宫内妊娠合并输卵管间质部妊娠腹腔镜手术治疗的临床观察  

Laparoscopic surgical treatment and obstetric outcomes of women with interstitial heterotopic pregnancy in IVF-ET

作　　者：宋雪凌[1] 杨艳[1] 张佳佳[1] 李嘉[1] 王丽颖[1] 马彩虹[1] 

机构地区：[1]北京大学第三医院生殖医学中心

出　　处：《中国妇产科临床杂志》2018年第1期36-38,共3页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：首都卫生发展科研专项重点攻关项目(首发2014-1-4091);北京大学第三医院临床重点支持项目(Y67437-10)

摘　　要：目的评价宫内妊娠合并输卵管间质部妊娠（interstitial heterotopic pregnancy,IHP）腹腔镜手术治疗的效果及妊娠结局。方法回顾性分析了2011年1月至2015年12月期间,在北京大学第三医院生殖医学中心接受体外受精-胚胎移植（In Vitro Fertilization and Embryo Transfer IVF-ET）技术后发生IHP的患者中,经过腹腔镜下输卵管间质部妊娠病灶切开、绒毛组织清除、残腔内壁电凝和宫角缝合治疗的18名患者的临床资料及宫内妊娠结局。结果 18例患者中9例输卵管间质部妊娠病灶破裂,其中6例病变侧的输卵管已切除。平均手术时间（62.1±16.4）min,术中术后无并发症发生。2例分别于孕35周及孕36周早产,余16例均足月分娩。妊娠期间、分娩过程中及剖宫产术中均未发现持续性异位妊娠及子宫破裂。结论早期腹腔镜手术治疗宫内妊娠合并输卵管间质部妊娠是安全可行的。既往有患侧输卵管切除术史的患者更易发生病灶破裂。Objective To investigate the clinical efficacy of laparoscopic treatments for women with interstitial heterotopic pregnancy（IHP） after in vitro fertilization and embryo transfer（IVF-ET）,and the obstetric outcomes.Methods The women who had IHP after fresh or frozen-thawed embryo transfer were retrospectively studied,and they were all treated with laparoscopic surgery at the Center for Reproductive Medicine of Peking University Third Hospital from January,2011 to December,2015.The laparoscopic surgery was conducted by opening the interstitial pregnancy mass,removing the gestational tissue,electrodessicating the inner wall of interstitial cavity,and suturing the cornual.Patients＇ genenral conditions,peri-surgical data and pregnancy outcomes were reviewed.Results All the 18 women with the diagnosis of IHP were successfully treated by laparoscopic surgery.Ruptured interstitial pregnancy and internal bleeding were found in 9 cases,and 6 of them had the history of salpingectomy at the same side.The average operating time was（62.1±16.4）minutes,no peri-operative complications.All the 18 patients had live-birth deliveries.Two patients had preterm births at 35-and 36-gestation week separately,and the other 16 patients had full term deliveries.No signs of persistent ectopic pregnancy and uterine rupture were found.Conclusions The laparoscopic technique was feasible and safe for IHP with satisfactory obstetric outcomes.To the patients of interstitial pregnancy with salpingectomy history,more attention should be paid and earlier intervention should be taken to prevent the ectopic pregnancy rupture.

关 键 词：宫内妊娠合并输卵管间质部妊娠 腹腔镜手术 IVF-ET 

分 类 号：R713.8[医药卫生—妇产科学]