宫颈妊娠16例分析

A study of 16 cases of cervical pregnancy

目的 对宫颈妊娠的诊断和治疗进行探讨。方法 通过对 1993年 10月～ 2 0 0 3年 10月在北京大学人民医院、贵州兴义市黔西南州人民医院住院收治的 16例宫颈妊娠病例做回顾性分析 ,对诊断和治疗结果进行比较。结果 初次就诊时作B超者 12例 ,6例明确诊断 ,余 6例诊断为其他疾病 (难免流产、先兆流产、人工流产不全、粘膜下子宫肌瘤、输卵管妊娠 ) ;初次就诊时未作B超者 4例 ,均误诊为难免流产及先兆流产。16例患者 3例行全子宫切除术 ,采取联合保守性治疗 13例 ,成功 12例。 9例患者采取MTX药物保守治疗 ,发生阴道大出血 4例 ,其中 1例行全子宫切除术 ,而另 3例在应用子宫动脉栓塞治疗后成功止血。结论 B超对宫颈妊娠的早期诊断有重要价值 ;宫颈妊娠大出血时 ,子宫全切术不是治疗的唯一手段 。

Objective To explore the diagnosis and treatment of cervical pregnancy Methods A retrospective study was conducted on sixteen patients with CP who were admitted to the Peking University People's Hospital and the People's Hospital of Southwest of Guizhou from Oct.1993 to Oct.2003.Results Twelve patients underwent transvaginal ultrasonography,six of them were diagnosed correctly,and others were mis-diagnosed to other diseases,such as inevitable abortion,threatened abortion,incomplete abortion,submucous myoma and fallopian tube pregnancy.The other four cases who didn't have transvaginal ultrasonography during their first visiting were diagnosed for inevitable abortion and threatened abortion.Total abdominal hysterectomy was performed in 3 of 16 cases,and the other 13 cases were treated by combined conservative therapy with 12 successful.Methotrexate was used in 9 patients,and great vaginal hemorrhage occurred in 4 cases,one of whom had to receive total abdominal hysterectomy,but the hemorrhage was reduced by uterine artery embolization in other three.Conclusions The transvaginal ultrasonography is an important method in early diagnosis of CP.Total abdominal hysterectomy is not the only treatment to control postevacuation bleeding,uterine artery embolization might be another choice.