探讨异位妊娠(ectopic pregnancy)及重复异位妊娠发生的相关因素。

以2007年3月至2008年1月在本院住院确诊的148例(A组)异位妊娠患者的临床病历资料及同期门诊超声提示宫内早孕90例(B组)的临床病历资料为研究对象。A组27例重复异位妊娠患者中，22例首次异位妊娠时在本院治疗，病历资料完整，将其纳入A1组；另121例为首次异位妊娠患者，将其按约1∶2比例随机选取54例纳入A2组。采用回顾性临床研究法，对其年龄、孕次、性生活时间、避孕方式、盆腔手术史、慢性盆腔感染史、血β-人绒毛膜促性腺激素(human chorionic gonadotropin, HCG)、妊娠结局等变量，采用多因素非条件Logistic回归法，筛查异位妊娠及重复异位妊娠发生的相关因素。对A1组重复异位妊娠患者的首次异位妊娠临床资料进行回顾性分析，与A2组首次异位妊娠患者的临床资料进行比较，利用χ²检验分析其首次异位妊娠治疗方式的差异。

多因素非条件Logistic回归法分析异位妊娠发生的相关危险因素及比值比(OR)分别为：年龄(OR＝1.153，P＝0.000)，放置宫内节育器(intrauterine device，IUD)(OR＝4.782，P＝0.008)，口服紧急避孕药(OR＝12.735，P＝0.018)，慢性盆腔感染史(OR＝6.352，P＝0.001)，异位妊娠史(OR＝5.292，P＝0.035)。重复异位妊娠的相关危险因素的比值比分别为孕次(OR＝1.419，P＝0.013)，慢性盆腔感染史(OR＝3.026，P＝0.015)。χ²检验显示，治疗异位妊娠方式以保守性治疗较手术治疗的重复异位妊娠率明显增加(χ²＝4.046，P＝0.036)。

慢性盆腔感染史、口服紧急避孕药、放置宫内节育器、无避孕措施和不严格工具避孕为发生异位妊娠或重复异位妊娠发生的危险因素。治疗异位妊娠方式以手术切除患侧输卵管并酌情结扎对侧输卵管为保护因素。

To explore relative factors of the onset of ectopic pregnancy and repeated ectopic pregnancy.

From March 2007 to January 2008, the clinical data of ectopic pregnancy (group A, n=148) and normal pregnancy (group B, n=90) were retrospectively analyzed. Among group A, 22 cases were repeated ectopic pregnancy with completed clinical data (group A1), and 121 cases of ectopic pregnancy occurred in the first pregnancy, in accordance with the ratio of 1∶2 of 54 cases were randomly selected into group A2. The following factors were analyzed by retrospective clinical research method: Age at onset of disease, gravidity, sexual life time, methods of contraception, history of pelvic surgery, chronic pelvic inflammation, β-human chorionic gonadotropin (HCG) level, pregnancy outcome. Multi-factorial non-conditional Logistic regression analysis was performed to determine the relative factors of onset of ectopic pregnancy and repeated ectopic pregnancy. The comparison conducted between the retrospective analysis of clinical data of group A1 and group A2 by using χ² test to tell the difference of ectopic pregnancy which occurred in the first pregnancy.

The risk factors of ectopic pregnancy and its odds ratio (OR) from the multi-factorial Logistic regression analysis were as follows: Age at onset of disease(OR=1.153, P=0.000), intrauterine device (IUD) insertion (OR=4.782, P=0.008), oral emergency contraception (OR=12.735, P=0.018), chronic pelvic inflammation (OR=6.352, P=0.001), history of ectopic pregnancy (OR=5.292, P=0.035). The risk factors of repeated ectopic pregnancy and its odds ratio from the multi-factorial Logistic regression analysis were as follows: Gravidity (OR=1.419, P=0.013), chronic pelvic inflammation (OR=3.026, P=0.015). Compared with operational therapy, the incidence of repeated ectopic pregnancy increased following conservative therapy (χ²=4.046, P=0.036).

The risk factors of ectopic pregnancy include: Chronic pelvic inflammation, oral emergency contraception, intrauterine device insertion, no contraception and contraception by condom occasionally. The protective factor of approach in treatment of ectopic pregnancy is surgical removal of ipsilateral fallopian tube and appropriate ligation of contralateral fallopian tube.