胚胎移植后宫内外复合妊娠手术治疗264例分析

Clinical Analysis of 264 Cases of Heterotopic Pregnancy after Embryo Transfer

目的:分析胚胎移植(ET)后宫内外复合妊娠(HP)手术治疗效果和妊娠结局。方法:选择2011年12月至2019年1月重庆市妇幼保健院收治的ET后发生HP并行手术治疗确诊的患者264例,回顾性分析其临床表现、手术治疗情况和妊娠结局。结果:本组患者包括202例(76.5%)输卵管妊娠(除外间质部),间质部妊娠和宫角部妊娠各29例,肌壁间妊娠及卵巢妊娠各2例。初次疑诊时间是移植后第16~62天,平均27.7±6.6天。162例患者诊断前有症状,以腹痛为最常见首发症状(29.9%)。接受手术时间是ET后第18~63天,平均30.4±7.5天。术中发现异位妊娠包块破裂31例,其中输卵管妊娠20例、间质部妊娠7例及宫角妊娠4例,盆腔积血10~1500 ml,其中11例患者予术后输血。233例异位妊娠包块未破裂者术中有157例有盆腔积血,量为5~800 ml,异位妊娠包块未破裂患者术中盆腔积血量明显少于破裂者(P<0.001)。14例患者为孕12周前发生早期流产,手术方式(开腹或腹腔镜)、异位妊娠是否破裂及异位妊娠部位均与早期流产无关(P>0.05)。术前宫内妊娠有胎心者流产率明显低于无胎心者(3.6%vs 13.6%,P<0.05)。结论:ET后患者应遵循严格的随访策略,尽早发现HP,降低患者风险。术前宫内妊娠有胎心可能与早期流产率降低有关。

Objective:To investigate the efficacy and pregnancy outcomes in patients with heterotopic pregnancy(HP)who had received embryo transfer(ET).Methods:A total of 264 patients with HP after ET were retrospectively analyzed between December 2011 and January 2019.Results:There were 202(76.5%)patients with heterotopic tubal pregnancy,29 with heterotopic interstitial pregnancy and cornual pregnancy,2 with heterotopic intramural pregnancy and 2 with heterotopic ovarian pregnancy.The initial consultation time is 16 to 62 days after transplantation(mean time:27.7±6.6 days).162 patients had symptoms before diagnosis by sonography.Lower abdominal pain was the most common symptom(29.9%).The interval time from ET to surgery was 30.4±7.5 days(18-63 days after ET).31 patients had ruptured ectopic pregnancy mass,including 20 cases of tube pregnancy,7 cases of interstitial pregnancy and 4 cases of cornual pregnancy.The pelvic hemorrhage was 10-1500 ml.Among them,11 patients received blood transfusion after operation.There were 157 cases of pelvic hemorrhage with a volume of 5-800 ml.which was significantly more than that of those without ruptured masses(P<0.001).14 patients had early abortion before 12 weeks of gestation,but surgical methods(laparotomy or laparoscopy),rupture of ectopic pregnancy and location of ectopic pregnancy were not related to early abortion(P>0.05).The abortion rate of preoperative intrauterine pregnancy with fetal heart rate was significantly lower than that of non-fetal heart rate(3.6%vs 13.6%,P<0.05).Conclusions:Women conceived via ET should been followed up closely to make early diagnosis of HP.Before surgery,taking the status of the intrauterine pregnancy into account may improve the outcomes of HP.