子宫肌壁间妊娠误诊分析及文献复习

Analysis of misdiagnosis of intramural pregnancy and literature review

目的分析3例子宫肌壁间妊娠(IMP)的临床特征及诊治经过,总结防范IMP误诊的措施。方法收集2020年5月至2022年8月湖北省妇幼保健院诊治的1例误诊为妊娠滋养细胞肿瘤及2例早期宫内妊娠的IMP患者的临床资料,对其临床特征及诊治经过进行回顾性分析。结果3例IMP患者的误诊时间为10d~1个月。1例被误诊为妊娠滋养细胞肿瘤,行宫腹腔镜联合下IMP去除术+诊断性刮宫术。2例被误诊为早期宫内妊娠,分别行宫腔镜下子宫IMP病灶电切术和宫腹腔镜联合下IMP去除术。3例患者术后复查血人绒毛膜促性腺激素(hCG)下降均良好,康复出院。结论IMP患者早期无特异性临床表现,极易漏诊、误诊。当发现血hCG上升、B超检查提示宫内未见孕囊影、既往有人工流产史的患者时,应高度警惕IMP;若超声检查妊娠囊显示不明确,应行磁共振成像(MRI)检查,进一步分辨孕囊与子宫内膜的关系,若超声及MRI检查均无法明确诊断时应及时行手术探查明确诊断,宫腹腔镜联合手术探查可快速明确诊断,并可予以治疗。

Objective To analyze the clinical characteristics,diagnosis and treatment process of 3 cases of intramural pregnancy(IMP),and summarize the measures to prevent misdiagnosis of IMP.Methods Clinical data of 1 case misdiagnosed as gestational trophoblastic tumor and 2 cases misdiagnosed as early intrauterine pregnancy of IMP diagnosed in Hubei Maternal and Child Health Hospital from May 2020 to August 2022 were collected,and their clinical characteristics,diagnosis and treatment process were retrospectively analyzed.Results The misdiagnosis time of 3 IMP patients was 10 days-1 month.One case was misdiagnosed as gestational trophoblastic tumor and underwent uterine laparoscopy combined with subcutaneous IMP removal+diagnostic curettage.Two cases were misdiagnosed as early intrauterine pregnancy and underwent hysteroscopic electroresection of intrauterine IMP and hysteroscopy and laparoscopy combined with subcutaneous IMP removal respectively.All the 3 patients recovered and were discharged from hospital after postoperative reexamination.Conclusions IMP patients have no specific clinical manifestations in the early stage,which is easy to miss diagnosis and misdiagnosis.When the increase of human chorionic gonadotropin(hCG)is found,B-ultrasound examination indicates that there is no pregnancy sac shadow in intrauterine,and there is a history of induced abortion,patients should be highly alert to IMP.If the ultrasound examination showed the pregnancy sac is not clear,magnetic resonance imaging(MRI)should be performed to further distinguish the relationship between the pregnancy sac and the endometrium.If neither ultrasound nor MRI can make a clear diagnosis,surgical exploration should be performed in time to make a clear diagnosis.Hysteroscopy combined with laparoscopy can quickly make a clear diagnosis and can provide treatment.