异位妊娠药物保守治疗后的再妊娠影响因素研究

发布时间：2018-07-31 08:15

【摘要】：目的:了解异位妊娠(Extrauterine pregnancy,EP)行保守治疗(Conservative treatment)后患者输卵管通畅情况及其影响因素以及再妊娠的情况及其相关影响因素。研究对象和方法:我们选取2009年01月-2013年12月期间,在山西医科大学第一医院收治异位妊娠(Ectopic pregnancy,EP)行药物保守治疗成功,达到出院标准的患者作为研究对象。采用回顾性研究,以电话随访为主,结合书信、邮件等方式,采用问卷调查的方式获取这部分患者的以下信息,如:治疗期间盆腔包块的存在情况、治疗后包块消退时间、人绒毛膜促性腺激素(Human chorionic gonadotropin,HCG)值下降到正常值所需的时间、月经恢复情况、行输卵管通液(Tubal liquid operation)结果、院外有无遵嘱口服中药(Traditional Chinese medicine)、治疗后有否妊娠的打算、避孕情况、再次妊娠结局。使用SPSS19.0对相关因素进行交叉列联表分析以及生存分析,并使用COX多因素分析进一步分析可能影响妊娠结局的因素。结果:1、对于异位妊娠保守治疗后93.2%的患者HCG在出院1-2周之内恢复,86.4%的患者盆腔包块在出院后3-4周之前恢复正常,93.2%的患者未出现腹痛(Abdominal pain)的情况,76.5%的患者在出院3-4周之内月经(Menstruation)恢复正常,82.7%的患者月经量(Menstrual quantity)无明显变化,92.6%的患者经期(Menstrual period)无明显变化。2、中药、输卵管通液、腹痛、停经天数、年龄是与输卵管通畅情况有关联的因素。并且口服中药、输卵管通液是对于促进输卵管通畅是有利的因素;而腹痛、停经天数、年龄是对于输卵管的通畅性是不良的因素。3、对于计划妊娠的患者,在保守治疗后91.8%的患者HCG在出院1-2周之内恢复;97.3%的患者在院外继续口服中药治疗,其中13.7%口服中药超过一个月;84.9%的患者盆腔包块在出院后3-4周之前恢复正常,94.5%的患者未出现腹痛的情况,68.5%的患者在出院3-4周之内月经恢复正常,87.7%的患者行输卵管通液术或者输卵管造影术提示输卵管是通畅的;72.6%的患者通过自然受孕的方式实现再次妊娠。4、药物治疗宫外孕后可以再次妊娠的妊娠率(The pregnancy rate)为71.2%,再次发生同侧异位妊娠的构成比为4.1%,发生对侧异位妊娠的构成比为1.4%。5、再次妊娠的中位妊娠时间t=13.0月。6、治疗后盆腔痛(Pelvic pain)(RR=0.280,P0.05)、HCG恢复至正常的时间(RR=2.434 P0.15,RR=3.927 P0.05)以及治疗后半年内输卵管通畅(RR=16.079,P0.05)是影响异位妊娠保守治疗后计划妊娠妇女再次妊娠的因素。结论:1、保守治疗辅以中药治疗以及在后期行输卵管通液对于促进输卵管通畅是有意义的。2、药物治疗宫外孕可以有较为满意的再次妊娠率。3、对于有妊娠需求的患者,密切关注HCG变化的速度、输卵管通畅性以及治疗后盆腔痛的情况,对于指导生育有意义。
[Abstract]:Objective: to investigate the patency of fallopian tube and its influencing factors and related factors of ectopic pregnancy (Extrauterine preconception EP) after conservative treatment of (Conservative treatment). Subjects and methods: from January 2009 to December 2013, we selected patients with ectopic pregnancy (Ectopic preconception EP) treated in the first Hospital of Shanxi Medical University, who were successfully treated with drugs and met the discharge criteria. The following information was obtained by questionnaire, such as the existence of pelvic mass during treatment, the time of mass regression after treatment, and the time of mass regression after treatment, using the retrospective study, telephone follow-up, correspondence, mail, and so on, using questionnaire to obtain the following information of these patients, such as: the presence of pelvic mass during treatment, and the time of mass regression after treatment. The time when the value of human chorionic gonadotropin (Human chorionic) decreased to the normal value, the recovery of menstruation, the (Tubal liquid operation) results of fallopian tube fluid, whether or not there was any intention of pregnancy after the treatment of (Traditional Chinese medicine), by oral administration outside the hospital, and the situation of contraception. Re-pregnancy outcome. SPSS19.0 was used to analyze the related factors and survival analysis, and COX multivariate analysis was used to further analyze the factors that might affect the outcome of pregnancy. Results: for ectopic pregnancy, 93.2% of the patients recovered from HCG within 1-2 weeks after conservative treatment of ectopic pregnancy. 86.4% of the patients recovered to normal pelvic mass within 1-2 weeks after discharge. 93.2% of the patients did not have abdominal pain (Abdominal pain) before discharge. 76.5% of the patients had no abdominal pain (Abdominal pain) in 3 to 4 weeks after discharge. Within weeks, the menstrual (Menstruation) returned to normal in 82.7% of the patients, and the menstrual volume of (Menstrual quantity) did not change significantly. 92.6% of the patients had no significant changes in (Menstrual period) during menstrual period. Salpingocele, abdominal pain, menopause days and age were associated with tubal patency. And oral Chinese medicine, fallopian tube liquid is a favorable factor for promoting tubal patency, and abdominal pain, menopause days, age is a bad factor for tubal patency, for patients planning pregnancy, After conservative treatment, 91.8% of the patients recovered from HCG within 1-2 weeks of discharge and 97.3% of the patients continued to take oral Chinese medicine treatment outside the hospital. Of these, 13.7% of the patients took oral Chinese herbal medicine for more than one month and 84.9% of the patients returned to normal before 3 to 4 weeks after discharge. 68.5% of the patients had no abdominal pain. Within 3-4 weeks of discharge, 87.7% of the patients returned to normal menstruation and 87.7% had tubal patency. Fluid surgery or salpingography showed that the tubal was patency. 72.6% of the patients achieved re-pregnancy by natural pregnancy. The pregnancy rate of ectopic pregnancy after drug therapy was 71.2%, and the ectopic occurred again. The constituent ratio of pregnancy was 4.1, the constituent ratio of contralateral ectopic pregnancy was 1.4. 5, the median gestational time of second pregnancy was t = 13.0months. 6, the time of recovery to normal (RR=2.434 P0.15RRRRR3.927) and the unobstructed fallopian tube (RR=2.434 P0.15rRRRR3.927) and the patency of fallopian tube (RRR16.079p 0.05) were also found in six months after treatment. Factors affecting repregnancy after conservative treatment of ectopic pregnancy. Conclusion: 1. Conservative treatment with traditional Chinese medicine and salpingocele in the later stage is significant in promoting tubal patency. Drug therapy for ectopic pregnancy may have a satisfactory re-pregnancy rate of 0.3, and for patients with pregnancy needs, Close attention to the speed of HCG changes, tubal patency, and pelvic pain after treatment is significant for fertility guidance.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.22

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