輸卵管妊娠手術后持續性異位妊娠的臨床分析

章彩萍+程蓓

【摘要】目的：探討輸卵管妊娠術后并發癥——持續性異位妊娠（persistent ectopic pregnancy， PEP）的高危因素、監測及診治方法。方法：對我院2011年1月至2013年12月412例輸卵管妊娠腹腔鏡手術后出現的持續性輸卵管妊娠共19例患者的資料進行分析，在輸卵管妊娠術前預測PEP的高危因素，術后血β-絨毛膜促性腺激素（β-human chorionic gonadotropin，β-HCG）監測，治療以甲氨蝶呤（MTX）1mg/kg單次肌肉注射為主，必要時給予米非司酮50mg，1次/d，5d或行再次手術。結果：發生PEP患者中保留輸卵管手術比根治性的輸卵管切除術發生PEP者高，輸卵管傘部妊娠行妊娠產物擠出術又較其他術式高（ P<0.05）；術前高血β-HCG 值、妊娠包塊周邊血流半環～環狀、輸卵管手術史、盆腔炎史者均明顯高于未發生PEP患者（ P<0.05）。結論：手術前、中、后對發生PEP風險的評估、早期診斷、及時治療是PEP防治的關鍵。

【關鍵詞】持續性異位妊娠；手術方式；風險評估；診治

Clinical analysis of persistent ectopic pregnancy after tubal pregnancy operationZHANG Caiping1， CHENG Bei2. 1. Department of Obstetrics and Gynecology，Jinhua Peoples Hospital， Jinhua 321000， Zhejiang， China； 2. The Obstetrics and Gynecology Hospital Affiliated to Zhejiang University School of Medicine， Hangzhou 310006， China

【Abstract】Objectives： To discuss the risk factors， diagnosis and treatment of complication of tubal pregnancy-persistent ectopic pregnancy （PEP）. Methods： The 19 patients having PEP of the 412 patients in our hospital form January 2011 to December 2013 after tubal pregnancy laparoscopic surgery were studied. Risk factors of PEP were predicted before tubal pregnancy surgery， andβ-human chorionic gonadotropin （β-HCG） was monitored after surgery. The treatment was mainly by 1mg/kg MTX a single Intramuscular injection， 50mg mifepristone once per day or reoperation if necessary. Results： The possibilities of having PEP in the retained tubal surgery group were higher than in the radical resection of fallopian tube group， while tubal fimbria pregnancy pregnant products extrusion surgery was of higher possibility than other surgical procedures （P<0. 05）. Before operation， the PEP patients had higher possibility of high blood beta-HCG， half ring ～ ring blood flow around pregnancy package， tubal surgery history， and pelvic inflammatory history than those did not have PEP （P<0.05）.Conclusion： Risk assessments， early diagnosis and prompt treatment are the key points of PEP prevention and treatment.

【Key words】Persistent ectopic pregnancy； Surgical methods； Risk assessment； Diagnosis and treatment

【中圖分類號】R714.22【文獻標志碼】A

異位妊娠是指受精卵在子宮體腔以外著床，是婦產科常見急腹癥之一，而輸卵管妊娠占異位妊娠的95%。當前臨床上治療輸卵管妊娠患者的手術方式主要有保守性手術及根治性手術，腹腔鏡因創傷小、恢復快已成為主要方式[1]，我院412例患者均為腹腔鏡手術[2]。由于未婚或未育年輕女性異位妊娠逐年增多，從而行保守性手術的比例明顯增多，故輸卵管妊娠術后并發癥——持續性異位妊娠（persistent ectopic pregnancy， PEP）發生率亦逐年增多，但根治性手術后在本次調查中也有發生[3]。PEP常表現術后血β-HCG水平下降緩慢或下降后再上升、下腹痛、盆腔包塊、盆腹腔出血， 嚴重時甚至危及生命。本文對本院診治的19例PEP患者的臨床資料進行詳細分析，探討PEP的高危因素、術后監測、診治及預防方法。現將結果總結如下。endprint

1資料與方法

1.1一般資料