辅助生殖技术后致异位妊娠的临床特点及处理

目的：探讨辅助生殖技术后致异位妊娠的临床特点及处理对策，加深临床医师对辅助生殖技术并发症的认识，减少移植后异位妊娠的误诊或漏诊。方法：回顾性总结我院近12年间助孕中心辅助生殖技术后致异位妊娠并行手术治疗的49例患者的异位妊娠类型、高危因素及手术治疗方案。结果：输卵管妊娠是辅助生殖后致异位妊娠最为常见的类型，单纯输卵管妊娠和复合妊娠中输卵管妊娠者占85.71%。其它类型包括宫角妊娠、卵巢妊娠及腹腔妊娠。辅助生殖技术后致异位妊娠的高危因素包括输卵管因素、子宫内膜异位症、异位妊娠及其他妇科手术史、人流史、子宫因素等。各高危因素间差异有统计学意义（X2=34.8，P＜0.001），其中输卵管因素占42.86%，为辅助生殖后致异位妊娠的最主要因素。输卵管妊娠者多行腹腔镜下患侧或双侧输卵管切除术，宫角妊娠依据胎囊部位，可行腹腔镜联合腹部超声下吸宫术，或腹腔镜下宫角部分切除术。49例患者术后均无持续性宫外孕，均临床治愈（治愈率100%）。结论：ART后致EP的高危因素中输卵管因素为最主要的因素。对于输卵管因素导致不孕的患者，建议ART前行输卵切除术，以降低异位妊娠发生的概率。在移植前需与患者沟通，做好心理准备和疏导。异位妊娠提倡及早发现，及时治疗。复合妊娠不提倡期待疗法，应立即手术治疗。既要去除异位妊娠灶，又要力争宫内活胎继续妊娠。

Clinical Features and Countermeasures of Ectopic Pregnancy caused by Assisted Reproductive Technology

Abstract Objective: To investigate the clinical characteristics and countermeasures of ectopic pregnancy (EP) after assisted reproductive technology (ART), deepen the understanding of complications of ART and reduce the misdiagnosis or missed diagnosis of EP after ART. Methods: The types, high risk factors and surgical treatment options were studied in 49 cases of EP after ART in Assisted Reproduction Center of our hospital during the past 12 years. Results: The tubal pregnancy is the most common type of EP after ART. The simple tubal pregnancy and tubal pregnancy in heterotopic pregnancy (HP) cases account for about 85.71% of the total number. Other types included cornual pregnancy, ovarian pregnancy and abdominal pregnancy. The high risk factors of EP after ART included tubal factors, endometriosis, EP surgery and other gynecological surgery history, abortion history, uterine factors. And the difference of above high risk factors was significantly significant (X2 = 34.8, P <0.001). Tubal factors were accounted for a percentage of 42.86%, which was the main factor for EP after ART. Patients with tubal pregnancy were performed laparoscopic ipsilateral or bilateral salpingectomy. Patients with cornual pregnancy, based on fetal sac location, were performed either aspiration of uterus by laparoscopy combined with abdominal ultrasound or laparoscopic cornual patial resection. There were no persistent ectopic pregnancy in 49 postoperative patients. The clinical cure rate was 100%. Conclusion: The tubal factor is one of the most important risk factors induced EP after ART. The salpingectomy is recommended before ART for infertility patients caused by tubal factors to reduce the probability of ectopic pregnancy. Doctors should communicate with patients before ART and make them mentally prepared, in order to promote early detection and timely treatment for EP. Patients should have surgical treatment immediately to remove the EP lesions, and also strive to continue the intrauterine pregnancy.