28例体外受精-胚胎移植术后异位妊娠的临床研究

Clinical research for 28 cases of ectopic pregnancy after in vitro fertilization and embryo transfer

目的分析与探讨体外受精-胚胎移植(IVF-ET)术后异位妊娠(EP)的特点及危险因素。方法回顾性分析298例EP患者的临床资料,包括EP发生部位(只统计手术中证实发生部位患者)、高危因素及治疗方式,并采用SPSS 19.0软件进行统计学分析。结果 IVF-ET术后EP组较自然受孕EP组宫角/间质部妊娠、合并宫内妊娠发生率高,输卵管壶腹部妊娠发生率较自然受孕组低,差异有统计学意义(P<0.01);输卵管盆腔炎史、输卵管手术史、人流及引产史、EP史在EP患者既往史中较常见,IVF-ET组EP患者输卵管手术史及既往EP史多于自然受孕组,差异有统计学意义(P<0.05);异位妊娠以腹腔镜手术治疗为主,IVF-ET组与自然受孕组EP在腹腔镜手术及经腹手术方面差异无统计学意义(P>0.05),但IVF-ET组腹腔镜手术概率稍高。结论 IVF-ET术后EP患者中特殊妊娠包括宫角/间质部妊娠及合并宫内妊娠较多见;输卵管盆腔炎史及输卵管手术史、流产引产史、异位妊娠史是EP的高危因素,IVF-ET术后EP术中发现输卵管结扎后改变及输卵管间质部残留较多见;腹腔镜手术是EP的主要治疗方式,如需切除患侧输卵管应尽量靠近宫角处凝切避免残留。

Objective To analyze and discuss the characteristics and hazards of ectopic pregnancy （Pregnancy Ectopic,EP） after vitro fertilization and embryo transfer （IVF-ET）. Methods The clinical data were analyzed of 298 cases of ectopic pregnancy patients,in-cluding the location, risk factors and treatment methods of EP. Statistical analysis was performed using SPSS 19. 0 software. Results In the EP after IVF-ET group,compared with natural pregnancy EP group,the incidences of cornual and heterotopic pregnancy were high-er, but the incidence of tubal ampulla pregnancy was lower; the difference was statistically significant （ P 〈 0. 01 ） ; the incidences of tube pelvic inflammation history, tubal surgery history, abortion and odinopoeia history and the history of EP were higher in patients with previous history of EP. EP patients of IVF-ET group with tubal operation history and EP history were more than the control group;the difference was statistically significant （P 〈0. 05） ; the main treatment of ectopic/the ministry of interstitial pregnancy was laparoscopic surgery,there was no significant difference between the IVF-ET group and the control group （P 〉0.05） ,but in the IVF-ET group there was a slightly higher rate of laparoscopic surgery. Conclusions After IVF-ET,the cornual pregnancy, the ministry of interstitial preg-nancy and heterotopic pregnancy were more common in EP. Tubal pelvic inflammation history,tubal operation history,abortion and odi-nopoeia history and ectopic pregnancy history were high risk factors of EP. After IVF-ET, the changes of tubal ligation and tubal intersti-tial residue were more common in EP patients. Laparoscopic surgery is the main treatment for ectopic pregnancy. If the resection is nec-essary of the unilateral oviduct,the excision should be as close to the cornua uteri as possible to avoid residua.