剖宫产瘢痕处双胎异位妊娠患者诊治研究并文献复习  

Diagnosis and treatment research of patient with twin ectopic pregnancy in a previous cesarean scar section:a case report and literature review

作　　者：魏双双 张治芬 李鼎恒 黄坚 金雪静 Wei Shuangshuang;Zhang Zhifen;Li Dingheng;Huang Jian;Jin Xuejing(Department of Obstetrics and Gynecology,Hangzhou Women′s Hospital,Hangzhou 310000,Zhejiang Province,China;Department of Gynecology,Reproductive Endocrinology Center,Hangzhou Women′s Hospital,Hangzhou 310000,Zhejiang Province,China;Department of Gynecology,Hangzhou Women′s Hospital,Hangzhou 310000,Zhejiang Province,China)

机构地区：[1]杭州市妇产科医院妇产科,310000 [2]杭州市妇产科医院妇科、生殖内分泌中心,310000 [3]杭州市妇产科医院妇科,310000

出　　处：《中华妇幼临床医学杂志（电子版）》2021年第4期453-458,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：浙江省科技厅资助项目(LY20H040001);浙江省卫生计生委资助项目(2018248116);杭州市科技发展计划项目(20170533B59)。

摘　　要：目的探讨既往剖宫产瘢痕处双胎异位妊娠(TEPC)患者的临床特征、诊治经过,并进行相关文献复习。方法选择2019年9月24日,杭州市妇产科医院收治的要求终止妊娠的1例TEPC患者为研究对象。采用回顾性分析方法,收集其临床病例资料,进行临床表现和诊治经过分析。同时,以“剖宫产瘢痕妊娠”“双胎妊娠”“cesarean scar pregnancy”“twin pregnancy”为关键词,对中国知网数据库、万方数据知识服务平台、PubMed数据库中,TEPC相关文献进行检索。文献检索时间设定为各数据库建库至2019年12月31日。总结TEPC患者的临床特点及诊治方案。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果①本例要求终止妊娠患者年龄为35岁,2019年9月24日因“外院超声提示异位妊娠”,于本院妇科门诊就诊收治入院,G_(6)P_(2),为剖宫产术分娩后月经尚未来潮,哺乳期意外妊娠患者,入院时为剖宫产术后8个月。入院检查:血清β-人绒毛膜促性腺激素(hCG)为18587 mIU/mL;阴道超声检查可见子宫呈葫芦状,子宫下段2.9 cm×1.7 cm×1.5 cm、1.7 cm×1.6 cm×1.3 cm混合回声暗区,局部向膀胱凸起,孕囊种植瘢痕处肌层厚度仅为0.10 cm,确定孕龄为6+孕周。2019年9月26日,对患者进行双侧子宫动脉栓塞术(UEA),24 h后再进行经腹部超声引导下清宫术,术中出血量为300 mL,术后采取宫腔放置16F气囊压迫止血。术后每周检测1次血清β-hCG水平,第63天时降至<5 mIU/mL。②根据本研究设定的文献检索策略进行检索的结果显示,共计4篇TEPC相关病例报道,纳入TEPC患者为5例。其中3例患者被确诊为TEPC时孕龄较小,采取甲氨蝶呤治疗,2例治疗成功,1例治疗失败后,采取宫腔镜下清宫术;1例因孕囊种植瘢痕处肌层较薄,周围血供丰富,采取经腹部超声引导下清宫术;1例采取宫腔镜下清宫术联合腹腔镜下子宫瘢痕修复术。这5例�Objective To explore clinical features and treatment of patients with twin ectopic pregnancy in a previous cesarean scar section(TEPC),and review relevant literature.Methods One TEPC patient admitted to Hangzhou Women′s Hospital on September 24,2019,who required pregnancy termination was selected as research subject.Clinical data of the patient was collected by retrospective analysis method,and her clinical features,diagnosis and treatment methods were analyzed.With the following key words of"cesarean scar pregnancy""twin pregnancy"both in Chinese and English,literature related to TEPC were searched from China National Knowledge Infrastructure,Wanfang data knowledge service platform and PubMed database.Literature retrieval time was set from construction of each database to December 31,2019.Clinical features,diagnosis and treatment methods of TEPC patients in searched literature were summarized.This study was consistent with the World Medical Association Declaration of Helsinki revised in 2013.Results①This patient with requirement of pregnancy termination was a 35 years old female who was admitted to the gynecological clinic of our hospital on September 24,2019 because of"ectopic pregnancy indicated by ultrasound in other hospital".She was G6P2.She still did not have menstruation after the second cesarean section and was unexpectedly pregnant during lactation.It was 8 months after cesarean section on admission.Serumβ-human chorionic gonadotropin(hCG)after admission was 18587 mIU/mL.Results of transvaginal ultrasound showed that her uterus was gourd shaped,and 2.9 cm×1.7 cm×1.5 cm and 1.7 cm×1.6 cm×1.3 cm mixed echo dark area which were locally protruded to bladder could be found in lower part of uterus,thickness of scar muscle layer where gestational sac planted was 0.10 cm.Her gestational age was 6+weeks.On September 26,2019,she underwent bilateral uterine artery embolization(UEA).And then 24 hours later,she underwent transabdominal ultrasound-guided uterine curettage.The amount of transoperative bleedin

关 键 词：妊娠 多胎 妊娠 异位 妊娠 高危 剖宫产瘢痕妊娠 双胎妊娠 子宫动脉栓塞术 孕妇 

分 类 号：R71[医药卫生—妇产科学]