子宫肌壁间妊娠的早期识别及临床诊疗策略  

Early diagnosis and management of intramural ectopic pregnancy

作　　者：李琳[1] 成九梅[1] 陈超[1] 王金娟[1] Li Lin;Cheng Jiumei;Chen Chao;Wang Jinjuan(Gynecological Minimal Invasive Center,Beijing Maternity Hospital,Capital Medical University,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心,100006

出　　处：《北京医学》2020年第11期1124-1126,1131,共4页Beijing Medical Journal

摘　　要：目的探讨子宫肌壁间妊娠(intramural pregnancy,IMP)的临床特征、早期识别及诊疗策略。方法选取2016年6月16日首都医科大学附属北京妇产医院收治的1例IMP患者,并成功在宫腔镜下完成肌壁间妊娠组织的切除。通过PubMed检索2000-2018年有关IMP的文献,共检索到37例。总结38例患者的孕周、症状、孕产史、手术史、妊娠囊位置及处理、妊娠结局等资料。结果38例患者的年龄为20~45岁,停经孕周为5~37周,多发生在早孕期,一般<12周。所有患者均无典型临床症状。最常见的导致IMP的高危因素是吸宫或刮宫术史(36.8%),其次为子宫腺肌病和体外受精术(各15.8%)以及剖宫产术(10.5%)等其他手术操作史。胚胎种植部位多位于子宫后壁及宫底(65.8%)。38例患者术前的血β-HCG水平与其临床症状及妊娠结局并无成比例相关性。超声下测量妊娠囊与子宫浆膜层和内膜层的距离有助于治疗方式的选择。结论临床需加强对子宫IMP的认识,包括对临床症状的识别、早期诊断,以避免发生严重的妊娠合并症、保护患者的生育能力。对妊娠囊位置需充分评估,为患者选择最恰当有效的治疗方案。Objective To investigate the clinical characteristics,early diagnosis and treatment of intramural pregnancy(IMP).Methods The data of one case of IMP in Beijing Maternity Hospital,Capital Medical University in 2016 was analyzed,hysteroscopy was performed and the gestational sac was removed completely.A total of 37 cases of IMP could be checked up on PubMed from 2000 to 2018.All of the clinical data of 38 cases were reviewed.Results The age of 38 patients was 20-45 years old.The period of menopause was 5-37 weeks,most of which occursed in early pregnancy,generally<12 weeks.All the patients had no typical clinical symptoms.The most common high-risk factors of IMP were the history of curettage(36.8%),followed by adenomyosis and in ritro fertilization(15.8%,respectively),cesarean section(10.5%)and other kinds of operation.Most of the embryo implantation was in the posterior wall and fundus of uterus(65.8%).The HCG level of 38 patients before operation was not proportional to their clinical symptoms and pregnancy outcome.Ultrasound measurement of the distance between the gestational sac and the serous and en-dometrial layers of the uterus could be helpful for the choice of treatment.Conclusions Fully awareness of the symptoms and adequate assessment on the exact position of the sac could help clinicians to choose reasonable and individual treatment.

关 键 词：宫腔镜 子宫肌壁间妊娠 异位妊娠 诊断 治疗 

分 类 号：R714.22[医药卫生—妇产科学]