腹腔镜下输卵管妊娠术后持续性异位妊娠病因分析

目的分析腹腔镜下手术治疗输卵管妊娠后持续性异位妊娠的病因，指导预防和治疗。方法将114例行腹腔镜手术治疗的输卵管妊娠患者分为2组：术后发生持续性异位妊娠的12例患者为A组，未发生持续性异位妊娠的102例患者为B组。分析比较两组患者的术前血人绒毛膜促性腺激素水平及其术后下降幅度、停经时间、妊娠部位、手术方式，保守性手术是否术中使用甲氨蝶呤局部注射、盆腔包块大小等。结果持续性异位妊娠的易发因素：术前血人绒毛膜促性腺激素水平高、术后下降幅度小，停经〈40d或〉60d，峡部妊娠，伞端挤压术，保守性手术中未使用甲氨蝶呤局部注射，盆腔包块大小与持续性异位妊娠的发生无相关性。结论对异位妊娠拟行腹腔镜手术治疗者，应仔细分析其术前资料，选择合适的手术方式，术中仔细操作，以避免手术后续性异位妊娠。

Persistent Ectopic Pregnancy after Surgery for Tubal Pregnancy by Laparoscopic

Objective To investigate the factors of persistent ectopic pregnancy（PEP） after surgery for tubal pregnancy by laparoscopic, and provide guideline for the clinical prevention and therapy. Methods 114 cases of tubal pregnancy by laparoscopic surgery were divided into 2 groups： 12 cases of PEP as the group A, 102 cases without PEP as the group B, The factors including ~-HCG levels of pre and after surgery, time of menopause, the sites of ectopic pregnancy, patterns of surgery, conservative surgery with injection of MTX or not, and the size of the pelvic mass between the two groups were compared. Results The factors of higher rate of PEP were patients with higher [I-HCG pre-surgery and limited decrease after operation, days of menopause less than 40 or more than 60, pregnancy in the isthmus, the compression surgery of pregnancy from the fimbriae tube, conservative surgery without injection of MTX. The PEP had no correlation with the size of pelvic mass. Conclusion The preoperative data should be carefully analyzed for patients with ectopie pregnancy laparoscopic surgery. The appropriate surgical approach and delicate operation could reduce the rate of PEE