49例输卵管型复合妊娠患者的腹腔镜治疗分析

Analysis of laparoscopic treatment in 49 cases of tubal type heterotopic pregnancy

目的探讨采用腹腔镜治疗的输卵管型复合妊娠(HP)患者的临床特点,并分析影响妊娠结局的因素。方法选择2015年1月-2021年5月郑州大学第一附属医院收治的输卵管型HP患者,共纳入研究49例。回顾性分析输卵管型HP患者的临床特点,单因素分析采用t检验、χ^(2)检验或秩和检验,多因素分析采用Logistic回归分析法。结果临床特点:①妊娠方式:91.84%为胚胎移植技术(IVF-ET)后,8.16%为促排卵治疗后;②手术史:24.49%无盆腔手术史,63.27%有输卵管手术史,12.24%有其他盆腔手术史;③首发临床症状:20.41%无临床症状,26.53%仅表现为下腹痛,12.24%仅表现为阴道出血,40.82%表现为下腹痛并阴道出血;④宫内有无胎心胎芽:75.51%有胎心胎芽,24.49%无胎心胎芽。7例术后流产,腹腔镜治疗输卵管型HP患者的流产率为14.29%。单因素分析影响妊娠结局的因素:两组间孕龄、盆腔积血量和宫内有无胎心胎芽比较,差异有统计学意义(P<0.05),年龄、手术史、首发临床症状、手术方式、手术时间和术中出血量比较,差异无统计学意义(P>0.05)。多因素分析影响妊娠结局的因素:盆腔积血量≥200 mL是影响妊娠结局的独立危险因素(P=0.012)。结论输卵管型HP患者大部分有胚胎移植病史和输卵管手术史,其临床症状不典型,临床中应提高认知。超声检查十分重要,不要因有双侧输卵管切除史、结扎史和阻塞病史而放松警惕;盆腔积血量≥200 mL的HP患者更易流产,故手术指征明确时应尽早手术。

Objective To investigate the clinical characteristics of tubal heterotopic pregnancy under laparoscopic treatment and analyze the factors affecting pregnancy outcome.Methods From January 2015 to May 2021,clinical data of 49 patients with tubal heterotopic pregnancy were collected.Clinical characteristics of tubal heterotopic pregnancy were retrospectively analyzed.Univariate analysis was performed by T test,χ^(2) test or ranksum test.Multivariate analysis was performed by Logistic regression.Results Clinical features:①Pregnancy mode:91.84%after embryo transfer,8.16%after ovulation induction;②Surgical history:24.49%had no pelvic surgery history,63.27%had tubal surgery history,12.24%had other pelvic surgery history;③The first clinical symptoms:20.41%had no clinical symptoms,26.53%only showed lower abdominal pain,12.24%only showed vaginal bleeding and 40.82%showed lower abdominal pain with vaginal bleeding;④Whether there were fetal cardiac and fetal buds in utero:75.51%had fetal cardiac and fetal buds,24.49%did not.7 cases of postoperative abortion,laparoscopic treatment of tubal heterotopic pregnancy abortion rate was 14.29%.Univariate analysis:gestational age,pelvic blood volume and intrauterine heart and fetal embryo between the two groups were statistically significant differences(P<0.05).There were no significant differences in age,surgical history,first clinical symptoms,surgical method,surgical time and intraoperative blood loss(P>0.05).Multivariate analysis:pelvic blood volume≥200 mL was an independent risk factor for pregnancy outcome(P=0.012).Conclusion Most of the patients with tubal heterotopic pregnancy have a history of embryo transfer and tubal surgery and their clinical symptoms are not typical,so the clinical cognition should be improved.Ultrasound examination is very important,clinicians should not relax vigilance because of the history of bilateral salpingectomy,ligation and obstruction;When pelvic blood volume≥200 mL,the probability of abortion increases.When surgical indications are clear,patients should be operated as soon as possible.