子宫肌壁间妊娠诊治分析

Diagnosis and treatment of intramural uterine pregnancy

目的探讨子宫肌壁间妊娠的临床表现、发病因素、诊断及治疗方案。方法回顾性分析2002年1月至2020年1月福建省妇幼保健院收治的11例子宫肌壁间妊娠患者的病史及诊治经过,探讨子宫肌壁间妊娠的病因、诊断及治疗方案。结果11例患者中9例被误诊为宫内妊娠、宫角妊娠、输卵管妊娠或妊娠滋养细胞疾病。3例接受药物保守治疗,其中1例中转手术;8例接受宫腹腔镜手术治疗。11例患者治疗后血人绒毛膜促性腺激素(β-hCG)均降至正常范围。结论子宫肌壁间妊娠无特异的临床表现,对于有子宫手术史,而影像学检查提示子宫肌层占位的患者应高度警惕,宫腹腔镜探查可明确诊断同时清除病灶。

Objective To identify the clinical features,risk factors,diagnosis and treatments of the intramural uterine pregnancy.Methods The medical history,diagnosis and treatment process on 11 patients with intramural uterine pregnancy admitted to Fujian maternal and child health care hospital from January 2002 to January 2020 was conducted to explore the etiology,diagnosis and treatment of intramural uterine pregnancy.Results Nine of the 11 patients were misdiagnosed as intrauterine uterine pregnancy,cornual pregnancy,tubal pregnancy or gestational trophoblastic disease.Three patients received conservative medical treatment,but 1 of them was converted to surgery,8 received hysteroscopy combined with laparoscopy surgery.After treatment,the levels of blood human chorionic gonadotropin of 11 patients decreased to the normal range.Conclusion There are no specific clinical manifestations of intramural uterine pregnancy.More attention should be paid to patients with uterine operation history,and imaging examination indicates uterine myometrial mass.Hysteroscopy combined with laparoscopy can make a definite diagnosis and resect the lesions at the same time.