Clinical Observation of Assisted Reproduction Intrauterine and Extrauterine Combined Pregnancy Operation in 32 Cases
-
摘要:
目的 观察行辅助生殖助孕后诊断宫内宫外复合妊娠并采取手术治疗的患者，其宫内妊娠的足月活产率，以及分析在手术治疗过程中影响宫内妊娠足月活产率的相关因素。 方法 回顾性分析行辅助生殖助孕后诊断宫内宫外复合妊娠并经手术治疗宫外妊娠的患者，收集患者的基本资料及手术资料，并随访所有患者宫内孕的妊娠结局。 结果 （1）本实验共收集到32例患者，其中术后宫内妊娠足月活产有28例，活产率为：87.5%。宫内妊娠的足月活产率与手术时间、术中盆腔积血量呈明显负相关，其中与手术时间的相关系数r = -0.510，P = 0.003（P < 0.005）；与术中盆腔积血量的相关系数r = -0.494，P = 0.005（P < 0.05）；（2）比较32例患者中针对宫外妊娠包块行手术治疗的手术方式及麻醉方式对宫内妊娠足月活产率差异无统计学差异（P > 0.05）。 结论 对于辅助生殖后宫内宫外复合妊娠需手术处理宫外妊娠的患者，减少手术时间及对有手术指征的患者及时手术能提高术后宫内妊娠的足月活产率。 Abstract:Objective To observe the full term live birth rate of intrauterine pregnancy in patients diagnosed with intrauterine and extrauterine combined pregnancy and treated with surgery after the assisted reproduction, and to analyze the related factors affecting the full term live birth rate of intrauterine pregnancy in the course of treatment. Methods A total of 32 patients diagnosed with intrauterine and extrauterine combined pregnancy after the assisted reproduction and treated with surgery for extrauterine pregnancy were collected and, their case data and surgical data were retrospectively analyzedand the pregnancy outcomes of all patients with intrauterine pregnancy were followed up. Results （1） Among the patients, 28 of them had the full term live birth of postoperative intrauterine pregnancy, and the live birth rate was 87.5%. The full term live birth rate of intrauterine pregnancy was negatively correlated with operation time and intraoperative pelvic blood volume, and the correlation coefficient with operation time was r = -0.510, P = 0.003 （P < 0.005）. Correlation coefficient r = -0.494, P = 0.005 （P < 0.05）. （2） There was no statistical difference in the full term live birth rate of intrauterine pregnancy between 32 patients with ectopic pregnancy mass treated by surgical method and anesthesia method （P > 0.05）. Conclusion For the patients with intrauterine and extrauterine combined pregnancy in the assisted reproduction requiring surgical treatment of extrauterine pregnancy, reducing the operation time and early operation for patients with surgical indications can improve the postoperative intrauterine pregnancy to full term live birth rate. -
表 1 32例患者基线资料
Table 1. Basic situation of patients
基本资料 n/（$\bar x \pm s $ ） 年龄（岁） 30.2 ± 3.9 停经时间（d） 52.1 ± 7.1 血HCG（mIUm/L） 45235.6 ± 18311.1 血孕酮（pg/mL） 21.8 ± 5.6 手术时间（min） 58.4 ± 13.1 术中盆腔积血量（mL） 159.6 ± 107.5 腹腔镜手术（n） 20 开腹手术（n） 12 全身麻醉（n） 15 腰硬联合麻醉（n） 17 宫内妊娠活产（n） 28 宫内妊娠流产（n） 4 
