疑难输卵管间质部妊娠的诊治探讨  

Diagnosis and treatment of complicated interstitial pregnancy

作　　者：林开清[1] 范华光[1] 许泓[1] 张信美[1] 

机构地区：[1]浙江大学医学院附属妇产科医院,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2008年第6期638-641,共4页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:探讨输卵管间质部妊娠(间质部妊娠)的诊断和治疗方法,旨在为临床诊治提供线索。方法:分析2004年1月至2007年6月收治的4例疑难间质部妊娠患者的临床资料。结果:4例患者术前均误诊且均未生育,其中位年龄为30岁,中位停经时间为48天,术前中位血hCG值为3245.5IU/L。2例患者行腹腔镜检查后确诊为间质部妊娠,其中1例在腹腔镜监护下经宫颈吸刮术;1例吸刮术失败后改行腹腔镜下间质部切开取胚术。另2例患者行宫腔镜检查后确诊为间质部妊娠,并在宫腔镜直视下插管,在胚囊植床部位注入50mgMTX进行局部化疗。4例患者术后血hCG平均13天降至正常,术后3个月B超检查子宫均恢复完整性。结论:可疑间质部妊娠应及早行腹腔镜(或宫腔镜)检查;腹腔镜监护下经宫颈吸刮术(或宫腔镜插管局部化疗),可为要求保留生育功能的间质部妊娠年轻患者提供有效的保守治疗方法。Objective： To review the diagnosis and treatment of interstitial pregnancy. Methods： Four cases with complicated interstitial pregnancy were diagnosed and treated from January, 2004 to June, 2007 at the Affiliated Obstetrics and Gynecology Hospital, College of Medicine, Zhejiang University. The clinical data and follow-up records were analyzed retrospectively. Results： All 4 nulliparous patients were misdiagnosed before operation. The median age was 30 years （25-34 years） ,and the median duration of amenorrhea was 48 days （37-58 days）. The median concentrations of serum beta-hCG were 3245.5 IU/L （282-30729 IU/L）. Two patients with interstitial pregnancy had high levels of beta-hCG, and were diagnosed and treated under laparoscopy. Among them one patient was underwent transcervical curettage under laparoscopic guidance, and another underwent laparoscopic salpingotomy. The remained two patients had low levels of beta-hCG,and were diagnosed and treated under hysteroscopy,50 mg methorexate （MTX）was injected into the implanted sites under hysteroscopic guidance. The levels of serum beta-hCG in 4 patients dropped down quickly, reaching undetected levels at a mean duration of 13 days after operation. Three months postoperatively ,ultrasonic examination revealed the normal contour of uterus. Conclusions： Endoscopic examination is helpful to make a correct diagnosis, and transcervical curettage （or transcatheter chemotherapy ） under laparoscopic guidance （or under hysteroscopic guidance） may be a promising approach for young or nulliparous women with interstitial pregnancy who want to maintain future fertility.

关 键 词：妊娠 输卵管/诊断 妊娠 输卵管/治疗 输卵管间质部妊娠 腹腔镜检查 宫腔镜检查 吸刮术 插管化疗 

分 类 号：R713.8[医药卫生—妇产科学]