经阴道B超引导下减胎术治疗ART后宫内合并宫角妊娠的效果:7例病例资料及文献复习  

Effect of transvaginal ultrasound-guided fetal reduction for post-ART cornual heterotopic pregnancy:a report of 7 cases and literature review

作　　者：谭丽[1] 徐小娅 齐越凡 张洁[1] 程兰兰 李艳[1] 王梦[1] 项云改[1] 宋玉霞[1] 王亚芹 TAN Li;XU Xiao-ya;QI Yue-fan;ZHANG Jie;CHENG Lan-lan;LI Yan;WANG Meng;XIANG Yun-gai;SONG Yu-xia;WANG Ya-qin(Reproductive Medical Center,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014;Medical Imaging Department,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014)

机构地区：[1]郑州大学第二附属医院生殖中心,郑州450014 [2]郑州大学第二附属医院医学影像科,郑州450014

出　　处：《生殖医学杂志》2022年第2期214-219,共6页Journal of Reproductive Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金[320.6750.18558(9)];郑州市科技局科技惠民计划项目(2019KJHM0009)。

摘　　要：目的探讨阴道B超引导下减胎术治疗ART术后宫内妊娠合并宫角妊娠(CHP)的效果。方法回顾性分析2015年1月至2021年4月在我院生殖中心行体外受精-胚胎移植(IVF-ET)及冻融胚胎移植(FET)治疗后获得妊娠并经B超检查确诊为CHP的7例患者的临床资料,记录患者的年龄、不孕年限、孕产次、输卵管情况、移植胚胎情况及B超检查情况等,分析7例患者的治疗方案和预后情况。结果2015年1月至2021年4月我院生殖中心助孕妊娠患者中CHP发生率为0.072%。7例患者均行减胎术治疗,其中2例采用腹腔镜监控下经阴道B超引导宫角异位妊娠减胎术,5例直接采用经阴道B超引导下选择性宫角妊娠减胎术。7例患者均1次减胎成功,无术中大出血症状,其中6例孕足月行剖宫产,1例孕36 W因胎膜早破行剖宫产,新生儿出生情况均良好,Apgar评分8~10分。结论采用经阴道B超引导下抽吸减胎术治疗CHP可以有效终止宫角妊娠和保留宫内妊娠,且具有手术时间短、创伤小、恢复快等优点,可作为CHP治疗的可选术式之一。Objective:To investigate the effect of transvaginal ultrasound-guided fetal reduction in the treatment of cornual heterotopic pregnancy(CHP)after assisted reproductive technology(ART).Methods:The clinical data of 7 patients who got pregnancy(diagnosed as CHP by B-ultrasound)after frozen-thawed embryo transfer(FET)and IVF-ET treatment in our fertility center from January 2015 to April 2021 were retrospectively analyzed.The age,infertility years,gravidity&parity,the status of fallopian tube,embryo transfer and B-ultrasound examination of the patients were collected,and the treatment scheme and prognosis of 7 patients were analyzed.Results:From January 2015 to April 2021,the incidence of CHP in assisted pregnancy patients in the reproductive center of our hospital was 0.072%.Seven patients were treated with fetal reduction,2 patients were treated with laparoscopic transvaginal B-ultrasound-guided fetal reduction of ectopic cornual pregnancy,and 5 patients were treated directly with transvaginal B-ultrasound-guided selective cornual pregnancy reduction.The fetal reduction was successful in all 7 patients at one time without symptoms of massive intraoperative hemorrhage.Six patients were delivered by cesarean section at full term,and one patient was delivered by cesarean section due to premature rupture of membranes at 36 weeks of gestation.All the newborns were born in good condition with Apgar score of 8-10.Conclusions:Transvaginal B-ultrasound-guided aspiration for fetal reduction in the treatment of CHP can effectively terminate cornual pregnancy and retain intrauterine pregnancy,and has the advantages of short operation time,less trauma and rapid recovery.It can be used as one of the optional methods for treatment of CHP.

关 键 词：宫内妊娠合并宫角妊娠 体外受精-胚胎移植 腹腔镜 选择性减胎术 

分 类 号：R714.22[医药卫生—妇产科学] R711.6[医药卫生—临床医学]