| Objective To evaluate the effect of laparoscopy and laparotomy on the outcome of intrauterine pregnancy in patients with heterotopic pregnancy.Methods Articles published up to June 2020 were retrievaled from databases such as PubMed,the Cochrane,CNKI,Wanfang and VIP data,this screening involves a case-control study cohort study of heterotopic pregnancy with both laparoscopy and laparotomy for intrauterine pregnancy outcomes,to extract the relevant data,statistics of postoperative patients with abortion,premature delivery,term delivery and total live birth,RevMan 5.3 was used for analysis.Results A total of 12 articles were included,with a total of 537 patients,including 304 in the laparoscopy group and 233 in the laparotomy group.Total abortion situation(OR=1.91,95%CI:1.05,3.47),the laparoscopy group was higher than the laparotomy group(P=0.03).Live birth(odds ratio[OR]=0.55,95%confidence interval[CI]:0.32,0.93),the laparotomy was better than the laparoscopy group(P=0.03).Preterm delivery(OR=0.98,95%CI:0.62,1.53),full-term delivery(OR=0.80,95%CI:0.55,1.16)there was no statistically significant difference between the two surgical approaches(P>0.05).Conclusions For patients with HP,laparotomy compared with laparoscopy can reduce postoperative intrauterine pregnancy miscarriage and increase postoperative intrauterine pregnancy live birth.Objective:The purpose of this study is to analyze the clinical characteristics of intrauterine and extrauterine heterotopic pregnancy and the effects of laparoscopic and laparotomy on the intrauterine pregnancy outcome of heterotopic pregnancy,so as to provide empirical advice for clinical diagnosis and treatment of heterotopic pregnancy.Method:The clinical medical records of 22 HP patients admitted to the First Affiliated Hospital of Kunming Medical University from January 2016 to December 2020 were analyzed retrospectively.All patients were treated with surgery and were divided into open surgery group(n=7)and laparoscopic surgery group(n=15)according to different surgical methods.The clinical characteristics,surgical methods and intrauterine pregnancy outcomes were analyzed statistically by tracking the cases and telephone follow-up.Results: 1.Among the 22 patients,1 case was conceived by ovulation induction,21 cases were after IVF_ET,among which 2 cases were transplanted with fresh embryos(9.1%)and 19 cases were transplanted with frozen embryos(86.4%).2 cases(9.1%)had a history of basic diseases(including 1 case of hypothyroidism and 1 case of PCOS),13 cases(59.1%)had a history of pelvic and abdominal surgery,and 13 cases(59.1%)had dysmenorrhea.2.The TVS diagnosis time of 22 patients was 35-58 days of pregnancy,with an average of 45.45 days 7.41 days.Vaginal bleeding was the first symptom in 8 cases(36.4%),simple abdominal pain in 1 case(4.5%),abdominal pain and vaginal bleeding in 7 cases(31.8%)and asymptomatic in 6 cases(27.3%).The sites of ET were fallopian tube in 20 cases(90.9%),ovary in 1 case(4.55%)and broad ligament in 1 case(4.55%).Seven patients underwent open surgery(31.8%),with an average operation time of 101.86 21.29 minutes(72-130 minutes).Intraoperative ectopic pregnancy rupture occurred in 3 cases(13%),ET mass ≥ 4cm in 3 cases(13%)and pelvic adhesion in 4 cases(17.4%).Pelvic hematocele ranged from 0 to 0-300 ml,with an average of 135.71 ± 154.69 ml.15 patients underwent laparoscopic surgery(68.2%),and the operation time ranged from 20 to 145 minutes,with an average of 82 37.5minutes.Intraoperative ectopic pregnancy rupture occurred in 4 cases(17.4%),ET mass ≥4cm in 5 cases(21.7%)and pelvic adhesion in 10 cases(43.5%).Pelvic hematocele ranged from 10 to 2000 ml,with an average of 346 ±590.13 ml.3.Among the 7 patients who underwent laparotomy,1 patient(14.3%)stopped developing embryos 2 weeks after operation and underwent induced abortion.Five patients(71.4%)were pregnant and gave birth to one live baby after cesarean section,and the maternal and infant outcomes were good.One newborn(20%)was transferred to pediatric treatment after being bom with hyperbilirubinemia,and all newborns have developed well in physique and intelligence so far.One patient(14.3%)developed gestational diabetes mellitus(GDM)during pregnancy,and one patient(14.3%)is still in pregnancy for 24+ weeks without complications during pregnancy.Of the 15 patients who underwent laparoscopic surgery,7 cases(46.7%)had abortion after operation,2 cases(13.3%)had complications during pregnancy,and 7 cases(46.7%)were pregnant and gave birth to a live baby at fiill term(including 4 cases of natural delivery and 3 cases of cesarean section).All newborns scored well at birth,and their maternal and infant outcomes were safe.No newborn was transferred to pediatrics.All newborns have good physical and mental development up to now,and there are still many newborns.There was no significant difference in the outcome of intrauterine pregnancy after the two operations,including abortion rate,live birth rate,delivery mode and newborn weight(P > 0*05).All newborns had no deformity and normal mental and physical development.Conclusion:Both laparotomy and laparoscopy can effectively treat heterotopic pregnancy,and the operation mode does not affect the outcome of intrauterine pregnancy after operation. |
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