宫颈妊娠的诊断与治疗  

Diagnosis and treatment of cervical ectopic pregnancy

作　　者：连成瑛[1] 陈秀娟[1] 黄小琛[1] 林元[1] 刘晓青[1] 倪翊华[1] 熊秀梅[1] 陈清香 LIAN Cheng-Ying;CHEN Xiu-Juan;HUANG Xiao-Chen(Fujian Provincial Maternity and Children Hospital,Affiliated Hospital of Fujian Medical University,Fujian,Fuzhou 350001,China)

机构地区：[1]福建省妇幼保健院福建医科大学附属医院,福建福州350001 [2]福建医科大学研究生院,福建福州350001

出　　处：《中国妇幼保健》2018年第22期5070-5073,共4页Maternal and Child Health Care of China

基　　金：福建省临床重点专科建设项目资助(2012149)

摘　　要：目的探讨宫颈妊娠的早期诊断和不同治疗方法的临床疗效,为宫颈妊娠的诊断和治疗提供理论依据。方法选取2006年1月-2015年12月福建省妇幼保健院诊治的34例宫颈妊娠患者为研究对象,回顾性分析其临床资料。根据首治方案分为直接清宫术组、甲氨蝶呤(MTX)治疗+/-清宫术组和子宫动脉栓塞(UAE)+清宫术组。电话随访所有保留生育功能的患者。结果急/误诊患者输血及子宫切除风险明显高于非急/误诊患者,差异有统计学意义(P<0. 05)。直接清宫术组、MTX治疗+/-清宫术组和UAE+清宫术组治疗成功率、手术出血量<200 ml患者比例、住院时间和住院费用比较,差异均有统计学意义(均P<0. 05)。34例研究对象有30例患者保留生育功能,随访到17例,继发不孕率为38. 5%。结论宫颈妊娠早期诊断是治疗的关键,UAE联合清宫术治疗安全有效; MTX治疗联合清宫术需在备有开腹或UAE条件下进行。宫颈妊娠保留生育功能治疗后需加强再生育管理。Objective To investigate the early diagnosis and the efficiency of different methods in treating cervical eetopic pregnan- cy. Methods The clinical data of 34 patients with cervical ectopie pregnancy who were treated in Fujian Provincial Maternity and Children Hospital from January 2006 to December 2015 were retrospectively reviewed. They were divided into 3 groups as curettage directly group （Curettage group） , methotrexate （MTX） injection with or without curettage gruup （MTX group） and curettage after uterine artery embo- lization （UAE） group （UAE group） according to the first treatment. All fertility- preserving patients were followed- up by tele- phone. Results The risk of blood transfusion and hysterectomy in patients with emergency or misdiagnosis was significantly higher than that of non-emergency or misdiagnosis （P〈0. 05） . Among all 3 groups, therapeutic success rate, blood loss less than 200 ml, hospitalization time and hospitalization cost showed statistically significant difference （P〈0. 05） .30 cases had fertility requirements, 17 cases of them were followed up, the incidence of infertility after fertility preservation was 38.5%. Conclusion Early diagnosis is the key to the treatment of cervical ectopic pregnancy. UAE combined with curettage is safe and effective. The preparation of laparotomy or UAE is necessary to MTX combined with curettage. The management should be strengthened after treatment of fertility oreservation.

关 键 词：宫颈妊娠 诊断 治疗 子宫动脉栓塞 甲氨蝶呤 

分 类 号：R714.266[医药卫生—妇产科学]