腹腔镜治疗宫内合并输卵管间质部妊娠21例效果分析
摘要
目的:探讨宫内合并输卵管间质部妊娠的腹腔镜治疗及妊娠结局。方法:回顾性分析我院腹腔镜治疗IVF-ET后宫内合并输卵管间质部妊娠21例,比较采用宫角切开取胚术(16例)与宫角切除术(5例)的治疗及妊娠结局。结果:21例患者总的手术时间为58.5±6.3分钟,术中出血量52.9±5.8 ml,术后住院时间4.7±0.4天。两组患者在异位妊娠包块破裂率、手术时间、术中出血量、术后住院时间及足月产率差异均无统计学意义(P>0.05)。接受宫角切除术患者的异位妊娠包块平均直径大于接受宫角切开取胚术患者(2.5 cm vs 3.6 cm)。17例患者术后顺利分娩,除1例顺产外均行剖宫产,其中足月产11例,无一例患者发生子宫破裂。结论:腹腔镜治疗宫内合并输卵管间质部妊娠安全且妊娠结局良好。宫角切除术是目前主要的手术方式,但需注意子宫破裂;输卵管间质部妊娠包块较小时可选择行宫角切开取胚术。
引文
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[3] 李百加,林小娜,匡琳,等.输卵管病变的预处理方式对胚胎移植后妊娠结局的影响[J].中华医学杂志,2014,4(37):2941-2944.
[4] Kim MJ,Jung YW,Cha JH,et al.Successful management of heterotopic cornual pregnancy with laparoscopic cornual resection[J].Eur J Obstet Gynecol Reprod Biol,2016,203:199-203.
[5] Guan Y,Ma C.Clinical outcomes of patients with heterotopic pregnancy after surgical treatment[J].J Minim Invasive Gynecol,2017,24(7):1111-1115.
[6] Lyu J,Ye H,Wang W,et al.Diagnosis and management of heterotopyic pregnancy following embryo transfer:clinical analysis of 55 cases from a single institution[J].Arch Gynecol Obstet,2017,296(1):85-92.
[7] Pearl JP,Price RR,Tonkin AE,et al.SAGES guidelines for the use of laparoscopy during pregnancy[J].Surg Endosc,2017,31(10):3767-3782.
[8] Kwon YS,Lee SH,Im KS,et al.Laparoscopic management of heterotopic interstitial pregnancy with subsequent term delivery[J].Int J Fertil Steril,2015,9(2):265-267.
[9] 潘琼,薛敏,曙光.经腹腔镜治疗胚胎移植术后子宫内输卵管间质部同时妊娠患者5例[J].中南大学学报(医学版),2016,41(11):1237-1240.
[10] Jiang Y,Chen J,Zhou H,et al.Management and obstetric outcomes of 17 heterotopic interstitial pregnancies[J].BMC Pregnancy Childbirth,2018,18(1):78.
[11] 万虹,孙玲玲.妊娠13+4周子宫破裂1例[J].实用妇产科杂志,2010,26(7):537.
[12] 覃梅,唐娟.体外受精一胚胎移植术后宫内妊娠合并输卵管间质部、宫角妊娠9例分析[J].广西医学,2016,38(2):285-290.
[13] Siow A,Ng S.Laparoscopic management of 4 cases of recurrent cornual ectopic pregnancy and review of literature[J].J Minim Invasive Gynecol,2011,18(3):296-302.