超声导引下治疗宫角妊娠的临床价值  

Clinical value of ultrasound-guided treatment in cornual pregnancy

作　　者：王炽秋[1] 陈绍光[1] 林卫平[1] 潘爱云 莫璟娟 颜钊波 

机构地区：[1]浙江中医药大学附属温岭市中医院彩超室,317500

出　　处：《临床超声医学杂志》2014年第2期133-135,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声导引下介入治疗在终止宫角妊娠中的价值。方法 78例宫角妊娠患者,23例孕囊大部分位于子宫内,且宫壁肌肉层厚度≥4 mm,超声监护下行吸宫及人流术;55例孕囊或包块不易清除,注射甲氨蝶呤终止宫角妊娠,并随机分为两组。A组28例,甲氨蝶呤肌肉注射;B组27例,超声监测下孕囊或包块内穿刺抽液后注入甲氨蝶呤。结果 23例吸宫及人流术患者,未出现穿孔和大出血,其中5例蜕膜残留超过15 mm。A、B两组治疗后4,7,14 d血β-HCG较治疗前均下降(P<0.05);与A组比较,B组治疗后4,7,14 d血β-HCG下降(P<0.05)。与治疗前比较,A组治疗后14 d包块直径逐渐缩小,B组治疗后4,7,14 d包块直径缩小,差异均有统计学意义(P<0.05)。B组治疗后14 d包块直径较A组小(P<0.05)。结论如果孕囊大部分位于子宫内,宫壁肌肉层厚度≥4 mm,采取超声监护下行吸宫及人流术是安全有效的,但是易残留。而超声监护下孕囊或包块内穿刺注入甲氨蝶呤较肌肉注射甲氨蝶呤疗效好。Objective To explore the value of ultrasound-guided interventional treatment in terminating cornual pregnancy. Methods Seventy-eight patients with cornual pregnancy were studied. Twenty-three patients that gestational sac was in utero and muscle layer thickness of uterine wall was ≥4 mm were performed ultrasound-guided uterine aspiration and artificial abortion. Fifty-five cases were performed termination of pregnancy by methotrexate injection. They were randomly divided into two groups, including group A （treated with methotrexate intramuscular injection, n =28） and group B （treated with methotrexate injection in gestational sac or mass after ultrasound-guided puncture and drainage, n=27）. Results Twenty-three patients with uterine aspiration and artificial abortion had no perforation and bleeding, residual decidua was more than 15mm in 5 cases. In group A and B, serum β -HCG at 4 d,7 d and 14 d after treatment was lower than that before treatment （P〈0.05）. Compared with group A, serum β -HCG at 4 d,7 d and 14 d after treatment decreased obviously in group B （P〈0.05）. Compared with before treatment, mass diameter reduced at 14 d after treatment in group A and reduced at 4 d,7 d and 14 d after treatment in group B （P〈O.05） . 14 d after treatment, mass diameter in group B was smaller than that in group A （P〈0.05）. Conclusion If gestational sac is in utero and muscle layer thickness of uterine wall is ≥ 4 mm, it is safe and effective to perform ultrasound- guided uterine aspiration and artificial abortion, but it is easy to have residual decidua. The effect of ultrasound-guided puncture and methotrexate injection in gestational sac or mass is better than that of methotrexate intramuscular iniection.

关 键 词：超声检查 宫角妊娠 甲氨蝶呤 

分 类 号：R445.1[医药卫生—影像医学与核医学]