摘要
目的分析宫内合并宫颈复合妊娠(HCP)的临床特征。方法回顾性分析2011年1月至2022年4月在北京大学第三医院生殖医学中心接受辅助生殖技术助孕并确诊HCP的17例患者的一般临床资料、辅助生殖技术助孕资料、HCP诊断及治疗资料及宫内妊娠结局。结果17例HCP患者年龄为(34.2±1.5)岁,均发生于辅助生殖技术应用后;其中11例有宫腔操作史。17例患者均有阴道出血,仅有1例伴腹痛。确诊HCP时孕周为[6^(+2)(5^(+2)~6^(+4))]周。2例患者接受保守观察,严密随访下均宫内妊娠至足月后行剖宫产;1例患者行超声引导下宫颈妊娠减胎术,宫内妊娠18+1周胎膜早破流产;1例患者先行超声引导下宫颈妊娠减胎术后因出血量大,随后行子宫动脉栓塞+宫腔镜检查+宫颈妊娠病灶清除+清宫术;1例患者因阴道出血多,行子宫动脉栓塞+宫腔镜检查+宫颈妊娠病灶清除+清宫术;1例患者因宫内妊娠胚胎停育,行宫腔镜检查+宫颈妊娠病灶清除术+清宫术;11例行超声引导下宫颈妊娠病灶清除术,均活产。13例分娩患者中4例早产,9例足月产;5例顺产,8例剖宫产。结论HCP较常见临床表现为阴道出血,超声引导下宫颈妊娠病灶清除术安全可行,妊娠结局良好。
Objective To investigate the clinical characteristics of heterotopic cervical pregnancy(HCP).Methods A retrospective analysis was conducted based on the general clinical data,assisted reproductive technology(ART)data,diagnosis and treatment data,and pregnancy outcomes of 17 patients diagnosed with HCP who received ART at the Reproductive Medicine Center of Peking University Third Hospital from January 2011 to April 2022.Results The age of 17 HCP patients was(34.2±1.5)years,all of whom occurred after the application of ART;Among them,11 cases had a history of uterine cavity operation.All 17 patients had vaginal bleeding,with only 1 case accompanied by abdominal pain.The gestational age at the diagnosis of HCP was[6^(+2)(5^(+2)-6^(+4))]weeks.Two patients underwent conservative observation and were closely followed up.Both of them had intrauterine pregnancy until full-term and underwent cesarean section;One patient underwent ultrasound-guided cervical pregnancy reduction surgery,resulting in miscarriage due to premature rupture of membranes at 18+1 weeks of intrauterine pregnancy;One patient underwent ultrasound-guided cervical pregnancy reduction surgery,followed by uterine artery embolization,hysteroscopy,removal of cervical pregnancy lesions,and curettage due to excessive bleeding;One patient underwent uterine artery embolization,hysteroscopy,cervical pregnancy lesion clearance,and curettage due to excessive vaginal bleeding;One patient underwent hysteroscopy examination,cervical pregnancy lesion removal surgery,and uterine curettage due to embryo arrest during intrauterine pregnancy;11 cases underwent ultrasound-guided cervical pregnancy lesion clearance surgery,all of which resulted in live births.Among the 13 delivery patients,4 cases were premature and 9 cases were full-term;5 cases of vaginal delivery and 8 cases of cesarean section.Conclusions The most common clinical manifestation of HCP is vaginal bleeding.Ultrasound guided cervical pregnancy lesion clearance surgery is safe and feasible,and with good pregnancy outcomes.
作者
林明媚
李桃梅
葛逸盟
杨硕
杨蕊
李蓉
Lin Mingmei;Li Taomei;Ge Yimeng;Yang Shuo;Yang Rui;Li Rong(National Clinical Research Center for Obstetrics and Gynecology(Peking University Third Hospital),Ministry of Education Key Laboratory of Assisted Reproduction(Peking University),Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology,Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;Center for Reproductive Medicine,the First Affiliated Hospital of Hainan Medical University,Haikou 570100,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第34期3242-3247,共6页
National Medical Journal of China
基金
云南省科技厅重点项目(202302AA310044)
北京大学第三医院临床重点孵育项目A(BYSYZD2023022)
关键词
妊娠
异位
宫内合并宫颈复合妊娠
治疗方案
预后
Pregnancy,ectopic
Heterotopic cervical pregnancy
Treatment plan
Prognosis
