体外受精-胚胎移植并发颅内静脉窦血栓1例报道并文献复习

Cerebral venous sinus thrombosis after in-vitro fertilization and embryo transfer:a case report and review of the literature

目的:提高体外受精-胚胎移植(In-vitro fertilization and embryo transfer,IVF-ET)并发颅内血栓形成的诊治水平。方法:报告1例IVF-ET并发颅内静脉窦血栓并获得成功治疗病例的临床资料,结合文献复习讨论IVF-ET并发颅内血栓形成的临床特点、预防和处理。结果:1例继发不孕患者行黄体期长方案IVF,hCG日E2为7083pmol/L,获卵18个,移植3个胚胎。取卵后第14天出现腹水,妊娠试验阳性,第15天出现头痛和颈痛,第17天突发神志不清和左侧偏瘫。MR和MRV证实左侧额叶及右侧额顶叶和颞叶皮层多发梗死灶,上矢状窦、右侧横窦和乙状窦血栓形成。予以降颅压、终止妊娠和低分子肝素处理。8周后患者除左手背精细感觉异常外余完全恢复。结论:IVF-ET并发颅内血栓是一个少见的可能致死或致残的并发症。预防卵巢过度刺激综合征(OHSS)的发生应是避免颅内血栓发生的主要措施。IVF-ET治疗中出现头部和颈部疼痛及任何神经症状,都要详细检查确定是否出现颅内血栓。低分子肝素抗凝可作为其主要的治疗手段。

Objective： To improve the diagnosis and treatment of intracranial thrombosis after in-vitro fertilization and embryo transfer （IVF-ET） cycles in clinical practice. Methods： The clinical data regarding a case of intracranial sinus thrombosis in IVF-ETwere reviewed. Clinical characteristics, prevention and treatment of intracranial thrombosis in IVF-ET were discussed in review of literature. Results： A woman with secondary infertility underwent an IVF cycle with long protocol controlled ovarian hyperstimulation. The oestradial concentration was 7 083 pmol/L on the day of human chorionic gonadotrophin （hCG）. Eighteen oocytes were retrieved and 3 embryos were transferred. Forteen days after ovum pickup, the patient had ascites and the pregnancy test was positive. Two days later, she presented with progressive headache and neck pain. And two more days later, she developed a sudden coma and left hemiparesis. Magnetic resonance image （MRI） showed multiple infarct lesions on the left prefrontal cortex and on the right temporal lobe, and magnetic resonance venography （MRV） showed extensive thrombosis in the superior sagittal, the right transverse and sigmoid sinus. Pregnancy was terminated and low-weight-molecular heparin （LWMH） was used. After 8 weeks, she recovered with only fine sense defect on the backofleft hand. Literatures were also reviewedand the manifestations, relevant causing factors and the methods of prevention and treatment of intracranial thrombosis were discussed after ovarian hyperstimulation and IVF-ET. Conclusion： The complication of intracranial thrombosis in IVF- ET is rare and life-threatening, and may cause neurological sequelae after treatment. Prevention of OHSS may reduce its incidence. Any pain in head or neck and neurologic symptoms following IVF-ET should be watched closely to exclude the possible cerebrovascular thrombosis. Early diagnosis is important for successful treatment. Anticoagulation therapy with LWMH can serve as a major therapy.