异位妊娠512例临床分析

目的探讨异位妊娠（EP）的早期诊断及保守性治疗。方法回顾性分析2003年1月至2008年12月间收治的512例EP患者的临床资料，比较其中200例有生育要求患者，输卵管妊娠不同方法治疗后再次受孕情况。结果从2003年到2008年，本地区异位妊娠的发生率增加1倍。血B—HCG阳性率为100％；宫内无妊娠囊者93．9％，期待疗法成功率为85．4％，单剂量肌注甲氨蝶呤（MTX）治愈率为92．3％，保守性手术成功率为89．5％，24个月累积再次妊娠宫内孕率分别为56．7％,65．0％,46．7％、EP的复发率分别为13．3％、7．5％、11．3％。结论与沙眼衣原俸相关的急、慢性输卵管炎发生率增加和关键性技术的提高，是异位妊娠发生率增加的主要因素。当血β-HCG≥2000mlu／ml而宫内无妊娠囊，可确诊早期EP。MTX单剂量肌肉注射化疗是一种最适用、最有效的保守性治疗，可望成为早期异位妊娠的标准疗法。

Clinical analysis of 512 cases of ectopic pregnancy

Objective To investigate the early diagnosis of ectopic pregnancy （EP）, as well as use conservative treatment of EP. Methods The clinical datas of five hundred and twelve patients with EP admitted from Jan. 2003 to Dec. 2008 were analyzed retrospectively, and 200 of them attemped to conceive again with fertility after radical by different treatment for tubal pregnancy were compared. Results From 2003 to 2008, the incidence of EP in this region increased one times. Positive serum β - hCG test was 100%, the absence of intrauterine gestational sac was 93.9%, the success rate of expectant management was 85.4%, the curative rate of single agent methotrexate therapy was 92.3% ,the success rate of conservative surgery was 89.5%, there was 56.7%, 65.0% and 46.7% respectively, the two- year cumlative rate that next pregnancy was intrauterine, the rate of reectopic pregnancy was 13.3% , 7.5% and 11.3% , respectively. Conclusions Improved pivotal technology and the rising incidence of acute and chronic salpingirtis, related to chlamydia trachomatis is primary factors of this increased incidence. The diagnosis of early EP may be confirmed by serum β - HCG ≥2000 mlu/ml and the absence of intrauterine gestational sac. Single - agent im MTX chemotherapy is a most effective and most applies to conservative treatment, within sight will become the standardized therapy of early EP.