流产后包块型宫角妊娠治疗方法临床分析  

Clinical analysis of treatment methods for mass-type cornual pregnancy after abortion

作　　者：胡乔飞[1] 罗岚蓉[1] 陈素文[1] 李长东[1] 李坚[1] Hu Qiaofei;Luo Lanrong;Chen Suwen;Li Changdong;Li Jian(Department of Reproduction Regulation,Beijing Obsetrics and Gynecology Hospital,Capital Medical Uniersity,Beijing Maternal and Child Health Care Hospital,Beijing 100006,P.R.China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院生殖调节科,北京100006

出　　处：《中国计划生育和妇产科》2022年第9期62-65,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：北京市医院管理中心临床医学发展专项经费资助(项目编号:ZYLX201830);北京市医院管理中心"登峰"计划专项经费资助(项目编号:DFL20191401)。

摘　　要：目的 探讨流产后包块型宫角妊娠的治疗方法。方法 回顾性分析2016年2月至2022年2月在北京妇产医院治疗的16例流产后包块型宫角妊娠患者的临床资料,分析不同治疗方式的临床疗效。结果 (1) 16例患者中,腹腔镜下宫角切开术+子宫修补+宫腔镜检查2例;腹腔镜或B超监测下宫腔镜下宫角胚物切除术11例;药物保守治疗3例。所有患者均治疗成功,无失血性休克及子宫切除。(2) 13例患者在宫腹腔镜下完成手术,无中转开腹,手术时间(48.1±10.5)min,术中出血量(57.3±30.0)mL,术后阴道流血时间(8.5±2.9)d,β-hCG恢复正常时间(14.5±6.4)d。(3) 3例药物保守治疗的患者均未生育且均有输卵管手术史,术前血β-hCG(365.8±215.6)IU/L,病灶最大径线(2.7±0.6)cm;住院时间(12.7±4.7)d,β-hCG恢复正常时间(46.0±25.5)d,包块消失时间7~8个月。结论 流产后包块型宫角妊娠可根据个体化原则选择手术治疗或药物保守治疗,宫腹腔镜联合手术治疗是较安全、有效的治疗方法;如患者药物保守治疗意愿强烈,结合其妇科手术病史,血hCG<500 IU/L~1 000 IU/L,包块<3 cm也可以考虑在严密监测下行药物保守治疗。Objective To explore the treatment methods of mass-type cornual pregnancy after abortion.Methods The clinical data of sixteen patients with mass-type cornual pregnancy after abortion treated in Beijing Obstetrics and Gynecology Hospital from February 2016 to February 2022 were retrospectively analyzed, and the clinical effects of different treatment methods were analyzed.Results(1)16 cases of cornual pregnancy were eligible.Laparoscopic cornuostomy was performed in 2 cases, 11 cases underwent hysteroscopic embryonectomy for cornual pregnancy under laparoscopic or B-ultrasound monitoring, and 3 cases were treated conservatively with drugs.All patients were successfully treated without hemorrhagic shock and hysterectomy.(2) The 13 cases completed the operation under hysteroscopy and laparoscopy without conversion to laparotomy.The operation time was(48.1±10.5)min, the intraoperative blood loss was(57.3±30.0)mL,the postoperative vaginal bleeding time was(8.5±2.9)days, and the β-hCG recovery time was(14.5±6.4)days.(3) 3 patients treated conservatively with drugs had no children and had a history of fallopian tubal surgery.Preoperative blood β-hCG was(365.8±215.6) IU/L,and the maximum diameter of the lesion was(2.7±0.6)cm.The hospital stay was(12.7±4.7)days, the time for β-hCG to return to normal was(46.0±25.5)days, and the time for mass disappearance was 7~8 months.Conclusion Mass-type cornual pregnancy after abortion can be treated surgically or conservatively with drugs according to the principle of individualization.Hysteroscopy combined with laparoscopy is a safe and effective treatment.If the patient’s desire for conservative medication is strongly combined with her gynecological history, medication can be done under close monitoring with blood β-hCG<500 IU/L~1 000 IU/L and mass <3 cm.

关 键 词：包块型宫角妊娠 流产后 治疗 

分 类 号：R714.22[医药卫生—妇产科学]