目的：分析我院近10年来异位妊娠发生率、发病年龄、诊断和治疗。方法：以5年为一个时间段回顾分析我院1997年1月至2006年12月异位妊娠发生率、发病年龄、诊断和治疗。结果：我院1997年1月至2006年12月共收治异位妊娠740例。异位妊娠数与同期宫内妊娠数之比，由1997年1月至2001年12月的1∶23.99上升为2002年1月至2006年12月的1∶11.60（P＜0.01）。≤25岁异位妊娠的发病率由1997年至2001年的14.7%上升到2002年至2006年的289%，其中≤20岁妇女及合并不孕者有增多趋势。异位妊娠的早期诊断率增高，发生异位妊娠破裂者由1997年至2001年的120例（45.3%）下降至2002年至2006年的85例（17.9%）（P＜0.01）。经腹行输卵管切除仍为主要治疗手段，但腹腔镜手术及保守性手术逐渐增多，非手术治疗明显增多。结论：异位妊娠发生率呈上升趋势，发病年龄年轻化，近年早期诊断率增高，减少误诊及异位妊娠破裂发生，经腹手术仍为主要治疗手段，但腹腔镜和保守治疗上升。
Objective To compare the surgical outcome and investigate the clinic value between laparoscopic operation and laparotomy in the treatment of ectopic pregnancy. Methods We searched PubMed, EMbase, SCI, The Cochrane Library, Chinese Biomedical Literature Database, China Journal Full Text Database, Chinese Medical Association Journals, and references of the included studies up to April 2009. Studies involving treatment outcome of ectopic pregnancy using laparoscopy compared with laparotomy were included. Data were extracted and methodological quality were evaluated by two reviewers independently with designed extraction form. The Cochrane Collaboration’s RevMan 5.0.1 software was used for data analyses. Results A total of 11 studies involving 1795 patients were included. The results of meta-analyses showed that laparoscopy comparing with laparotomy; the operation time and complications had no difference; intraoperative blood loss was less than laparotomy; intestinal gas exhaust and evacuation active time was earlier than laparotomy. Conclusion Laparoscopy treating for ectopic pregnancy is better than laparotomy. It is a minimally invasive surgical technique, and is worthy to be popularized.
目的 探讨腹腔镜下输卵管妊娠开窗取胚术后缝合与否对输卵管再通、宫内妊娠率的近期影响。方法 回顾分析2008年4月－2010年4月112例有保留生育功能意愿且具备随访条件的输卵管妊娠患者行腹腔镜手术的临床资料。根据手术方法将患者分为两组：A组54例，行患侧输卵管开窗取胚术，术后缝合输卵管；B组58例，行患侧输卵管开窗取胚术，术后不予缝合输卵管。两组术毕均予甲氨喋呤20 mg注射于病变输卵管处系膜，并行通液了解患侧输卵管通畅情况（对侧输卵管均通畅）。3个月后比较两组患侧输卵管的再通情况，并随访其近期（12个月内）宫内妊娠率、重复性异位妊娠率情况。 结果 A组54例患者术中患侧输卵管通畅48例，通而不畅6例；术后3个月B型超声监测下通液43例通畅，10例通而不畅，1例不通，通畅率79.63%。B组58例患者术中患侧输卵管通畅54例，4例通而不畅；术后3个月B型超声监测下通液37例通畅，13例通而不畅，8例不通，通畅率63.79%。近期（12个月内）宫内妊娠率、重复性异位妊娠率情况：A组54例，实访42例，宫内妊娠29例，占69.05%；重复性异位妊娠6例，占14.29%。B组58例，实访44例，宫内妊娠18例，占40.91%，重复性异位妊娠12例，占27.27%。A组术后患侧输卵管通畅率、宫内妊娠率高于B组，而重复性异位妊娠率明显降低，两组差异有统计学意义（P＜0.05）。 结论 腹腔镜下输卵管妊娠开窗取胚术后行输卵管缝合，可以减少对患侧输卵管损伤并恢复其正常的解剖结构，从而有效地保留患者生育功能。术后患侧输卵管通畅率、宫内妊娠率明显高于术后不缝合者，而重复性异位妊娠率明显降低。
Objective To analyze the effectiveness of conservative medical treatments for ectopic pregnancy (EP): methotrexate (MTX) + mifepristone + Ectopic Pregnancy II decoction (EP-II) vs. methotrexate + mifepristone. Methods A total of 95 patients with EP in Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University from January 2009 to January 2011 were randomly divided into two groups: 45 patients in the experimental group were treated with MTX, mifepristone and EP II decoction, while the other 50 patients in the control group were treated with MTX and mifepristone. The effectiveness of the two groups was analyzed with SPSS 13.0 software. Results There were significant differences in the time of serum β-HCG return to normal (16.13±8.13 ds vs. 22.05±7.15 ds, Plt;0.05), time of EP mass absorption (30.46±7.56 ds vs. 39.99±18.26 ds, Plt;0.05) and tubal patency rate (80% vs. 75%, Plt;0.05) between the two groups. But there were no significant differences in effective rate (95.56%, 43/45 vs. 94%, 47/50, χ2=0.0809, Pgt;0.05) and side effects. Conclusion The combination of methotrexate, mifepristone and EP II decoction for ectopic pregnancy is more effective than mifepristone and methotrexate in coordinately killing the embryo, shortening the time of serum β-HCG return to normal and the time of EP mass absorption, and improving the function of oviducts.
目的:探讨超声在异位妊娠中的诊断及鉴别诊断价值。方法:回顾性分析我院超声诊断45例异位妊娠,并与手术及病理检查结果进行对照。结果:经超声诊断异位妊娠正确率达88.9%(40/45)。结论:超声对异位妊娠的诊断和鉴别诊断均具有较好的临床价值。
目的：探讨超声诊断对异位妊娠的诊断及临床价值。方法：回顾性总结分析85例经临床确诊的异位妊娠。结果：输卵管壶腹部、峡部及伞部妊娠75例，符合率95.8%；间质部妊娠2例，符合率100%；卵巢妊娠1例，为误诊；宫角妊娠2例，符合率100%；宫颈妊娠5例，符合率100%；未破裂型异位妊娠51例，不典型34例。结论：超声检查对异位妊娠能作出较准确的定位诊断，对临床治疗提供了有力证据，具有较高的临床诊断价值。
目的:探讨米非司酮治疗异位妊娠的疗效,安全性及对患者生育的影响。方法:选取符合保守治疗条件患者31例,观察米非司酮治疗异位妊娠过程中的临床症状,各项试验室指标的变化;出现不良反应的几率及严重程度;治疗后输卵管的通畅情况,以判断是否对患者生育造成影响。结果:治疗成功率为87.09%;不良反应出现率为19.35%,均为轻度不适;成功病例中未育患者输卵管通畅率为100%。结论:米非司酮是一种治疗异位妊娠的高效药物,具有安全性高,不良反应少,对生育无影响的优点。