摘要
目的探讨腹腔镜下保守手术治疗输卵管妊娠术后发生持续性异位妊娠(persistent ectopic pregnancy,PEP)的影响因素.方法选择冀中能源峰峰集团有限公司总医院2007年10月至2017年10月收治的行腹腔镜下保守治疗的301例输卵管妊娠患者的临床资料,按术后是否发生PEP将患者分为PEP组(21例)和非PEP组(280例),对两组患者的年龄、停经时间、术前血清β-人绒毛膜促性腺激素(beta-human chorionic gonadotropin,β-hCG)水平、手术方式、术中黄体剥除术、术中是否应用甲氨蝶呤、包块直径等指标进行分析,并应用Logistic回归进行多因素分析.结果两组患者年龄比较差异无统计学意义.两组患者停经时间、术前血清β-hCG水平、手术方式、术中黄体剥除术、应用甲氨蝶呤、包块直径比较,差异均有统计学意义(P<0.05或P<0.01).多因素Logistic回归分析结果表明多因素Logistic回归结果表明,停经时间短、术前血清β-hCG浓度高、输卵管伞端妊娠囊挤出术、未行黄体剥除术、术中未应用甲氨蝶呤及包块直径小为输卵管妊娠患者发生持续性异位妊娠的危险因素[OR(95%CI)分别为1.476(1.035~3.961)、1.513(1.391~3.017)、5.301(1.304~19.570)、1.104(1.015~2.769)、1.180(1.020~2.543)、1.540(1.181~5.120),P均<0.05)].结论腹腔镜下保守手术治疗输卵管妊娠患者中停经时间短、包块直径小、术前血清β-hCG浓度较高、术中未行黄体剥除术及局部未应用甲氨蝶呤及采用输卵管伞端妊娠囊挤出术等因素容易发生PEP.因此,临床中采用腹腔镜下保守手术治疗时需选择恰当的手术时机、适宜的术式、术中行黄体剥除术及局部注射甲氨蝶呤是减少PEP发生的关键措施.
Objective To investigate the influencing factors of persistent ectopic pregnancy (PEP)after laparoscopic conservative surgery for tubal pregnancy. Methods Three hundred and one cases of tubal pregnancy treated by laparoscopic conservative surgery in Jizhong energy Fengfeng Group Hospital from October 2007 to October 2017 were divided into PEP group (21 cases)and non PEP group (280 cases)according to whether PEP occurred after operation.The age, menopause time and preoperative serum of the two groups were analyzed.The levels of beta-human chorionic gonadotropin (beta-hCG), surgical methods, corpus luteum exfoliation, methotrexate and mass diameter were analyzed.Logistic regression was used to analyze the multiple factors. Results There was no significant difference in age between the two groups.There were significant differences in the time of menopause, preoperative serum beta-hCG level, operative methods, corpus luteum exfoliation, methotrexate application and mass diameter between the two groups (P<0.05 or P<0.01). Multivariate logistic regression analysis showed that short menopause time, high preoperative serum beta-hCG concentration, sac extrusion at the umbrella end of fallopian tube, no corpus luteum exfoliation, no intraoperative methotrexate and small mass diameter were risk factors for persistent ectopic pregnancy (OR(95%CI)were 1.476 (1.035~3.961), 1.513 (1.391~3.017), 5.301 (1.304~19.570), 1.104 (1.015~2.769), 1.180 (1.020~2.543), 1.540 (1.181~5.120), respectively, all P<0.05). Conclusion PEP is prone to occur in patients with tubal pregnancy treated by laparoscopic conservative surgery, such as short menopause time, small size of mass, high preoperative serum beta-hCG concentration, no corpus luteum exfoliation, no local methotrexate and umbrella sac extrusion.Therefore, the key measures to reduce the occurrence of PEP in clinic are to choose the right operation time, appropriate operation method, corpus luteum exfoliation and local injection of methotrexate.
作者
张媛
解蓓蓓
李宏杰
Zhang Yuan;Xie Beibei;Li Hongjie(Department of Gynecology and Obstetrics, Jizhong energy Fengfeng Group Hospital, Handan 056200, China)
出处
《中国综合临床》
2019年第5期395-398,共4页
Clinical Medicine of China
基金
河北省医学科学研究重点课题计划项目(20181738).
关键词
持续性异位妊娠
输卵管妊娠
腹腔镜
保守手术
Β-人绒毛膜促性腺激素
黄体剥除术
甲氨蝶呤
Persistent ectopic pregnancy
Tubal pregnancy
Laparoscopy
Conservative surgery
Beta-human chorionic gonadotropin
Corpus luteum removal
Methotrexate
