输卵管妊娠不同方法治疗后再次妊娠的探讨

目的:探讨输卵管妊娠用不同方法治疗后再次妊娠的情况。方法:随访562例输卵管妊娠后患者,分析影响治疗选择的因素;用生存曲线方法及多因素COX回归分析其中100例有生育要求患者治疗后宫内自然妊娠率和再次异位妊娠率。结果:100例中行输卵管根治术44例,保守性手术28例,药物保守治疗28例。24个月累积重复异位妊娠发生率分别为6.9%,13.7%,0.04%,差异有统计学意义(P<0.005);累积自然宫内妊娠率分别为31.8%,34.4%,65.3%,用COX回归排除影响治疗选择因素,得出年龄≤30岁,无影响输卵管功能高危因素的患者,药物保守治疗后宫内妊娠率最高,保守性手术次之,根治性手术最低;年龄>30岁,存在影响输卵管功能的因素,3种方法治疗后宫内妊娠率差异无统计学意义。结论:为提高年轻输卵管妊娠患者治疗后的宫内妊娠率,应尽量行药物保守治疗。

Investigation of fertility after radical,conservative-surgical or medical treatment for tubal pregnancy

Objective:To investigate the factors influencing the choice of treatment for eetopic pregnancy and to compare the subsequent fertility rates of radical,conservative-surgical or medical treatments.Method:Five hundred and sixty-two patients were followed up and 100 of them attempted to conceive again.Cumulative fertility curves were calculated by the Kaplan- Meier estimator and compared by log rank test for univariate analysis and by Cox regression to take into aecount confounding variables.Results:Among 100 cases,44 cases were treated by u- nilateral salpingectomy,28 by salpingostomy,28 by medical conservative therapy.The two-year cumulative rate of recurrence was 6.9%,13.7% and 0.04% vs radical,conservative-surgical and medical treatments respectively,with significant difference between treatment.The cumula- tive intrauterine pregnancy rate was 31.8%,34.4% and 65.3% respectively.For women with age less than 30 years and had no previous infertility factors,the cumulative intrauterine preg- nancy was lower for radical treatment and higher for medical treatment than that for conservative surgical treatment.For women with age larger than 30 years and with previous infertility factors, there was no significant difference between treatments.Conclusion:For younger tubal pregnan- cy patients who attempted to conceive again,medical treatment should be given as possible as we can.