宫颈妊娠27例治疗策略分析

Analysis of Management Strategy of 27 Cases of Cervical Pregnancy

目的探讨宫颈妊娠治疗策略。方法对27例宫颈妊娠病例临床特点、诊断和治疗进行回顾性分析。结果17例采用氨甲喋呤(MTX)化学治疗(简称化疗),其中3例失败改手术治疗;5例直接行全子宫切除术;5例经导管行双侧子宫动脉栓塞并局部加MTX化疗。27例均达到预期疗效。结论若阴道出血多,对勿需保留生育功能的年长者,直接行全宫切除,迅速有效;对需保留生育功能者,可采用介入治疗行子宫动脉栓塞并局部加MTX化疗;若出血不多,可单纯采用MTX化疗,化疗的成功率取决于血βHCG值、孕嚢大小及有无胎心搏动。

Objective To investigate the management strategy of cervical pregnancy. Methods Clinical features, diagnosis and treatment of 27 cases of cervical pregnancy were retrospectively analyzed. Results In 17 cases treateded with chemotherapy, 3 were failed and subjected to surgical treatment, 5 cases were treated with hysterectomy, and 5 cases were treated with uterine arterial embolism in combination with chemotherapy. All 27 cases achieved expected effects. Conclusion Hysterectomy is a quick and effective management for elder women who needn＇t reserve birth function; For women with serious vaginal hemorrhage who want reserve birth function, uterine arterial embolism with chemotherapy is recommended, In the women without serious vaginal hemorrhage, simple chemotherapy is performed and the effects depend on titre of blood β-HCG, size of pregnancy sac and embryocardia beating.