摘要
目的:探讨残角子宫妊娠的临床特点、治疗方案选择及手术治疗后生育力恢复情况。方法:回顾性收集2010年1月1日至2022年12月31日北京大学第三医院诊治的12例残角子宫妊娠患者的临床资料,统计分析所有残角子宫妊娠患者的一般临床资料、诊治经过及手术后妊娠情况。结果:12例残角子宫妊娠患者的年龄中位数为29岁(范围:24~37岁);8例残角子宫妊娠发生于Ⅰ型残角子宫,4例残角子宫发生于Ⅱ型残角子宫;其中5例术前超声检查误诊。所有患者均行残角子宫切除术,手术过程顺利;术后9例患者有妊娠需求,5例成功受孕。5例再次妊娠者中,3例自然妊娠,2例通过辅助生殖技术成功妊娠;4例剖宫产术活产分娩,1例孕早期自然流产;均未发生子宫破裂或异位妊娠。结论:残角子宫妊娠患者可通过超声检查进行早期诊断,但超声检查存在一定的误诊率,临床医师需根据病史、查体及辅助检查综合判断并决策,一旦确诊积极手术治疗,必要时宫腹腔镜联合手术探查。对手术后不孕的患者可积极行辅助生殖技术治疗,并警惕子宫破裂等妊娠并发症的发生,选择剖宫产术终止妊娠较为安全。
ObjectiveTo investigate the clinical characteristics,treatments and fertility recovery of rudimentary horn pregnancy(RHP).MethodsThe clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1,2010 to December 31,2022 were retrospectively analyzed.Clinical informations,diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed.ResultsThe median age of 12 RHP patients was 29 years(range:24-37 years).Eight cases of pregnancy in residual horn of uterus occurred in typeⅠresidual horn of uterus,4 cases occurred in typeⅡresidual horn of uterus;among which 5 cases were misdiagnosed by ultrasound before surgery.All patients underwent excision of residual horn of uterus and affected salpingectomy.After surgery,9 patients expected future pregnancy,and 3 cases of natural pregnancy,2 cases of successful pregnancy through assisted reproductive technology.Four pregnancies resulted in live birth with cesarean section,and 1 case resulted in spontaneous abortion during the first trimester of pregnancy.No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies.ConclusionsUltrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases.Thus,a comprehensive judgment and decision ought to be made based on medical history,physical examination and assisted examination.Surgical exploration is necessary for diagnosis and treatment of RHP.For infertile patients,assisted reproductive technology should be applied when necessary.Caution to prevent the occurrence of pregnancy complications such as uterine rupture,and application of cesarean section to terminate pregnancy are recommended.
作者
林明媚
葛逸盟
杨硕
杨蕊
李蓉
Lin Mingmei;Ge Yimeng;Yang Shuo;Yang Rui;Li Rong(Department of Obstetrics and Gynecology,Peking University Third Hospital,National Clinical Research Center for Obstetric and Gynecologic Diseases,Key Laboratory of Assisted Reproduction,Ministry of Education,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology,Beijing 100191,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2024年第1期49-55,共7页
Chinese Journal of Obstetrics and Gynecology
关键词
妊娠
异位
早期诊断
妇科外科手术
腹腔镜检查
宫腔镜检查
残角子宫
Pregnancy,ectopic
Early diagnosis
Gynecologic surgical procedures
Laparoscopy
Hysteroscopy
Rudimentary horn of uterus
