宫颈妊娠的诊断和治疗

Diagnosis and Treatment of Cervical Ectopic Pregnancy

目的总结宫颈妊娠的诊断和治疗经验。方法回顾性分析1990年1月至2009年11月在北京协和医院就诊的27例宫颈妊娠患者的临床资料,比较3种保留生育功能治疗方法的疗效。结果 27例患者中,1例行全子宫切除;26例选择保留生育功能治疗,其中14例行子宫动脉栓塞(UAE)后刮宫术,8例直接行刮宫术,4例行甲氨蝶呤(MTX)保守治疗后刮宫。UAE+刮宫术组、直接刮宫术组和MTX+刮宫术组的治疗成功率分别为100%、75.0%和50.0%,UAE+刮宫术组明显高于MTX+刮宫术组(P=0.005)。MTX+刮宫术组的住院时间为(17.0±3.2)d,明显长于UAE+刮宫术组的(6.1±2.9)d(P=0.004)和直接刮宫术组的(4.9±3.4)d(P=0.001)。3组的平均住院费用差异无统计学意义(P=0.104)。结论对于明确诊断或高度可疑宫颈妊娠的患者,选择UAE后刮宫是一种安全有效的治疗方法。

Objective To investigate the diagnosis and treatment of cervical ectopic pregnancy.Methods The clinical data of 27 patients with cervical ectopic pregnancy who were treated in Peking Union Medical College Hospital from January 1990 to November 2009 were retrospectively reviewed.The clinical effectiveness of three fertility-preserved treatment modes were compared.Results Of these 27 patients,one underwent hysterectomy,while all the other 26 patients selected fertility-preserved treatment,which included curettage after uterine artery embolization（UAE）（n=14）,curettage directly（n=8）,and curettage after methotrexate（MTX）injection（n=4）.The effectiveness rates of these three methods were 100%,75.0%,and 50.0%,respectively,which was significantly higher in curettage after UAE group than in curettage after MTX group（P=0.005）.The duration of hospitalization was（17.0±3.2）days in curettage after MTX group,which was significantly longer than that in curettage after UAE group（6.1±2.9）d（P=0.004）and curettage directly group（4.9±3.4）d（P=0.001）.The mean hospitalization cost showed no significant difference among three groups（P=0.104）.Conclusion Curettage after UAE is safe and effective for patients diagnosed or highly suspicious of cervical pregnancy.