超声引导下宫腹腔镜联合治疗子宫斜隔妊娠一例并文献复习

A Case Report of Treatment of Pregnancy in Robert Uterus with Hysteroscopy Combined with Laparoscopy Guided by Ultrasound

子宫斜隔又名Robert子宫,为阻塞型苗勒管发育畸形,隔板的下端与一侧子宫壁融合,使该侧宫腔封闭,其在子宫畸形中较为罕见。Robert子宫通常是宫腔被纵隔分为两腔,纵隔偏向宫腔一侧,多在青春期和月经来潮后由于宫腔积血不断增多产生进行性加重痛经而发现,部分病例痛经不是特别明显。临床上着床于斜隔内的妊娠更为罕见,且多存在漏诊、误诊等情况。本例患者停经41 d,查血人绒毛膜促性腺激素(hCG)3 077.83 mIU/mL,妇科彩色超声示:右侧肌壁不均回声团——输卵管间质部妊娠待除外(大小约1.6 cm×0.9 cm×1.2 cm,内可见一大小为0.5 cm×0.4 cm×0.4 cm暗区,与宫腔不相通);盆腔积液,行宫腔镜下诊断性刮宫,术后3 d复查hCG为10 220.12 mIU/mL,行超声引导下宫腹腔镜联合手术,最终诊断为子宫斜隔妊娠。本例患者诊治经验对临床异常妊娠处理及诊断流程有一定参考价值,为减少罕见异常妊娠漏诊、误诊提供了临床经验。

The oblique septum of uterus,known as Robert′s uterus,is an developmental malformation of obstructive Mullerian tube.The lower end of the septum is fused with one side of the uterine,and this part of uterine cavity is closed.It is rare in uterine malformations.Robert′s uterus is usually divided into two cavities by mediastinum.Mediastinum is inclined to one side of the uterine cavity.It is often found after menarche in puberty,because of the progressive dysmenorrhea occurs due to the increasing blood accumulation in the uterine cavity.Dysmenorrhea is not particularly obvious in some cases.Clinically,the pregnancy implanted in the oblique septum is more rare,and some of them are misdiagnosed.After 41 days of menopause,the hCG of the patient′s blood was 3077.83 mIU/mL.Gynecological sonography showed that there was an uneven echo mass on the right muscle wall-tubal interstitial pregnancy is not excluded.The size was about 1.6 cm×0.9 cm×1.2 cm,and there was a dark area with a size of 0.5 cm×0.4 cm×0.4 cm,which was not connected to the uterine cavity.Hysteroscopy and dilatation and curettage were performed.Three days later,the retested hCG is 10220.12 mIU/mL,ultrasound-guided hysteroscopy combined with laparoscopic surgery was performed,the final diagnosis of oblique septal pregnancy.The diagnosis and treatment experience of this case has a certain reference value for the treatment and diagnosis process of clinical abnormal pregnancy and provides clinical experience for reducing missed diagnosis and misdiagnosis of rare abnormal pregnancy.