黄晓斌 柳晓春

[摘要] 结合本院经验积累，通过对文献检索，从病因及高危因素、临床表现及术后β-HCG变化特点、诊断与鉴别诊断、持续性异位妊娠的综合预防、PEP的治疗五个方面进行分析，重点在持续性异位妊娠的综合预防上，介绍如何高质量完成手术的方法，并介绍如何联合应用术前处理、联合用药等方法，以减少持续性异位妊娠的发生。

[关键词] 持续性异位妊娠；手术；预防；治疗

[中图分类号] R714.22 [文献标识码]B[文章编号]1673-7210（2011）11（c）-190-03

Comprehensive prevention and control for persistent ectopic pregnancy in postoperation of ectopic pregnancy

HUANG Xiaobin, LIU Xiaochun

Maternity and Child Care Center of Foshan City, Guangdong Province, Foshan 528000, China

[Abstract] Combine with the accumulation of experience, through the literature retrieval, five aspects about etiology and risk factors, clinical manifestation and postoperative beta HCG change characteristics, diagnosis and differential diagnosis,comprehensive prevention of persistent ectopic pregnancy, treatment of PEP are analysed, the key point is the comprehensive prevention of persistent ectopic pregnancy, this paper describes the method of how to perform the operations in high quality and introduce the methods of joint application preoperative processing and combination administration, in order to reduce the occurrence of persistent ectopic pregnancy.

[Key words] Persistent ectopic pregnancy; Operation; Prevention; Treatment

近年来，异位妊娠的发生率增加，甚至有流行趋势，但术后持续性异位妊娠（persistent ectopic pregnancy，PEP）的发生给患者造成额外的痛苦，加重医者心理负担，增加医疗纠纷。持续性异位妊娠的发生率报道不一，有文献报道[1]PEP发生率在开腹保守性手术为3%～5%，腹腔镜保守性手术为3%～20%，腹腔镜术后PEP发生率似乎偏高，通过提高手术质量等综合防治措施，其发生率应可逐渐下降。

1 病因及高危因素

1.1 病因

持续性异位妊娠发生的根本原因是滋养细胞残留并繁殖。有研究认为[2]，输卵管妊娠时，滋养叶细胞有40%左右穿入输卵管壁。输卵管保守性手术后，浸润至输卵管壁肌层、浆肌层的残留滋养细胞继续繁殖，分泌人体绒毛膜促性腺激素（HCG），可形成包块甚至导致内出血。这似乎是持续性异位妊娠发生率不可能降至0的理论依据。但从腹腔镜保守性手术后持续性异位妊娠发生率为3%～20%的数字来看，医源性因素是导致PEP发生的更重要、更直接的因素。由于腹腔镜的快速发展、推广，部分术者经验缺乏，对异位妊娠腹腔镜手术的理解不深，经验不够，造成妊娠物清除不彻底，更直接地提高了PEP的发生率。……