宫角妊娠36例临床分析  

Clinical analyses of 36 cases of cornual pregnancy

作　　者：彭萍[1] 成宁海[1] 石英[2] 沈铿[1] 

机构地区：[1]中国医学科学院北京协和医院妇产科,北京100730 [2]山东省莱州市人民医院生殖中心

出　　处：《解放军医学杂志》2007年第5期531-532,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨宫角妊娠的临床特点、诊断和治疗方法。方法对1990年1月～2006年8月北京协和医院收治的36例宫角妊娠进行回顾性分析。结果在1717例异位妊娠中,宫角妊娠共36例,占2%,临床表现为停经(100%)、不规则阴道出血(44%)和腹痛(39%)。宫角妊娠术前诊断困难,误诊率达50%,易被误诊为输卵管间质部妊娠、绒癌。36例患者中1例(3%)观察治疗,9例(25%)在B超或腹腔镜监测下行清宫术,5例(14%)行全子宫切除术,16例(44%)行开腹或腹腔镜下宫角和/不和同侧输卵管切除术,5例(14%)行开腹或腹腔镜宫角妊娠物清除术。36例患者均预后良好,随访有3例宫内妊娠。结论宫角妊娠的诊断主要依据B超,治疗以手术为主,治疗方案应个体化。Objective To determine the clinical characteristics, diagnosis and treatment of angular intrauterine pregnancy. Methods During the study period from Jan. , 1990 to Aug. , 2006, Thirty-six patients with angular intrauterine pregnancy were analyzed retrospectively focusing on clinical characteristics, diagnostic methods and treatment. Results Thirty six angular intrauterine pregnancy. were incurred, with an incidence of 2%. The clinical characteristics of angular intrauterine pregnancy were cessation of menstruation （100%）, vaginal bleeding （44%） and abdominal pain （39%）. The incidence of hemorrhage shock was 8%. Angular intrauterine pregnancy was often misdiagnosed as interstitial tubal pregnancy and chorioma carcinoma, so the preoperative diagnosis was difficult. The incidence of misdiagnosis was 50%. Relying on preoperative B ultrasound, 53% patients were diagnosed angular intrauterine pregnancy, 29% patients had adnexal mass or mass close to uterus, and 15% patients had pathological changes in uterus and 3% patients were normal 17 patients received dilatation and curettage and no embryo was found in 14 patients. The negative incidence was 82%. One patient （3 % ） was observed, Nine patients （25 %）received dilatation and curettage under B ultrasound or laparoscopy, five patients （14 % ） received hysterectomy, sixteen patients （44%） received cornulrectomy transabdominal or laparoscopy and gestational objection were eliminated form five patients （14%） transabdominal operation or laparoscopy. All thirty-six patients of angular intrauterine pregnancy had optimal results and 3 cases have pregnancy in uterus during follow-up. Conclusion Angular intrauterine pregnancy was rare and the incidence of misdiagnosis was high. If misdiagnosed, its results were relatively severe. The diagnosis of angular intrauterine pregnancy mainly relied on preoperative B ultrasound. Operation was the main treatment and personal treatment was individualized.

关 键 词：异位妊娠 诊断 误诊 治疗 宫角妊娠 

分 类 号：R714.224[医药卫生—妇产科学]