阴道超声引导胚胎减灭术在少见部位异位妊娠中的应用  

Unusual ectopic pregnancy treated with transvaginal ultrasound-guided fetal reduction

作　　者：马彩虹[1] 乔杰[1] 王丽娜[1] 李蓉[1] 

机构地区：[1]北京大学第三医院生殖医学中心,100083

出　　处：《中国妇产科临床杂志》2007年第5期332-334,331,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的 探讨阴道超声引导胚胎减灭术在少见部位异位妊娠治疗中的应用价值。方法 2005年1月～2006年10月在北京大学第三医院生殖医学中心10例少见部位异位妊娠行阴道超声引导胚胎减灭术，并对治疗结局进行追踪和分析。结果 患者年龄25～37岁，妊娠周数7～8周。宫颈妊娠4例（宫颈合并宫腔内妊娠1例），输卵管间质部妊娠4例，宫角妊娠2例。6例超声显示异位妊娠囊内胎心搏动。hCG水平范围为4826～122300IU／L。术后1周血清hcG升高3例，其余术后血清hCG逐渐下降。1例间质部妊娠术后1周hCG水平升高，行第2次穿刺术时出现腹腔内出血症状和体征，急行腹腔镜探查和一侧输卵管切除术。其余患者血hCG4～8周降至正常，异位病灶3～5个月恢复正常。结论 阴道超声引导胚胎减灭术合并局部注射MTX作为一种微创技术，可安全有效地应用于非常见部位异位妊娠的保守治疗。Objective To describe a series of consecutive cases of unusual ectopic pregnancy managed with ultrasound- guided fetal reduction intraamniotic installation of methotrexate （MTX） or potassium chloride （KCI）. Methods From Jan 2005 to October 2006, ten women with live or unruptured cornual, interstitial or cervical ectopic pregnancies after embryo transfer were diagnosed in our center. Under transvaginal ultrasound guidance, puncture aspiration and injection of MTX or KC1 of the ectopic pregnancy was performed. Results The range of patients age was 25-37 years old. The range of gestation was 7 weeks to 8 weeks and the mean gestation age was 7^＋s weeks. The range of hCG level before treatment was 4 826-122 300 IU/L. Of these 10 ectopic pregnancy cases, 4 were cervical, 4 interstitial pregnancy and 2 cornual. One was cervical pregnancy coexisting intrauterine pregnancy. Serum hCG level increased during first week after procedure in 3 cases, while decreased in 5 cases. Serum hCG level increased more than 30% in one interstitial pregnancy. During second injection of MTX internal bleeding sign was occurred and emergent laparoscopic surgery was performed. In other cases serum hCG recovery after treatment was about 30-60 days. Conclusion Unruptured or live ectopic pregnancies of interstitial, cornual or cervical location can be successfully managed without surgical intervention through transvaginal ultrasound- guided fetal reduction and local injection of KCl or MTX.

关 键 词：少见部位异位妊娠 阴道超声引导胚胎减灭术 体外受精-胚胎移植 

分 类 号：R714.2[医药卫生—妇产科学]