不同治疗方式对复合妊娠患者及其宫内妊娠的影响

Effects of different therapeutics on heterotopic pregnancy patients and outcomes of their intrauterine pregnancy

目的探讨不同宫外妊娠的治疗方式,对宫内宫外复合妊娠(HP)患者及其宫内妊娠的影响。方法选择2013年1月1日至2016年8月31日,于广东省妇幼保健院接受治疗的33例需在处理宫外妊娠时,仍然保留宫内妊娠的宫内宫外HP患者为研究对象。根据对宫外妊娠的治疗方式,分别将其纳入期待观察组(n=4,采取期待观察治疗),开腹手术组(n=7,采用开腹手术治疗)及腹腔镜手术组(n=22,采用腹腔镜手术治疗)。回顾性分析3组患者的临床病例资料。采用Mann-Whitney U检验、成组t检验及Fisher确切概率法,对开腹手术组及腹腔镜手术组HP患者术中及术后情况,以及3组HP患者的宫内妊娠结局(活产儿分娩率),进行统计学比较。本研究遵循的程序,符合2013年修订的《世界医学协会赫尔辛基宣言》。结果①开腹手术组及腹腔镜手术组HP患者的术中所见及术后组织病理学检查结果显示,2例宫外妊娠为宫角妊娠,其余27例为输卵管妊娠。②腹腔镜手术组HP患者的手术时间为46.0 min(40.0~62.5 min),显著短于开腹手术组患者的80.0 min(60.0~105.0 min),并且差异有统计学意义(Z=-2.706、P=0.007)。这2组HP患者的术中出血量,盆、腹腔积血量,术后胃肠功能恢复时间,以及术后腹痛及阴道流血发生率比较,差异均无统计学意义(P>0.05)。③3组HP患者的活产儿分娩率比较,差异无统计学意义(P=0.697)。结论腹腔镜手术对于宫内宫外HP患者宫外妊娠的诊断,以及进行宫外妊娠治疗,同时保留宫内妊娠具有一定优势。该术式是否能改善HP患者的妊娠结局,则尚需扩大样本量进一步研究。

Objective To explore the effects of different treatment methods of extrauterine pregnancy on patients with heterotopic pregnancy(HP)and outcomes of their intrauterine pregnancy.Methods We collected clinical data of 33 patients with HP who needed to keep intrauterine pregnancy during therapy of extrauterine pregnancy in Guangdong Maternal and Child Health Hospital from 1 January,2013 to 31 August,2016.According to extrauterine pregnancy treatment methods,they were divided into expectation observation group(n=4,treated by expectation observation),laparotomy group(n=7,treated by laparotomy)and laparoscopy operation group(n=22,treated by laparoscopy operation).Retrospective analysis was performed on clinical data of 3 groups.The intraoperative and postoperative conditions between laparotomy group and laparoscopy operation group,and outcomes of their intrauterine pregnancy(live birth rate)among HP patients in 3 groups were statistically compared by Mann-Whitney U test,independent-samples t test and Fisher′s exact test.The study was in line with World Medical Association Declaration of Helsinki revised in 2013.Results①During intraoperative and postoperative histopathological examination confirmed that 2 of 29 HP cases in laparotomy group and laparoscopy operation group were cornual pregnancy,others were tubal pregnancy.②Duration of operation of laparoscopy operation group was 46.0 min(40.0-62.5 min),which was signigicantly shorter than that of 80.0 min(60.0-105.0 min)in laparotomy group,and the difference was statistically significant(Z=-2.706,P=0.007).There were no significant differences between two groups mentioned above in intraoperative volumes of bleeding,pelvic hematocele and hematocelia,postoperative gastrointestinal function recover time,incidence rates of postoperative abdomen pain and colporrhagia(P>0.05).③There was no significant difference of live birth rate of HP patients among 3 groups(P=0.697).Conclusions There is a certain advantage for diagnosis and treatment of HP patients who need to keep intrauterine pregnancy during therapy of extrauterine pregnancy by laparoscopic surgery.It still need to expand sample size for further study of outcomes of intrauterine pregnancy during extrauterine pregnancy treatment by laparoscopic surgery.