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目的分析行供精人工授精(AID)助孕后异位妊娠(EP)发生的情况及临床表现,并探讨EP发生前子宫输卵管造影(HSG)等检查和手术情况及其相关因素。方法回顾本院2007年4月—2012年10月期间AID术后发生33例EP的临床资料,对HSG等检查与EP发生、手术治疗情况及其相关因素进行分析。结果 33例EP占同期AID术后临床妊娠的1.37%;EP前HSG提示异常者12例,占36.36%(12/33)。EP行手术治疗25例,术中发现合并盆腔异常12例,占48%(12/25)。发生双侧输卵管妊娠1例,腹腔妊娠1例,其余为单侧输卵管妊娠。5例在HSG及EP术中均未发现异常,占20%(5/25)。除停经、妊娠试验阳性及B超宫内未见妊娠囊外,表现为少量或反复阴道流血22例,下腹痛21例,B超检查发现盆腔/附件区包块28例,占84.85%(28/33)。结论 AID助孕后EP发生率较低,以输卵管妊娠最为常见。在AID助孕后发生EP的患者中,孕前近40%的患者经HSG检查发现宫腔及输卵管的异常;近50%的患者在EP手术中发现盆腔的异常。阴道B超检查在EP的诊断中起着重要的作用。
Objective To analyze the occurrence and clinical manifestations of ectopic pregnancy (EP) after artificial insemination (AID) assisted pregnancy and to investigate the status and related factors of hysterosalpingography (HSG) before EP. Methods The clinical data of 33 patients with EP after AID were retrospectively analyzed from April 2007 to October 2012 in our hospital. The incidence of HSG, EP, surgical treatment and related factors were analyzed. Results 33 cases of EP accounted for 1.37% of the clinical pregnancy after AID; 12 cases of abnormal HSG prompted before EP, accounting for 36.36% (12/33). Twenty-five cases were treated with EP, and 12 cases (48%) had pelvic abnormality. Bilateral tubal pregnancy occurred in 1 case, 1 case of intraperitoneal pregnancy, the remaining unilateral tubal pregnancy. No abnormalities were found in 5 cases of HSG and EP, accounting for 20% (5/25). In addition to menopause, pregnancy test positive and no intrauterine pregnancy B intrauterine sac, the performance of a small amount or repeated vaginal bleeding in 22 cases, 21 cases of lower abdominal pain, B ultrasound examination found pelvic / attachment area mass 28 cases, accounting for 84.85% (28 / 33). Conclusions The incidence of EP after pregnancy is lower, which is most common in tubal pregnancy. Among AID-assisted EP patients, nearly 40% of pre-congenital myometrial and tubal abnormalities were detected by HSG; nearly 50% of patients had pelvic abnormalities during EP surgery. Vaginal ultrasound B plays an important role in the diagnosis of EP.