摘要
目的探讨腹腔镜手术治疗输卵管妊娠后持续性异位妊娠(PEP)的好发因素,以指导临床的预防和治疗。方法回顾性分析我院2004年1月～12月收治的114例行腹腔镜手术的输卵管妊娠患者的临床资料。将114例分为两组:A组为术后发生了持续性异位妊娠的病例,共12例;B组为术后未发生持续性异位妊娠的病例,共102例。对两组术前血β-HCG及术后β-HCG下降幅度,停经月份的大小,妊娠部位,手术方式,保守性手术是否术中使用甲氨喋呤(MTX)局部注射,盆腔包块的大小等因素进行综合性分析比较。结果两组相比,术前血β-HCG水平高,术后β-HCG下降少,易发生PEP;停经<40天、>60天较停经40～60天患者术后易发生PEP;输卵管峡部妊娠、伞端挤压术易发生PEP,两组差异均有非常显著性意义(P<0.01)。保守性手术中使用MTX局部注射发生PEP的可能性较小,反之则容易引起PEP;盆腔包块的大小与PEP的发生无相关性。结论异位妊娠腹腔镜手术治疗后持续性异位妊娠的发生与术后血β-HCG下降幅度、停经月份、妊娠部位、手术方式、保守性手术是否术中使用MTX局部注射有关。对拟行腹腔镜手术的异位妊娠患者,应仔细分析术前资料,选择合适的手术方式,术中仔细操作,这些将是避免PEP的关键所在。
Objective To investigate the etilogical factors of persistent ectopic pregnancy （PEP）. Methods The clinical date of 114 patients suffering from PEP after surgical removal of tubal pregnancy via taparoscopy in our hospital from January to December 2004 were analyzed retrospectively. The patients were divided into two groups, group A with PEP after surgical removal of tubal pregnancy via laparoscopy（n=12）, and group B with non-PEP after surgical removal of tubal pregnancy（n=102）. The pre- and postoperative β-HCG tier, the length of the gestation, the sites of ectopic pregnancy, patten of surgery, conservative surgery whether administer IM methotrexate（MTX）and the size of mass between the two groups were studied. Results The rule was that the higher of β-HCG titer before the surgery and lower fluctuations post the surgery ,the higher of the PEP rate. When the length of the gestation was less than 40 days or more than 60 days, the PEP rate was higher than that was 40 to 60 days. Pregnancy in the isthmus and expression of the pregnancy from the tube were amiable to the PEP（P〈 0.01）.The PEP rate was lower if we performed the conservative surgery with giving the local methotrexate therapy.There was no relation between the size of mass and PEP. Conclusion For the patients who would be performed laparoscopy, The etiological factors are the pre-operative and postoperative βHCG tier, the length of the gestation, the sites of ectopic pregnancy, manners of surgery and conservative surgery whether administer IM methotrexate（MTX）.We should carefully analyze the state of an illness and select appropriate surgery mode, which is the key to avoid the PEP.
出处
《罕少疾病杂志》
2006年第1期13-15,21,共4页
Journal of Rare and Uncommon Diseases
关键词
持续性异位妊娠
保守性手术
根治性手术
甲氨喋呤
persistent ectopic pregnancy（PEP）
conservative surgery
radical surgery
methotrexate （MTX）
