宫内早孕合并宫角妊娠腹腔镜手术后宫角妊娠物残留一例

A Case Report of Cornual Heterotopic Pregnancy Remained Pregnancy Residue on Uterine Angle after Laparoscopic Surgery

宫内外同时妊娠(heterotopic pregnancy,HP)是指宫腔内妊娠和异位妊娠同时存在的一种病理妊娠。其中,宫内合并宫角妊娠(cornual heterotopic pregnancy,CHP)是一种对母胎危害极大的罕见类型之一。CHP的治疗包括期待治疗、减胎术及手术治疗,目前尚未完全统一。2018年5月收治1例行体外受精-胚胎移植术(IVF-ET)后27 d经三维超声诊断为CHP的患者。于ET术后37 d通过腹腔镜手术清除宫角妊娠物,但术后多次超声提示宫角妊娠物残留。经整个孕期的严密随访,最终获得宫内妊娠活产及良好的母体结局。该病例提示CHP患者选择治疗方案前应权衡不同治疗手段的利弊,孕期做到严密随访,以获得良好的母胎结局。

Heterotopic pregnancy(HP)is a pathological pregnancy defined as the coexistent intrauterine and cornual heterotopic pregnancy(CHP),which is a rare type that can cause serious harm to both the intrauterine pregnancy and mother.The treatment of CHP was not completely unified,including expected treatment,fetal reduction and surgical treatment.In May 2018,a patient with CHP was diagnosed in our hospital by three-dimensional ultrasound at 27 days after in vitro fertilization-embryo transfer(IVF-ET).Laparoscopic surgery was performed at 37 days to remove the horn pregnancy,but ultrasound showed the pregnancy residue on cornua uteri after surgery.The live birth of intrauterine pregnancy and good maternal outcome were finally obtained.This case suggested that the advantages and disadvantages of various treatments should be carefully considered,and that those patients should be closely following up during pregnancy,in order to achieve good maternal and fetal outcomes.