顾性分析2002年1月-2015年2月我院237例因输卵管妊娠行腹腔镜保守性手术的临床资料,根据术后是否发生PEP分为PEP组和非PEP组。单因素分析包括年龄、停经时间、术前24 h内血β-hCG、包块直径、妊娠部位、腹腔积血、盆腔粘连、手术时间、术中出血量、手术方式、术中是否切除黄体和使用甲氨蝶呤（MTX）,并应用logistic回归进行多因素分析。结果术后发生PEP 14例（5.9%）。单因素分析显示术前24 h内血β-hCG、包块直径、手术方式、术中是否切除黄体和使用MTX差异有统计学意义（P〈0.05）。多因素分析显示术前24 h内血β-hCG（OR=6.026,P=0.002）,手术方式（OR=5.276,P=0.021）,术中未切除黄体（OR=0.094,P=0.028）和未使用MTX（OR=0.179,P=0.026）是发生PEP的独立危险因素。结论腹腔镜保守性手术治疗输卵管妊娠安全、有效,术前血β-hCG值较高、手术方式不恰当、术中未切除黄体及未使用MTX的患者术后易发生PEP。

Objective To analyze risk factors of persistent ectopic pregnancy（ PEP） after laparoscopic conservative surgery in patients with tubal pregnancy. Methods Clinical data of 237 patients with tubal pregnancy undergoing laparoscopic conservative surgery from January 2002 to February 2015 were studied retrospectively. All those patients were divided into either PEP group or nonPEP group. The single factor analysis included age,menopause time,preoperative serum β-hCG level,diameter of ectopic pregnancy mass,pregnancy location,volume of hemoperitoneum,pelvic adhesion,operation time,blood loss,surgical procedures,rate of luteectomy and methotrexate（ MTX） treatment. The logistic regression was used to conduct multiple factor analysis. Results A total of 14 cases（ 5. 9%） were included in the PEP group. The single factor analysis indicated preoperative serum β-hCG level,diameter of ectopic pregnancy mass,surgical procedure,rate of luteectomy and MTX treatment had significantly statistical differences between the two groups（ P〈0. 05）. The multivariate analysis showed preoperative serum β-hCG level（ OR = 6. 026,P = 0. 002）,surgical procedures（ OR = 5. 276,P = 0. 021）,without luteectomy（ OR = 0. 094,P = 0. 028） and without MTX treatment（ OR = 0. 179,P =0. 026） were independent statistically significant risk factors of PEP. Conclusion Laparoscopic conservative surgery for tubal pregnancy is safe and effective. There is significant relationship between PEP and preoperative serum β-hCG level, surgical procedures,corpus leteum removal and MTX treatment.