目的 探讨体外受精-胚胎移植后异位妊娠的发病率、致病因素、临床表现、早期诊断及治疗.方法 回顾性分析体外受精-胚胎移植后19例异位妊娠的临床资料.结果 同期新鲜周期和冻胚复苏移植周期共1 398个,临床妊娠498例,临床妊娠率为35.62%,其中异位妊娠19例,异位妊娠发生率为1.26%,包括宫内外同时妊娠3 例,单侧输卵管双妊娠1例.主要临床表现阴道不规则出血和下腹疼痛.致病因素主要是输卵管病变(特别是一侧梗阻伴另一侧炎症或积水),其次为排卵障碍和慢性盆腔炎.结论 体外受精-胚胎移植后异位妊娠的发病因素主要有输卵管病变、异位妊娠病史、排卵障碍和慢性盆腔炎等;阴道超声检查结合血HCG值测定是其最有效的诊断措施;腹腔镜下输卵管切除术是治疗未破裂单纯异位妊娠的较好方法.%Objective To investigate incidence rate, etiological factors, clinical manifestation , early diagnosis and treatment of ectopic pregnancy(EP) after in vitro fertilization and embryo transfer (IVF-ET). Methods The clinical data of 19 patients with EP after IVF-ET were retrospectively analyzed. Results Totally, 1398 embryos ( 944 fresh embryoes and 454 frozen embryos were transplanted in a IVF-ET cycle. Eventually, 498 women conceived after IVF-ET and clinical pregnancy rate was 35.62％. Of which, 19 women had EP, and incidence rate of EP was 1.26％ , including 3 cases of heterotopic pregnancy(HP) ,1 case of double pregnancy in single oviduct. The main clinical manifestations of women with EP were vaginal abnormal bleeding and lower abdomen distending pain. Tubal diseases (especially obstruction of one side Follopian tube associated with inflammation or hydrosalpinx in the other side of tube), ovulation failure and chronic pelvic inflammation were risk factors of EP. Conclusion Tubal diseases, history of EP, ovulation failure and chronic pelvic inflammation are main risk factors of EP after IVF-ET. The combination of ultrasonography and serum hCG detection is the most effective diagnostic method of EP. Laparoscopic salpingectomy is considered to be the best method to treat EP.
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