Objective: To investigate the clinical features, diagnosis and treatments of heterotopic pregnancy (HP) and demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Methods: A retrospective analysis was performed on 144 cases of HP in Women's Hospital, School of Medicine, Zhejiang University from January 2003 to December 2016. Results: (1) Clinical features of HP:the average age of patients was (30.8±3.8) years old, body mass index (BMI) was (21.9±2.9) kg/m(2), and was diagnosed at (6.5±1.3) weeks gestational age. Four patients (2.8%) were naturally pregnant, 10 patients (6.9%) received ovulation induction, and 130 patients (90.3%) had received infertility treatments. Fifty-one patients (35.4%) had no clinical symptoms, and 93 patients (64.6%) had clinical symptoms included vaginal hemorrhage,abdominal pain and hemorrhagic shock caused by intraperitoneal hemorrhage. The location of ectopic pregnancy was most common in the fallopian tubes (59.0%, 85/144) and the interstitial part (33.3%,48/144) . (2) Ectopic pregnancy treatment of HP:thirteen patients underwent expectation treatment, and the remaining 131 cases underwent surgical treatment, including laparoscopy (n=56) , laprotomy (n=52) , and fetal reduction (n=23) . Among the 131 patients underwent surgery, intrauterine pregnancy were found inevitable abortion in 6 cases preoperatively. The total early abortion rate after surgery was 14.4% (18/125) ; the second operation rate was 3.1% (4/131) . (3) Intrauterine pregnancy outcome of HP: 120 intrauterine fetal were survival, the total live birth rate was 83.3% (120/144) .One hundred and seven intrauterine fetal were survival after operation and the live birth rate after operation was 85.6% (107/125) . Twenty-nine cases were premature delivery and the premature delivery rate was 24.2% (29/120) . There was no significant differences between tubal HP and interstitial HP group in the preterm birth rate [25.8% (16/62) vs 26.3% (10/38) ; χ(2)=0.003, P>0.05]. Cesarean section rate of delivery in interstitial HP group was significantly higher than that in tubal HP group [97.4% (37/38) vs 59.7% (37/62) ], and the difference was statistically significant (χ(2)=17.400, P<0.05) . Conclusions: The clinical manifestations of HP are diversified, combining of high risk factors, clinical symptoms and ultrasonography could improve the accuracy of diagnosis. Different method has been used to treat HP, such as laparoscopic or laparotomy and fetal reduction, and there are varying degrees of failure rate and postoperative abortion rate. We should consider carefully to adopt expectant management. Through individualized treatment, most HP could get good perinatal outcomes.
目的： 探讨复合妊娠的临床特点、复合妊娠中异位妊娠的治疗方法及宫内妊娠的围产结局。 方法： 收集浙江大学医学院附属妇产科医院于2003年1月至2016年12月收治的144例复合妊娠患者的临床资料，回顾性分析复合妊娠的临床特点、复合妊娠中异位妊娠的治疗方法及宫内妊娠的围产结局。 结果： （1）复合妊娠的临床特点：144例复合妊娠患者的年龄为（30.8±3.8）岁，体质指数（BMI）为（21.9±2.9）kg/m(2)，诊断孕周为（6.5±1.3）周。其中，4例（2.8%）自然妊娠，10例（6.9%）促排卵治疗后妊娠，130例（90.3%）接受辅助生殖技术后妊娠；51例（35.4%）患者无临床症状，93例（64.6%）患者有临床症状，主要为阴道流血、下腹痛、腹腔内出血所致的失血性休克。复合妊娠中异位妊娠的部位以输卵管（本研究中特指除间质部以外的输卵管，包括输卵管壶腹部、峡部、伞端；85例，59.0%）和输卵管间质部（48例，33.3%）常见。（2）复合妊娠患者的异位妊娠治疗：13例行期待治疗，余131例行手术治疗，其中腹腔镜手术56例、开腹手术52例、穿刺减胎术23例。131例手术治疗患者中，术前宫内妊娠为难免流产者6例，其余125例患者的手术后总早期流产率为14.4%（18/125）；二次手术率为3.1%（4/131）。（3）复合妊娠患者的宫内妊娠结局：宫内胎儿存活者120例，总活产率为83.3%（120/144）；其中手术治疗后宫内胎儿存活者107例，手术治疗后活产率为85.6%（107/125）。活产分娩者中早产29例，早产率为24.2%（29/120）。其中，手术治疗后的输卵管复合妊娠和输卵管间质部复合妊娠的早产率分别为25.8%（16/62）和26.3%（10/38），两者比较，差异无统计学意义（χ(2)=0.003，P>0.05）；其剖宫产率分别为59.7%（37/62）和97.4%（37/38），两者比较，差异有统计学意义（χ(2)=17.400，P<0.05）。 结论： 复合妊娠的临床表现多样化，结合高危因素、临床症状和超声检查可提高诊断的准确率。腹腔镜或开腹手术、减胎手术均可用于复合妊娠中异位妊娠的治疗，但均存在不同程度的术后流产率和二次手术风险；期待治疗应谨慎选择。通过个体化的治疗，多数复合妊娠中的宫内妊娠可获得良好的围产结局。.
Keywords: Pregnancy outcome; Pregnancy, heterotopic; Pregnancy, interstitial; Pregnancy, tubal.