不同次数输卵管妊娠史患者再次妊娠结局分析  

Analysis of the consecutive pregnancy outcomes in women with different times of tubal pregnancy history

作　　者：林晓龙 姜文清 邹世恩 Lin Xiaolong;Jiang Wenqing;Zou Shien(Gynecology Department,Obstetrics&Gynecology Hospital of Fudan University,Shanghai 200001,China)

机构地区：[1]复旦大学附属妇产科医院妇科,上海200001

出　　处：《中华生殖与避孕杂志》2024年第2期148-153,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨不同次数输卵管妊娠史患者再次妊娠结局差异。方法回顾性队列研究分析2019年1月至2023年4月期间复旦大学附属妇产科医院妇科收治的输卵管妊娠史次数≥1次的415例患者,根据输卵管妊娠史分为2组:A组为1次输卵管妊娠史(n=359),B组为2次输卵管妊娠史(n=56),收集每组患者基线信息和再次妊娠结局,比较保留输卵管和切除输卵管后异位妊娠率的差异。B组患者根据复发部位,分为同侧复发亚组和对侧复发亚组,比较两亚组患者再次妊娠时异位妊娠率的差异,并通过二元logistic回归分析与输卵管妊娠复发相关的影响因素。结果A组患者再次妊娠时宫内妊娠率[66.0%(237/359)]高于B组[48.2%(27/56),P=0.008]。A组采用甲氨蝶呤(methotexate,MTX)注射、输卵管切开取胚和输卵管挤压的患者宫内妊娠率[77.0%(97/126)、78.2%(93/119)、90.0%(9/10)]均高于采用输卵管切除的患者[35.7%(35/98),均P<0.001];B组采用期待、MTX注射、输卵管切开取胚和输卵管切除的宫内妊娠率差异均无统计学意义(均P>0.05)。B组同侧复发亚组24例,对侧复发亚组32例,两亚组再次宫内妊娠率、同侧异位妊娠率、对侧异位妊娠率差异均无统计学意义(均P>0.05)。第二次输卵管妊娠的发生与距前次妊娠时间和受孕方式有关,距前次妊娠时间≥36个月对输卵管妊娠复发有显著影响(OR=5.012,95%CI:2.525~9.949,P<0.001)。体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕患者宫内妊娠率[91.4%(53/58)]高于自然受孕患者[61.1%(184/301),P<0.001],其对降低第二次输卵管妊娠的发生有显著影响(OR=9.666,95%CI:3.303~28.287,P<0.001)。第三次输卵管妊娠的发生与受孕方式有关,IVF-ET助孕患者宫内妊娠率[76.5%(13/17)]高于自然受孕患者[35.9%(14/39),P<0.001],其对降低第三次输卵管妊娠发生有显著影响(OR=5.987,95%CI:1.529~23.447,P=0.010)。结论对于首次出现输卵管妊娠的患�Objective To analyze the consecutive pregnancy outcomes in women with different times of tubal pregnancy(TP)history.MethodsThe data of 415 patients with a history of TP≥1 times admitted in Gynecology Department of Obstetrics&Gynecology Hospital of Fudan University from January 2019 to April 2023 were retrospectively analyzed.They were divided into two groups:the first TP group(n=359)and the second TP group(n=56).Clinical data and consecutive pregnancy outcomes were collected and the differences of TP rate between patients treated by retaining fallopian tubes and those treated by salpingectomy were analyzed.Patients with a second TP were divided into two subgroups:ipsilateral recurrence subgroup and contralateral recurrence subgroup,and difference of TP rate between the two subgroups was assessed.Risk factors for recurrent TP were assayed by binary logistic analysis.ResultsIntrauterine pregnancy rate in the first TP group was higher than that in the second TP group[66.0%(237/359)vs.48.2%(27/56),P=0.008].Salpingectomy resulted in significantly lower rate of intrauterine pregnancy[35.7%(35/98)]compared with treatment with methotrexate or salpingotomy or extrusion of fallopian tubes in the first TP group,77.0%(97/126),78.2%(93/119),90.0%(9/10),respectively;all P<0.001].There was no difference of intrauterine pregnancy rate among patients treated by expectant management or methotrexate or salpingectomy or salpingotomy in the second TP group(all P>0.05).There were 24 cases in the ipsilateral recurrent subgroup and 32 cases in the contralateral recurrent subgroup.The rates of recurrent intrauterine pregnancy,ipsilateral ectopic pregnancy and contralateral ectopic pregnancy were not different between the two subgroups(all P>0.05).Logistic regression analysis suggested time interval from prior TP to next pregnancy≥36 months were positively correlated with occurrence of the second TP(OR=5.012,95%CI:2.525-9.949,P<0.001).Patients concept by in vitro fertilization and embryo transfer(IVF-ET)after the first TP had higher r

关 键 词：妊娠 输卵管 复发 受精 体外 胚胎移植 妊娠结局 第三次输卵管妊娠 

分 类 号：R714.221[医药卫生—妇产科学]