输卵管妊娠治疗方式及再次妊娠结局比较  

Management strategies of ectopic pregnancy and reproductive outcomes：a report of 648 cases

作　　者：孙晋萍[1] 樊庆泊[2] 何玉文[3] 翟建军[1] 

机构地区：[1]首都医科大学附属北京同仁医院妇产科,100176 [2]中国医学科学院 北京协和医学院 北京协和医院妇产科 [3]河北省唐山市人民医院外科

出　　处：《中华全科医师杂志》2014年第6期457-459,共3页Chinese Journal of General Practitioners

摘　　要：目的：探讨输卵管妊娠治疗后生育结局。方法回顾分析我院2011年6月至2013年9月间648例输卵管妊娠患者的病例，并对符合条件的病例进行电话随访，以了解治疗后的生育结局情况。结果648例输卵管妊娠的患者中，手术治疗的共433例（66.8％），药物治疗共169例（26.1％），期待疗法为46例（7.1％）。随访到的415例患者中，192例（46.3％）有生育要求或未采取严格的避孕措施。192例患者分为3组，药物治疗组44例，期待治疗组11例和手术治疗组137例。160例（82.5％）自然受孕，其中130例（81.3％）为宫内妊娠，30例（18.7％）为再次异位妊娠。平均随诊时间为（20±6）个月，随访应答率87.1％，治疗后宫内妊娠率：手术组89例（65％），药物组35例（79.6％），期待治疗组6例（6/11）两组间差异有统计学意义（P＜0.05），药物治疗组宫内妊娠率高于手术治疗组，两组差异有统计学意义（ P ＜0.05）。三组的继发不孕率分别为4.5％，36.4％，19.0％，药物治疗组低于手术组及期待治疗组，差异有统计学意义（ P＜0.05）。开腹手术43例，腹腔镜手术94例，治疗后再次异位妊娠开腹手术13例（30.2％），腹腔镜11例（11.7％），差异有统计学意义（P＜0.05），开腹手术的再次异位妊娠率比腹腔镜高。结论为保留年轻输卵管妊娠患者生育功能，尽量药物保守治疗，若需手术，腹腔镜首选。Objective To explore the reproductive outcomes of different management strategies of ectopic pregnancy .Methods A retrospective cohort study was performed for 648 consecutive patients with a diagnosis of ectopic pregnaney between June 2011 and september 2013.The follow-ups were conducted telephone interviews of pregnancy outcomes after various treatments .Results The subsequent intrauterine pregnancy rates after surgical , medical and expectant managements were 89（65.0%）, 35（79.6%） and 6 （54.5%） the intrauterine pregnancy was higher for medical treatment than that for surgical treatment （P〈0.05）.The subsequent infertility rate after surgical , medical and expectant management were 4.5%, 36.4%, 19.0%.The subsequent infertility rate after medical treatment was lower than that for surgical and expectant managament （ P〈0.05） .The re-ectopic pregnancy rates of laproscopic versus abdominal operation were [11 （11.7%）, 13（30.2%）] with significant difference （P〈0.05）.And abdominal operation was higher than laproscopic operation .Conclusion For younger ectopic pregnancy patients , medical treatment shold be as possible as we can .If operation is necessary , laproscopic operation is preferred .

关 键 词：妊娠 输卵管 妊娠结局 生育力 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.221[医药卫生—诊断学]