输卵管间质部妊娠的临床诊治特点  

Clinical Diagnosis and Treatment of Tubal Interstitial Pregnancy

作　　者：王新燕[1] 赵双一 褚丹霞 郭瑞霞[2] WANG Xinyan;ZHAO Shuangyi;CHU Danxia;GUO Ruixia(Department of Obstetrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院产科,河南郑州450052 [2]郑州大学第一附属医院妇科,河南郑州450052

出　　处：《河南医学研究》2023年第14期2535-2538,共4页Henan Medical Research

摘　　要：目的探讨输卵管间质部妊娠的临床特点及诊疗方法。方法收集2019年10月至2022年3月郑州大学第一附属医院收治的80例输卵管间质部妊娠孕妇的临床资料,对其年龄、诊断孕周、血人绒毛膜促性腺激素(HCG)水平、受孕方式、孕产史、临床表现、诊断、治疗方法及结局进行分析。结果(1)一般情况:患者年龄为21~44(32.25±4.61)岁,确诊间质部妊娠的孕周为5~13(7.67±1.56)周。(2)临床表现:80例输卵管间质部妊娠妇女中,临床表现停经后阴道流血者共30例,占总人数37.50%;停经后有腹痛者33例,占41.25%;无临床症状(腹痛、阴道流血)仅超声发现者17例,占21.25%。(3)80例患者中,初次妊娠16例,初次妊娠者中,有盆腔手术、宫腔操作史者9例;2次及以上妊娠次数者64例,有异位妊娠史者13例,有分娩史者共51例,剖宫产史者30例,自然分娩史者21例。(4)受孕方式:通过体外受精-胚胎移植技术受孕者21例,自然受孕59例。(5)治疗结局:80例患者中,1例经甲氨蝶呤药物治疗成功,2例经甲氨蝶呤药物治疗失败后转腹腔镜手术治疗。最终79例经腹腔镜手术治疗,均无持续性宫外孕发生。结论输卵管间质部妊娠发病高危因素同其他异位妊娠,但临床表现不同,术前超声影像学诊断有一定的误诊率,由于解剖位置相近,更易误诊为宫角妊娠,输卵管间质部妊娠一经诊断,应尽早手术治疗。Objective Investigate the clinical characteristics,diagnosis and treatment of tubal interstitial pregnancy.Methods The clinical data of 80 pregnant women with tubal interstitial pregnancy admitted to the First Affiliated Hospital of Zhengzhou University from October 2019 to March 2022 were collected.The age,diagnostic gestational age,blood human chorionic gonadotropin(HCG)level,method of conception,pregnancy history,clinical manifestations,diagnosis,treatment and outcome were analyzed.Results(1)General information.The mean age of patients was 21-44(32.25±4.61)years old,and the mean gestational age of confirmed interstitial pregnancy was 5-13(7.67±1.56)weeks.(2)Clinical manifestations.In 80 cases of tubal interstitial pregnancy,30 cases of clinical manifestations of vaginal bleeding after menopause,accounting for 37.50%of the total number,and 33 cases(41.25%)had abdominal pain after menstruation.There were 17 cases(21.25%)with no clinical symptoms(abdominal pain,vaginal bleeding)found only by ultrasound.(3)Among the 80 patients,there were 16 cases of the first pregnancy,and 9 cases of the first pregnancy had pelvic operation or uterine operation history.There were 64 cases with two or more pregnancies,13 cases with ectopic pregnancy history,51 cases with history of childbirth,30 cases with history of cesarean section and 21 cases with history of natural childbirth.(4)Methods of conception.Twenty-one cases were conceived by in vitro fertilization and embryo transfer technology,and 59 cases were conceived naturally.(5)Treatment outcome.Among the 80 patients,1 case was successfully treated with methotrexate,and 2 cases failed,and then transferred to laparoscopic surgery.In the end,79 cases were treated by laparoscopic surgery,and no persistent ectopic pregnancy occurred.Conclusion The clinical manifestations of tubal interstitial pregnancy are different from those of other parts of tubal pregnancy.Because of the anatomical position,it is easily misdiagnosed as horn pregnancy.Imaging examination of early pregnancy i

关 键 词：异位妊娠 输卵管妊娠 输卵管间质部妊娠 

分 类 号：R714.22[医药卫生—妇产科学]