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目的探讨体外受精与胚胎移植术(IVF-ET)后异位妊娠(EP)的发生率、临床特点及应对措施。方法选择2010年1月至2015年12月于北京协和医院生殖中心经IVF-ET后确诊为EP的42例患者共计45个周期进行回顾性研究。结果 6年内共有3 656个周期为临床妊娠,42名患者共计45个周期为EP,比例为1.23%(45/3 656)。2名患者重复EP,5名患者宫内宫外同时妊娠(HP)。EP主要发生在输卵管壶腹部,共19周期,占EP的42.22%。因输卵管因素行IVF-ET后EP的患者有24周期(53.33%),非输卵管因素21周期(46.67%)。45周期EP中,3周期保守治疗,42周期采用腹腔镜或开腹手术治疗。5例HP患者中3例行手术+宫内孕保胎治疗,其中2例保胎成功最终娩出健康活婴。22名患者(52.38%)通过后续IVF-ET妊娠成功并产下健康活婴,3名患者(7.14%)暂时放弃生育计划,17名患者(40.48%)继续尝试IVF-ET。结论随着辅助生殖技术的改进与发展,其造成EP高风险或许会呈现逐渐降低趋势,但现今而言仍应引起我们高度重视。输卵管因素是EP发生的重要影响因素。在处理IVF-ET后患者时要考虑到IVF技术的特殊性,避免漏诊、误诊的发生。
Objective To investigate the incidence, clinical features and treatment of ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF-ET). Methods From January 2010 to December 2015, 42 patients who were diagnosed with EP after IVF-ET by the Peking Union Medical College Center for Reproductive Medicine for a total of 45 cycles were retrospectively studied. Results A total of 3 656 cycles of clinical pregnancy were performed over a 6-year period. A total of 42 patients were EP for 45 cycles, with a ratio of 1.23% (45/3 656). Two patients repeated EP and five had intrauterine ectopic pregnancy (HP). EP mainly occurs in the fallopian tube ampulla, a total of 19 cycles, accounting for 42.22% of the EP. There were 24 cycles (53.33%) of patients with EP due to tubal factors and 21 cycles (46.67%) of non-tubal factors after IVF-ET. 45 cycles of EP, 3 cycles of conservative treatment, 42 cycles of laparoscopic or laparotomy. Three of the five HP patients underwent surgery and intrauterine pregnancy with conception, of which two were successful and delivered healthy live births. Twenty-two patients (52.38%) were successful and gave birth to healthy live births through subsequent IVF-ET pregnancies. Three patients (7.14%) temporarily gave up their fertility plans and 17 patients (40.48%) continued IVF-ET. Conclusion With the improvement and development of assisted reproductive technology, the high risk of causing EP may show a gradual downward trend, but we still should attach great importance to it today. Tubal factor is an important factor in the occurrence of EP. In the treatment of patients after IVF-ET should take into account the particularity of IVF technology to avoid missed diagnosis, misdiagnosis.