目的:探讨宫内合并输卵管间质部妊娠的腹腔镜治疗及妊娠结局。方法:回顾性分析我院腹腔镜治疗IVF-ET后宫内合并输卵管间质部妊娠21例,比较采用宫角切开取胚术(16例)与宫角切除术(5例)的治疗及妊娠结局。结果:21例患者总的手术时间为58.5...目的:探讨宫内合并输卵管间质部妊娠的腹腔镜治疗及妊娠结局。方法:回顾性分析我院腹腔镜治疗IVF-ET后宫内合并输卵管间质部妊娠21例,比较采用宫角切开取胚术(16例)与宫角切除术(5例)的治疗及妊娠结局。结果:21例患者总的手术时间为58.5±6.3分钟,术中出血量52.9±5.8 ml,术后住院时间4.7±0.4天。两组患者在异位妊娠包块破裂率、手术时间、术中出血量、术后住院时间及足月产率差异均无统计学意义(P>0.05)。接受宫角切除术患者的异位妊娠包块平均直径大于接受宫角切开取胚术患者(2.5 cm vs 3.6 cm)。17例患者术后顺利分娩,除1例顺产外均行剖宫产,其中足月产11例,无一例患者发生子宫破裂。结论:腹腔镜治疗宫内合并输卵管间质部妊娠安全且妊娠结局良好。宫角切除术是目前主要的手术方式,但需注意子宫破裂;输卵管间质部妊娠包块较小时可选择行宫角切开取胚术。展开更多
OBJECTIVE:To summarize management of interstitial pregnancy and its outcome among 32re ported cases in the world METHODS:From 1999to 2002,32c ases of inter-stitial pregnancy were reported to t he registry of the Socie...OBJECTIVE:To summarize management of interstitial pregnancy and its outcome among 32re ported cases in the world METHODS:From 1999to 2002,32c ases of inter-stitial pregnancy were reported to t he registry of the Society of Reproductive Surgeons.The participants completed a five -page questionnaire regarding when and how diagnosis was made,the characteristics of the pregnancy,treatment modalities,and subsequent reprodu ctive outcome.RE-SULTS:History of ipsilateral salpi ngectomy was encoun-tered in 37.5%of patients,and the di agnosis was made by ultrasound in 71.4%of the patients.Eight women were treated with methotrexate either sy stemically(n =4),lo-cally under ultrasound guidance(n =2),or under la-paroscopic guidance(n =2).Eleven patients were treated by laparoscopy and 13by laparotomy.Three patients failed systemic methotrexate treatment an d subsequently required surgery.Persistently elevated serumβhuman chorionic gonadotropin levels were found in on e patient after laparo-scopic cornual excision,and she was successfully treated with methotrexate.Fourteen cases(43.7%)of rupture of interstitial pregnancy were found.This included five cases(15.6%)of heterotopic pregnancy;all were t he results of in vitro fertilization,and all rupt ured at the time of diag-nosis.Subsequent pregnancywas ach ieved in ten patients.No uterine rupture was encountered d uring pregnancy or labor.CONCLUSION:Ipsilateral salpingectomy,previous ectopic pregnancy,and in vitro fertilization are predispos-ing factors for interstitial pregnancy.Contrary to previous belief,rupture of interstitial pre gnancy occurs relatively early in pregnancy.In selected patients,laparoscopiccornual excision is a viable treatme nt option.展开更多
文摘目的:探讨宫内合并输卵管间质部妊娠的腹腔镜治疗及妊娠结局。方法:回顾性分析我院腹腔镜治疗IVF-ET后宫内合并输卵管间质部妊娠21例,比较采用宫角切开取胚术(16例)与宫角切除术(5例)的治疗及妊娠结局。结果:21例患者总的手术时间为58.5±6.3分钟,术中出血量52.9±5.8 ml,术后住院时间4.7±0.4天。两组患者在异位妊娠包块破裂率、手术时间、术中出血量、术后住院时间及足月产率差异均无统计学意义(P>0.05)。接受宫角切除术患者的异位妊娠包块平均直径大于接受宫角切开取胚术患者(2.5 cm vs 3.6 cm)。17例患者术后顺利分娩,除1例顺产外均行剖宫产,其中足月产11例,无一例患者发生子宫破裂。结论:腹腔镜治疗宫内合并输卵管间质部妊娠安全且妊娠结局良好。宫角切除术是目前主要的手术方式,但需注意子宫破裂;输卵管间质部妊娠包块较小时可选择行宫角切开取胚术。
文摘OBJECTIVE:To summarize management of interstitial pregnancy and its outcome among 32re ported cases in the world METHODS:From 1999to 2002,32c ases of inter-stitial pregnancy were reported to t he registry of the Society of Reproductive Surgeons.The participants completed a five -page questionnaire regarding when and how diagnosis was made,the characteristics of the pregnancy,treatment modalities,and subsequent reprodu ctive outcome.RE-SULTS:History of ipsilateral salpi ngectomy was encoun-tered in 37.5%of patients,and the di agnosis was made by ultrasound in 71.4%of the patients.Eight women were treated with methotrexate either sy stemically(n =4),lo-cally under ultrasound guidance(n =2),or under la-paroscopic guidance(n =2).Eleven patients were treated by laparoscopy and 13by laparotomy.Three patients failed systemic methotrexate treatment an d subsequently required surgery.Persistently elevated serumβhuman chorionic gonadotropin levels were found in on e patient after laparo-scopic cornual excision,and she was successfully treated with methotrexate.Fourteen cases(43.7%)of rupture of interstitial pregnancy were found.This included five cases(15.6%)of heterotopic pregnancy;all were t he results of in vitro fertilization,and all rupt ured at the time of diag-nosis.Subsequent pregnancywas ach ieved in ten patients.No uterine rupture was encountered d uring pregnancy or labor.CONCLUSION:Ipsilateral salpingectomy,previous ectopic pregnancy,and in vitro fertilization are predispos-ing factors for interstitial pregnancy.Contrary to previous belief,rupture of interstitial pre gnancy occurs relatively early in pregnancy.In selected patients,laparoscopiccornual excision is a viable treatme nt option.
