论文部分内容阅读
目的探讨输卵管妊娠保守性手术后持续性异位妊娠(persistent ectop ic pregnancy,PEP)的发生原因及预防和治疗措施。方法回顾性分析永煤集团总医院2005年1月—2011年12月输卵管妊娠保守性手术患者756例的临床资料。结果 PEP的发生与妊娠物直径有关,异位包块直径<2cm保守性手术后的患者发生PEP几率高。盆腔粘连组PEP发生率高于盆腔正常组;手术者的技能、方法与PEP有关,腹腔镜组PEP的发生率与经腹组PEP的发生率比较差异无显著性,输卵管伞部挤压术比输卵管开窗取胚术PEP发生率高;术前血β-人绒毛膜促性腺激素(β-human chorion ic gonado tropin,β-HCG)水平越高,PEP发生率越高;术前孕酮(Proges-terone)水平越高,PEP发生率越高;术中是否预防性应用氨甲喋呤(MTX)与PEP有关,应用MTX组PEP发生率显著低于未应用组。结论保守性手术治疗输卵管妊娠是安全有效的,要严格掌握手术适应症,提高手术技巧;输卵管妊娠物直径、部位及盆腔粘连情况、术前血β-HCG水平及孕酮水平等因素均与PEP的发生密切相关;术前和术后严密监测血β-HCG变化,术中预防性使用MTX,可降低术后PEP的发生率。
Objective To investigate the causes of persistent ectopic pregnancy (PEP) after conservative surgery of tubal pregnancy and the preventive and therapeutic measures. Methods The clinical data of 756 patients with conservative tubal pregnancy surgery from January 2005 to December 2011 in Yongmei Group General Hospital were retrospectively analyzed. Results The incidence of PEP was related to the diameter of the pregnancy. The ectopic mass <2 cm had a high incidence of PEP after conservative surgery. The incidence of PEP in pelvic adhesion group was higher than that in normal pelvic group. The skills and methods of operation were related to PEP. There was no significant difference in the incidence of PEP between laparoscopic group and transabdominal group, The incidence of preeclamptic PEP was high in tubal fenestration. The higher the level of β-human chorionic gonadotropin (β-HCG) was, the higher the incidence of PEP was. Preoperative progesterone Progesterone increased the incidence of PEP, whether intraoperative prophylactic methotrexate (MTX) and PEP related to the application of MTX group PEP incidence was significantly lower than the non-application group. Conclusions Conservative surgical treatment of tubal pregnancy is safe and effective. It is necessary to strictly understand the indications for surgery and improve surgical skills. The factors such as the diameter of tubal pregnancy, the site of pelvic adhesions, preoperative blood β-HCG level and progesterone level are all consistent with PEP Closely related to preoperative and postoperative close monitoring of blood β-HCG changes, intraoperative prophylactic use of MTX can reduce the incidence of postoperative PEP.