体外受精-胚胎移植术后宫内妊娠合并输卵管间质部妊娠6例临床分析

doi:10.3877/cma.j.issn.2095-3259.2019.03.012

目的

探讨体外受精－胚胎移植术(in vitro fertilization and embryo transfer, IVF-ET)后宫内妊娠合并输卵管间质部妊娠的临床特点和治疗方法。

方法

回顾性分析2014年3月至2018年12月暨南大学医学院附属深圳市宝安区妇幼保健院妇产科收治IVF-ET后宫内妊娠合并输卵管间质部妊娠的6例临床资料及治疗方法。

结果

6例患者均采用手术治疗，其中4例开腹手术，2例腹腔镜手术，发生早期流产1例，活产分娩5例，无子宫破裂及新生儿畸形发生。

结论

宫内妊娠合并输卵管间质部妊娠主要依靠阴道超声诊断，手术治疗可获得良好妊娠结局，腹腔镜手术是安全可行的。

关键词: 复合妊娠, 生殖技术，辅助

Objective

To evaluate the clinical features and treatment of the coexistence of intrauterine pregnancy and interstitial tubal pregnancy after in vitro fertilization-embryo transfer(IVF-ET).

Methods

Clinical data of features and treatments of 6 patients with interstitial heterotopic pregnancy after IVF-ET, who were conducted in Bao′an Maternity and Child Healthcare hospital affiliated to Jinan University School of Medicine from March 2014 to December 2018, were analyzed retrospectively.

Results

All the 6 patients were treated by surgery, including 4 patients of laparotomy and 2 patients of laparoscopic surgery. One patient had early abortion after surgery, the other 5 patients delivered successfully, without uterine rupture or neonatal malformation.

Conclusions

The majority of interstitial heterotopic pregnancy are diagnosed by transvaginal ultrasound. Surgical treatment can achieve good pregnancy outcomes, and laparoscopic surgery is feasible and safe.

Key words: Pregnancy, heterotopic, Reproductive techniques, assisted

表1 6例患者基本临床资料

序号	年龄(岁)	孕产史	移植胚胎个数	临床症状	术前阴道三维超声
1	33	孕3产0	2	腹痛	宫内孕6^＋2周，子宫左后方包块3.8 cm×1.8 cm
2	31	孕4产0	2	阴道流血	宫内孕6^＋3周，宫底左侧包块2.2 cm×1.9 cm
3	21	孕1产0	2	无	宫内孕7^＋1周，右侧宫角外侧包块2.3 cm×1.5 cm
4	27	孕2产0	2	无	宫内孕6^＋5周，子宫左后方包块2.3 cm×3.0 cm
5	30	孕2产0	2	无	宫内孕6^＋4周，右侧宫角外侧包块3.4 cm×3.9 cm
6	33	孕3产0	2	阴道流血	宫内孕6^＋4周，左侧宫角外侧包块2.8 cm×1.9 cm

表1 6例患者基本临床资料

序号	年龄(岁)	孕产史	移植胚胎个数	临床症状	术前阴道三维超声
1	33	孕3产0	2	腹痛	宫内孕6^＋2周，子宫左后方包块3.8 cm×1.8 cm
2	31	孕4产0	2	阴道流血	宫内孕6^＋3周，宫底左侧包块2.2 cm×1.9 cm
3	21	孕1产0	2	无	宫内孕7^＋1周，右侧宫角外侧包块2.3 cm×1.5 cm
4	27	孕2产0	2	无	宫内孕6^＋5周，子宫左后方包块2.3 cm×3.0 cm
5	30	孕2产0	2	无	宫内孕6^＋4周，右侧宫角外侧包块3.4 cm×3.9 cm
6	33	孕3产0	2	阴道流血	宫内孕6^＋4周，左侧宫角外侧包块2.8 cm×1.9 cm

表2 6例患者术中情况及妊娠结局

序号	异位妊娠部位	腹腔内出血(ml)	手术方式	术中出血(ml)	手术时间(min)	妊娠结局
1	左侧间质部(破裂)	750	开腹输卵管间质部切开取胚＋缝合术	20	75	早产剖宫产(35^＋6周，胎膜早破)
2	左侧间质部	无	开腹输卵管间质部切开取胚＋缝合术	20	55	早产剖宫产(35^＋3周，胎膜早破)
3	右侧间质部	无	腹腔镜输卵管间质部切开取胚＋缝合术	80	83	足月剖宫产(38^＋3周)
4	左侧间质部	无	开腹输卵管间质部切开取胚＋缝合术	20	62	足月剖宫产(39周)
5	右侧间质部	无	腹腔镜输卵管间质部切开取胚＋缝合术	100	102	足月剖宫产(38^＋5周)
6	左侧间质部	无	开腹输卵管间质部切开取胚＋缝合术	150	68	早期流产(孕12^＋2周)

表2 6例患者术中情况及妊娠结局

序号	异位妊娠部位	腹腔内出血(ml)	手术方式	术中出血(ml)	手术时间(min)	妊娠结局
1	左侧间质部(破裂)	750	开腹输卵管间质部切开取胚＋缝合术	20	75	早产剖宫产(35^＋6周，胎膜早破)
2	左侧间质部	无	开腹输卵管间质部切开取胚＋缝合术	20	55	早产剖宫产(35^＋3周，胎膜早破)
3	右侧间质部	无	腹腔镜输卵管间质部切开取胚＋缝合术	80	83	足月剖宫产(38^＋3周)
4	左侧间质部	无	开腹输卵管间质部切开取胚＋缝合术	20	62	足月剖宫产(39周)
5	右侧间质部	无	腹腔镜输卵管间质部切开取胚＋缝合术	100	102	足月剖宫产(38^＋5周)
6	左侧间质部	无	开腹输卵管间质部切开取胚＋缝合术	150	68	早期流产(孕12^＋2周)

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Clinical analyze of six patients of the coexistence of intrauterine pregnancy and interstitial tubal heterotopic pregnancy after in vitro fertilization-embryo transfer

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Clinical analyze of six patients of the coexistence of intrauterine pregnancy and interstitial tubal heterotopic pregnancy after in vitro fertilization-embryo transfer