105例宫内外复合妊娠临床诊治分析

Clinical analysis of diagnosis and treatment of 105 heterotopic pregnancy

目的:探讨宫内外复合妊娠(HP)的临床特点和妊娠结局。方法:选择2006年10月至2021年6月在中山大学孙逸仙纪念医院妇产科接受治疗的105例HP患者,回顾分析患者的临床资料、治疗方法及妊娠结局。结果:105例HP患者中,102例(97.1%)经辅助生殖技术(ART)受孕,输卵管因素是ART最常见的原因(73.5%,75/102)。82例(78.1%)有阴道流血和(或)腹痛症状,23例(21.9%)无症状。103例(98.1%)经超声检查诊断。96例行手术治疗,其中腹腔镜手术69例,开腹手术27例。腹腔镜手术组术中出血量[20mL(10~50mL)vs 30mL(20~50mL),P=0.006]和住院时间[(6.2±2.9)d vs(11.8±7.0)d,P<0.001]均显著少于开腹手术组。腹腔镜手术和开腹手术宫内妊娠活产率分别为90.9%(60/66)和84.0%(21/25),两组比较差异无统计学意义(P>0.05)。1例宫颈妊娠行超声引导下宫颈妊娠物清除术,术后宫内妊娠活产。6例术前稽留流产,其余99例HP患者治疗后总的活产率为86.8%(86/99)。结论:对于接受辅助生殖的女性,应警惕HP发生。腹痛和阴道流血是HP最常见的临床症状,阴道超声检查有助于HP早期发现,HP治疗以手术治疗为主,腹腔镜相比开腹手术具有微创的优势和相似的妊娠结局。HP患者治疗后宫内妊娠的预后较好。

Objective:To investigate the clinical characteristics of heterotopic pregnancy(HP)and intrauterine pregnancy(IUP)outcomes after treatment.Methods:The clinical records of patients with HP treated in the Department of Obstetrics and Gynecology of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2012 to December 2020 were collected.The baseline data,treatment and pregnancy outcomes were retrospectively analyzed.Results:A total of 105 patients with HP were enrolled.Out of 105 cases,102(97.1%)were conceived through assisted reproduction technology(ART).A total of 73.5%(75/102)of these cases came for ART treatment due to tubal factors.82(78.1%)patients had symptoms of vaginal bleeding and/or abdominal pain,while the remaining 23(21.9%)were asymptomatic.HP was diagnosed by transvaginal ultrasonography in 103 cases(98.1%).96 patients initially underwent surgical treatment for ectopic pregnancy in whom 27 underwent open surgery and 69 underwent laparoscopic surgery.Compared with open surgery,laparoscopic approach demonstrated lesser blood loss[20(10~50)mL vs 30(20~50)mL,P=0.006],and fewer days of hospital stay[(6.2±2.9)d vs(11.8±7.0)d,P<0.001].The live birth rate of IUP in laparoscopy and laparotomy were similar[90.9%(60/66)vs 84.0%(21/25),P>0.05].One case with heterotopic cervical pregnancy underwent extraction with forceps and curettage under ultrasound-guided,with a live birth of IUP.Excluding 6 cases of preoperative miscarriage,the total live birth rate of HP after treatment was 86.8%(86/99).Conclusion:For women receiving assisted reproduction,we should be alert to the occurrence of HP.Abdominal pain and vaginal bleeding are the most two common symptoms.Transvaginal ultrasound is helpful for early detection of HP.Surgery is the main method for the treatment of HP,and laparoscopy has the advantage of minimal invasiveness over open surgery,while the comparable pregnancy outcomes.The prognosis of IUP in HP patients is generally good.