Multivariate analysis of laparoscopic conservative surgery for persistent ectopic pregnancy after tubal pregnancy / 中国综合临床

ABSTRACT

Objective To investigate the influencing factors of persistent ectopic pregnancy (PEP) after laparoscopic conservative surgery for tubal pregnancy.Methods Three hundred and one cases of tubal pregnancy treated by laparoscopic conservative surgery in Jizhong energy Fengfeng Group Hospital from October 2007 to October 2017 were divided into PEP group ( 21 cases) and non PEP group ( 280 cases) according to whether PEP occurred after operation.The age,menopause time and preoperative serum of the two groups were analyzed.The levels of beta?human chorionic gonadotropin (beta?hCG),surgical methods, corpus luteum exfoliation, methotrexate and mass diameter were analyzed.Logistic regression was used to analyze the multiple factors.Results There was no significant difference in age between the two groups.There were significant differences in the time of menopause, preoperative serum beta?hCG level, operative methods,corpus luteum exfoliation, methotrexate application and mass diameter between the two groups (P＜0.05 or P＜0.01).Multivariate logistic regression analysis showed that short menopause time, high preoperative serum beta?hCG concentration, sac extrusion at the umbrella end of fallopian tube, no corpus luteum exfoliation, no intraoperative methotrexate and small mass diameter were risk factors for persistent ectopic pregnancy (OR(95%CI) were 1.476 ( 1.035～3.961),1.513 (1.391～3.017),5.301 (1.304～19.570),1.104 (1.015～2.769),1.180 (1.020～2.543),1.540 (1.181～5.120),respectively, all P＜0.05).Conclusion PEP is prone to occur in patients with tubal pregnancy treated by laparoscopic conservative surgery,such as short menopause time,small size of mass,high preoperative serum beta?hCG concentration,no corpus luteum exfoliation,no local methotrexate and umbrella sac extrusion.Therefore,the key measures to reduce the occurrence of PEP in clinic are to choose the right operation time,appropriate operation method,corpus luteum exfoliation and local injection of methotrexate.