下载: 导出CSV
表 2 患者宫内活产率的相关性分析
Table 2. Correlation analysis results of patients’ intrauterine live birth rate
宫内活产率 相关系数r P 年龄 0.169 0.354 停经天数 −0.247 0.173 血清HCG值 0.235 0.195 血清孕酮值 0.051 0.780 腹腔镜手术 0.061 开腹手术 −0.061 0.742 0.742 手术时间 −0.510 0.003 全身麻醉 −0.098 0.595 腰硬联合麻醉 0.213 0.242 盆腔积血量 −0.494 0.005
下载: 导出CSV
表 3 手术方式与麻醉方式对宫内妊娠足月活产率的差别
Table 3. The difference between surgical methods and anesthesia methods on the live birth rate of intrauterine pregnancy
组别 宫内活产率（%） χ2 P 腹腔镜手术 85.00 0.305 1.000 开腹手术 91.67 全身麻醉 90.00 0.305 0.620 腰硬联合麻醉 83.33
下载: 导出CSV
-
[1] Mj G, R R. Heterotopic pregnancy in natural conception[J]. Hum Reprod Sci, 2008, 1（1）: 37-38. [2] Talbot K,Simpson R,Price N,et al. Heterotopic pregnancy[J]. J Obstet Gynaecol,2011,31(1):7-12. doi: 10.3109/01443615.2010.522749 [3] Wu Z,Zhang X,Xu P,et al. Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or em- bryo transfer[J]. Eur J Med Res,2018,23(1):17. doi: 10.1186/s40001-018-0316-y [4] 陈璐,温弘,徐冬,等. 复合妊娠的治疗和围产结局分析[J]. 中华妇产科杂志,2018,53(11):768. doi: 10.3760/cma.j.issn.0529-567x.2018.11.007 [5] Yeh,J,Aziz N,Chueh J,et al. Nonsurgical management of heterotopic abdominal pregnancy[J]. Obstet Gynecol,2013,121(2):489-495. [6] Yu Y,Xu W,Xie Z,et al. Management and outcome of 25 heterotopic pregnancies in Zhejiang,China[J]. Eur J Ob- stet Gynecol Reprod Biol,2014,180(1):157-161. [7] 中国优生科学协会肿瘤生殖学分会. 输卵管妊娠诊治的中国专家共识[J]. 中国实用妇科与产科杂志,2019,35(7):780-787. [8] Jeon J H,Hwang Y I,Shin I H,et al. The risk factors and pregnancy outcomes of 48 cases of heterotopic pregnancy from a single center[J]. J Korean Med Sci,2016,31(7):1094-1099. doi: 10.3346/jkms.2016.31.7.1094 [9] 黄欢,马辉莺,叶青燕. 初产妇胎儿宫内发育迟缓相关因素分析[J]. 河北医药,2021,43(1):112-118. doi: 10.3969/j.issn.1002-7386.2021.01.026 [10] 刘丽娜,张丽颖. 胚胎停育高危因素和并发症的探索[J]. 疑难病杂志,2015,14(2):214-217. doi: 10.3969/j.issn.1671-6450.2015.02.033 [11] Brunette D D,Roline C. Heterotopic pregnancy resulting from in vitro fertilization[J]. Am J Emerg Med,2011,29(8):960-961. [12] 蔡兴苑,卢丹. 复合妊娠的治疗进展[J]. 中国临床医师杂志(电子版),2013,7(17):110-111. [13] 吕斌,郑艾. 腹腔镜诊断治疗宫内宫外复合妊娠6例临床分析[J]. 四川大学学报医学版,2014,45(3):539-541. [14] ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 474:nonobstetric surgery during pregnancy[J]. Obstet Gynecol,2011,117(21):420-421. [15] 褚春芳,卢丹,张宇迪. 宫内宫外复合妊娠腹腔镜手术治疗的可行性及对妊娠结局的影响[J]. 中国医刊,2017,52(11):51-55. doi: 10.3969/j.issn.1008-1070.2017.11.015 [16] 韩素云,袁鹏,丁辉,等. 腰硬联合麻醉下腹腔镜手术保守治疗宫内宫外复合妊娠[J]. 实用医学杂志,2012,28(20):3453-3454. doi: 10.3969/j.issn.1006-5725.2012.20.054 -
