宫颈妊娠及宫内孕合并宫颈妊娠的保守治疗  

The conservative therapy of cervical pregnancy and combined intrauterine and cervical pregnancy

作　　者：杨艳[1] 马彩虹[1] 乔杰[1] 郭红燕[1] 韩劲松[1] 

机构地区：[1]北京大学第三医院妇产科生殖医学中心辅助生殖教育部重点实验室,北京100191

出　　处：《现代妇产科进展》2011年第10期792-794,798,共4页Progress in Obstetrics and Gynecology

基　　金：国家杰出青年科学基金(No:308250381);国家教育部博士点专项基金(No:20090001110090)

摘　　要：目的:探讨宫颈妊娠的病因、诊断及保守性治疗方法。方法:回顾分析我院1996年1月1日至2010年12月31日收治的宫颈妊娠及体外授精胚胎移植术后宫内孕合并宫颈妊娠患者36例,探讨宫颈妊娠保守治疗方式的选择,并随访患者术后情况。结果:29例单纯宫颈妊娠:6例外院误诊为"难免流产",误诊率20.69%;10例经阴道B超引导下宫颈妊娠囊局部穿刺+MTX注射治疗,6例行子宫动脉栓塞术,6例MTX肌内注射治疗,7例腰麻下宫腔镜检查宫颈妊娠清除手术。7例宫内孕合并宫颈妊娠:1例阴道B超引导下局部妊娠囊穿刺注入KCl 1ml,3例期待疗法后清除宫颈妊娠物,3例腹部B超引导下宫颈妊娠物清除术。结论:阴道彩超用于宫颈妊娠的早期诊断有较大的价值,术前应充分评估,制定个体化的治疗方案。宫内孕合并宫颈妊娠的患者在腹部B超监测下清除宫颈妊娠物是有效的治疗方式之一,但要及时手术并且加强抗感染治疗。Objective：To explore the etiology,diagnosis and conservative therapy of cervical pregnancy（CP）.Methods：A retrospective study was conducted on 36 cases of cervical pregnancy and combined intrauterine and cervical pregnancy after in vitro fertilization and embryo transfer（IVF-ET）in Peking University Third Hospital from January 1996 to Dec.2010.Results：In cervical pregnancy group,6 patients（20.69%）were misdiagnosed as inevitable abortion.Transvaginal ultrasound-guided aspiration and methotrexate local injection were performed in 10 of the 29 patients with simple cervical pregnancy,and 6 cases were treated by selective uterine artery embolization.Six cases were treated by systemic methitrexate injection,and 7 cases were conducted with hysteroscopy.In the group of combined intrauterine and cervical pregnancy,1 of 7 patients was performed transvaginal ultrasound-guided aspiration and potassium chloride local injection,3 patients selected expectant management and 3 patients were treated by cervical curettage under abdominal ultrasound monitoring.All patients were followed up.Conclusions：The transvaginal ultrasonography is an important method in early diagnosis of CP.We should be made serious preoperative assessment and draw up individual treatment for the cervical pregnancy.Cervical curettage under ultrasonography monitoring is one of the effective methods to treat cervical pregnancy and reserve intrauterine pregnancy simultaneously.

关 键 词：宫颈妊娠 宫内孕合并宫颈妊娠 诊断 保守治疗 

分 类 号：R714.22[医药卫生—妇产科学]