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目的探讨甲氨蝶呤保守治疗后重复异位妊娠的病因及预防措施。方法回顾分析我院1996年6月～2006年6月甲氨蝶呤药物保守治疗异位妊娠205例患者的临床资料。将重复异位妊娠22例及同期随访到宫内妊娠40例临床资料进行对比分析。结果22例重复异位妊娠占同期异位妊娠的10.7%(22/205例)。22例中16例行手术治疗,对侧输卵管4例,同侧12例,病理检查示14例伴有慢性输卵管炎。2次异位妊娠间隔时间为3～60个月,平均32个月,15例间隔时间<12个月。宫内妊娠40例患者中,妊娠发生在治疗后24个月内的37例。辅助中药加物理治疗的有32例,26例妊娠前行输卵管通液术。结论慢性输卵管炎是重复异位妊娠的主要原因。严格掌握保守治疗指征,严密随访,在血β-hCG降至正常后口服活血化瘀中药并配合物理治疗,治疗过程中及治疗后一年内做好避孕工作,可以降低重复异位妊娠的发生率。
Objective To investigate the etiology and preventive measures of repeated ectopic pregnancy after methotrexate conservative treatment. Methods A retrospective analysis of our hospital from June 1996 to June 2006 methotrexate conservative treatment of 205 cases of ectopic pregnancy in patients with clinical data. 22 cases of ectopic pregnancy were repeated and the same period of follow-up to intrauterine pregnancy in 40 cases of clinical data for comparative analysis. Results 22 cases of repeat ectopic pregnancy accounted for 10.7% of ectopic pregnancy (22/205 cases). Among the 22 cases, 16 cases underwent surgical treatment. The contralateral fallopian tube was found in 4 cases and ipsilateral in 12 cases. Pathological examination showed that 14 cases had chronic salpingitis. Two ectopic pregnancy interval of 3 to 60 months, an average of 32 months, 15 cases of interval <12 months. Among the 40 patients with intrauterine pregnancy, pregnancy occurred in 37 patients within 24 months after treatment. Auxiliary traditional Chinese medicine plus physical therapy in 32 cases, 26 cases of tubal preoperative delivery of fluid. Conclusion Chronic salpingitis is the main reason for repeated ectopic pregnancy. Strict control of indications for conservative treatment, followed up closely, after the blood β-hCG down to normal oral Chinese medicine and blood circulation with physical therapy, treatment and treatment within one year after contraception can do to reduce the occurrence of repeated ectopic pregnancy rate.