体外受精-胚胎移植后宫内外同时妊娠14例分析  

Clinical analysis of heterotopic pregnancy after in vitro fertilization and embryo transfer in 14 cases

作　　者：林云俊[1] 李超[2] 林小娜[2] 

机构地区：[1]杭州市红十字会医院妇产科,浙江杭州310003 [2]浙江大学医学院附属邵逸夫医院妇产科生殖中心

出　　处：《全科医学临床与教育》2011年第5期530-533,共4页Clinical Education of General Practice

摘　　要：目的分析体外受精-胚胎移植(IVF-ET)术后,宫内宫外同时妊娠的好发因素、诊治及预后。方法回顾性分析接受IVF-ET治疗后的14例宫内宫外同时妊娠病例。结果 14例病例中8例有明显的盆腔炎性疾病史、1例盆腔炎性疾病史伴有双角子宫、3例盆腔炎并伴有男方畸精症、1例为男方无精症、1例为稀发排卵及男方少弱精症。14患者均B超提示宫内外同时妊娠,其中10例腹腔镜下患侧输卵管切除术、1例开腹行输卵管切除术、2例宫角妊娠分别行腹腔镜下及开腹宫角切开取胚+修补术、1例剖腹行患侧输卵管切除。术后9例宫内继续妊娠,5例宫内妊娠自然流产。结论盆腔炎性疾病是IVF-ET后宫外同时妊娠发生的主要原因;超声检查是最有效的诊断方法,及早治疗可明显改善预后;腹腔镜下输卵管切除术可能是治疗宫外同时妊娠的最佳方法。Objective To analyze the prevalence rate,diagnosis,treatment,prognosis of heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET）.Methods The clinical data of 14 patients diagnosed HP after IVF-ET were reviewed.Results Eight cases had history of tubal or chronic pelvic inflammation.One case had chronic pelvic inflammation and bicornuate uterus.Three cases had chronic pelvic inflammation and oligozoo-spermia.One case had azoospermia.One case had oligo-ovulation and oligozoo-spermia.All of them were diagnosed by sonography before surgery.Ten patients had salpingectomy by laparoscopy and one by laparotomy.Two patients of corneal pregnancy had laparoscopy and laparotomy respectively.one had salpingectomy in other hospital.After surgery,9 cases had ongoing intrauterinc pregnancy,5 cases were inevitable abortion.Conclusions Previous tubal or pelvic inflammation disease are the most common risk factors for HP.The sonographic examination is reliable in the diagnosis of HP.Early treatment can improve the prognosis obviously.Laparoscopic salpingectomy is still considered to be the best method for the treatment of HP.

关 键 词：体外受精-胚胎移植 宫内宫外同时妊娠 腹腔镜手术 

分 类 号：R714.8[医药卫生—妇产科学]