宫颈妊娠32例临床分析

Clinical analysis of 32 cases of cervical pregnancy

目的分析宫颈妊娠的临床特征,探讨安全、有效和经济的治疗措施。方法回顾性分析2013年1月~2016年12月本院32例宫颈妊娠的病例资料,统计宫颈妊娠的临床症状、体征、B超、血HCG、Hb结果及治疗方案等。结果在本院收治的异位妊娠患者中,宫颈妊娠占异位妊娠的0.41%。32例宫颈妊娠患者中,阴道出血29例,非贫血和失血性贫血各16例,输血治疗8例。直接B超下清宫14例,子宫动脉灌注MTX化疗栓塞+B超下清宫12例,其他方案6例。所有患者均成功保留子宫。结论血HCG不高(<20 000 m IU/ml),且阴道出血不多者,在有介入条件的医院推荐直接B超下清宫术;血HCG较高者(>20 000 m IU/ml)或阴道出血多者,推荐双侧子宫动脉灌注MTX化疗栓塞后1~3天行B超下清宫术,安全有效。

Objective To analyze the clinical characteristics of cervical pregnancy and explore the safe and effective and economical treatment measures.Methods The clinical data of 32 cases of cervical pregnancy in our hospital from January 2013 to December 2016 were analyzed retrospectively.The clinical symptoms,signs,results of ultrasound,HCG and Hb and treatment schemes of cervical pregnancy were counted.Results Cervical pregnancy accounted for 0.41%of ectopic pregnancy.In 32 cases,there were 29 cases of vaginal bleeding,16 cases of non-anemia,16 cases of hemorrhagic anemia and 8 cases of transfusion.Complete curettage of uterine cavity was directly performed for 14 cases under the guidance of ultrasound.The 12 cases were embolised by MTX chemotherapy in uterine artery,and then complete curettage of uterine cavity was performed under the guidance of ultrasound.6 cases were treated with other programmes.The uterus was preserved successfully.Conclusion For patients with low blood HCG(less than 20 000 mIU/ml)and with a little vaginal bleeding,complete curettage of uterine cavity directly under the guidance of ultrasound is recommended,which is desirable in hospitals with vascular intervention conditions.For patients with high blood HCG(more than 20 000 mIU/ml)or multiple vaginal bleeding,complete curettage of uterine cavity under the guidance of ultrasound after the bilateral uterine artery perfusion MTX chemoembolization for 1 to 3 days is recommended,which is safe and effective.