子宫肌壁间妊娠临床分析  

Clinical Analysis of Intramural Ectopic Pregnancy

作　　者：彭沙[1] 钱睿亚[1] PENG Sha;QIAN Ruiya(Department of Gynecology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University.Beijing Maternal and Child Health Care Hospital.Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院、北京妇幼保健院妇科,100026

出　　处：《医学研究杂志》2022年第5期141-145,160,共6页Journal of Medical Research

摘　　要：目的探讨子宫肌壁间妊娠的临床特点及诊治方法。方法回顾性分析2013年1月~2020年12月首都医科大学附属北京妇产医院收治的7例子宫肌壁间妊娠患者临床资料。结果7例肌壁间妊娠患者中2例既往有宫腔操作史,5例有盆腹腔手术史,3例为胚胎移植术后,1例合并子宫腺肌病,1例合并双卵巢子宫内膜异位囊肿。7例均有停经史,2例腹痛,4例少量阴道出血,3例无症状。术前3例诊断为肌壁间妊娠,1例诊断为右侧输卵管间质部妊娠,1例诊断为右宫角妊娠,2例诊断为普通异位妊娠。6例患者通过宫腹腔镜或经腹肌壁间妊娠物清除术均保留了子宫完整性,1例宫内合并肌壁间复合妊娠患者经期待治疗病灶逐渐吸收。结论肌壁间妊娠临床表现缺乏特异性,易误诊,对具有高危因素患者应提高警惕,早期诊治有助于保全患者生育力。经阴道超声是首选筛查方法,MRI增加了诊断的准确性,宫腹腔镜联合手术探查可快速明确诊断并治疗。子宫肌壁间妊娠的治疗方案应个体化。Objective To explore the clinical characteristics,diagnosis and treatment of intramural ectopic pregnancy.Methods From January 2013 to December 2020,the clinical data of 7 patients with intramural ectopic pregnancy in Beijing Obstetrics and Gynecology Hospital of Capital Medical University were retrospectively analyzed.Results Among the 7 cases of intramural pregnancy,2 cases had operation history of uterine cavity,5 cases had previous history of pelvic and abdominal surgery,3 cases had history of embryo transfer,1 case was complicated with adenomyosis and 1 case with bilateral ovarian endometriosis cyst.All 7 cases had menopause history,2 cases had abdominal pain,4 cases had vaginal bleeding,and 3 cases had no symptoms.Before operation,3 cases were diagnosed as intramural pregnancy,1 case as tubal interstitial pregnancy,1 case as right horn pregnancy and 2 cases as common ectopic pregnancy.The uterine integrity was preserved in 6 patients after treatment with hysteroscopy,laparoscopy or transabdominal intramural pregnancy clearance.The lesions were gradually absorbed in a patient with intrauterine pregnancy complicated with intramural pregnancy after expected treatment.Conclusion The clinical symptoms of intramural pregnancy are atypical and easy to be misdiagnosed.Patients with high risk factors should be vigilant.Early diagnosis and treatment is helpful to preserve the fertility of patients.Transvaginal ultrasound is the preferred screening method,MRI increases the accuracy of diagnosis.Hysteroscopy combined with laparoscopic exploration is an effective method for the treatment of intramural pregnancy,which can make a quick and definite diagnosis and perform minimally invasive surgery.The treatment of intramural pregnancy should be individualized.

关 键 词：子宫肌壁间妊娠 宫腔镜 腹腔镜 诊断 治疗 

分 类 号：R71[医药卫生—妇产科学]