宫颈妊娠的诊治分析

The diagnosis and treatment of cervical pregnancy

目的 探讨宫颈妊娠的诊治方法。方法 回顾性分析宫颈妊娠病例 9例 ,行全子宫切除术 3例占 3 3 .3 3 % ;保守治疗 6例 ,其中行MTX全身化疗 3例 ,行 5 Fu宫颈局部多点注射化疗 1例 ,行超选择性双侧子宫动脉灌注MTX +栓塞术 2例 ,均 1周后在B超监视下行钳刮术。并探讨误诊原因。结果 6例经保守治疗后血 β HCG明显下降 ,钳刮顺利 ,出血很少 ,效果满意。 结论 妊娠妇女体检时如出现宫颈增大、子宫正常体征 ,考虑宫颈妊娠的可能 ,借助B超检查 ,能早期明确诊断 ,避免盲目刮宫所致大出血发生。宫颈妊娠的保守治疗方法中 ,全身或局部化疗、子宫动脉栓塞术安全 ,疗效确切 ,既避免了手术损伤 。

Objective To investigate the diagnosis and treatment of cervical pregnancy.Methods 9 cases of cervical pregnancy treated in our hospital in recent 10 years were analysed retrospectively.Among the 9 cases,3 cases underwent hysterectomy because of uncontrollable profuse bleeding and shock;6 cases were treated conservatively,3 cases of which were given systemic chemotherapy with MTX,1 case of which was given mutiple injection in cervix localization with 5 Fu,2 cases of which were given superselective uterine artery embolization.The removal of gestional material was fulfilled successfully under the surveillance of B US one week after the conservative therapy.The reasons of misdiagnosis were also analysed.Results There was remarkable decrease of serum β HCG level after the conservative therapy,and a smooth removal of gestional material with less bleeding and satisfactory result.Conclusion For the routine examination of pregnant women,the possibility of cervical pregnancy should be consideredwhen enlarged cervix and normal uterus are found it should be checked by B US to assure early diagnosis and correct treatment.As for the conservative therapy of cervical pregnancy,systemic or local chemotherapy and uterine artery embolization are safe and effective.