腹腔镜保守手术治疗输卵管妊娠患者术后生育结局的影响因素

目的探讨腹腔镜保守手术治疗输卵管妊娠患者生殖预后的影响因素。方法选择冀中能源峰峰集团有限公司总医院2010年10月至2016年10月收治的253例行腹腔镜保守手术治疗输卵管妊娠患者的临床资料进行回顾性分析,术后24~36个月进行随访,观察患者宫内妊娠情况,并采用Logistic回归进行多因素分析,观察患者术后宫内妊娠的影响因素。结果术后24~36个月进行随访,患者均未避孕且在医生指导下受孕。253例中宫内妊娠182例(71.1%),异位妊娠37例(14.6%),余34例(13.4%)患者未妊娠。Logistic回归结果表明,术前血人绒毛膜促性腺激素水平高、重度盆腔粘连、术后患侧输卵管阻塞及有异位妊娠史者是影响患者术后宫内妊娠的危险因素OR(95%CI)值分别为1.982(1.075~3.149)、2.410(1.279~5.069)、2.485(1.071~3.594)、5.071(1.094~9.081),P<0.05或P<0.01]。结论腹腔镜保守手术治疗输卵管妊娠患者术后生育结局受多种因素影响,术前血人绒毛膜促性腺激素水平高、重度盆腔粘连、术后患侧输卵管堵塞及有异位妊娠史者是影响患者术后宫内妊娠的危险因素。

Analysis of the influencing factors of the outcome of laparoscopic conservative surgery in patients with tubal pregnancy

Objective To investigate the influencing factors of fertility outcome after laparoscopic conservative surgery for tubal pregnancy.Methods From October 2010 to October 2016,253 cases of tubal pregnancy treated by laparoscopic conservative surgery in General Hospital of Jizhong energy Fengfeng Group Hospital were analyzed retrospectively.All patients were followed up from 24 to 36 months after operation to observe the intrauterine pregnancy.Logistic regression was used to analyze the influencing factors of intrauterine pregnancy.Results After 24-36 months follow-up,the patients were not contraception and pregnant under the guidance of doctors.Among the 253 cases,182(71.1%)were intrauterine pregnancy,37(14.6%)were ectopic pregnancy,and 34(13.4%)were not pregnant.The results of logistic regression showed that high level of hCG,severe pelvic adhesions,obstruction of fallopian tube and history of ectopic pregnancy were the risk factors of intrauterine pregnancy(OR(95%CI)1.982(1.075-3.149),2.410(1.279-5.069),2.485(1.071-3.594),5.071(1.094-9.081),P<0.05 or P<0.01).Conclusion The reproductive outcome of laparoscopic conservative surgery for tubal pregnancy is influenced by many factors.The high level of hCG in preoperative blood,severe pelvic adhesions,obstruction of tubal and ectopic pregnancy history are the risk factors of postoperative pregnancy.