宫颈妊娠7例临床分析
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摘要
目的:主要探讨宫颈妊娠的早期诊断方法及子宫动脉栓塞术(UAE)治疗宫颈妊娠的疗效。
方法:收集2005年8月～2010年12月间赤峰学院附属医院妇产科收治的7例宫颈妊娠患者的临床资料,所有患者均经彩色超声检查及其它检查方法明确诊断。有3例宫颈妊娠患者伴有多量阴道流血,使用宫缩剂止血效果不佳,宫颈填塞纱布无效,行急诊双侧子宫动脉栓塞术止血;其余4例宫颈妊娠患者中有3例诊断明确后行药物保守治疗过程中阴道多量流血而急行双侧子宫动脉栓塞术,另1例疑诊宫颈妊娠行药物治疗后清宫时出现大量阴道流血而急行双侧子宫动脉栓塞术。栓塞术后严密观察患者的生命体征及局部穿刺部位情况。栓塞术后72小时行清宫术。
结果:1.7例患者UAE治疗后阴道流血均明显减少,术后止血起效时间为3.5～6.5分钟,平均为4.5分钟。2.7例栓塞术后清宫患者于术中出血量约10～50ml,于清宫术后1周内阴道血性分泌物消失。3.所有患者于术后1周复查血β-HCG,均呈进行性下降,下降幅度>80%,28～50天后恢复至正常值以下。4.UAE的副反应及并发症包括不同程度的栓塞后综合症(100%),尿频、尿急、尿痛(0%)和低热(4/7例,43%),阴道少量血性分泌物(1/7例,14%),尿潴留(1/7例,14%)。5.随访:7例患者于1月后复查超声提示宫颈形态恢复良好,于2～3个月内恢复月经,并无明显月经改变。7例患者最终均治愈出院。
结论:1.宫颈妊娠可发生大量阴道流血、失血性休克甚至危及生命等严重后果。因此早期诊断和正确处理至关重要。2.宫颈妊娠主要与难免流产、剖宫产瘢痕部位妊娠鉴别,因临床症状极为相似,主要依靠阴道彩色超声结果更为准确可靠。3.子宫动脉栓塞术具有安全、止血迅速、恢复快、避免了创伤性开腹手术及麻醉风险、保留了年轻患者的生育功能等优点,所以该方法是治疗宫颈妊娠切实、有效的治疗措施,对于有条件的医院应作为首选。
Objective: cervical pregnancy ( CP ) is the zygote implanted and developed in ce- rvix,which is an extremely rare and dangerous type of ectopic pregnancy. It often leads to fatal hemorrhage due to cervical atony. So hysterectomy is always used to save lives. The- refore, early detection of cervical pregnancy and taking effective measures is the key to de- al with this disease. As the transvaginal ultrasound has been used widely, the rate of early diagnosis of cervical pregnancy has been improved.Uterine artery embolization (UAE) has so many advantages such as rapid recovery,rapid controlling bleeding,retention of young patients with fertility function ,so it becomes a new effective treatment of cervical preg- nancy.This paper mainly describes the early diagnosis of cervi- -cal pregnancy and the eff- ect of UAE in curring cervical pregnancy.
Methods: We collected the seven cases of cervical pregnancy in the Affiliated Hospital of Chifeng University from August 2005 to December 2010. All seven patients were diagnosed specifically with color Doppler ultrasound and other examination methods.The- re are 3 patients with massive vaginal bleeding, Oxytocin and cervical packing was invalid and ineffective,so they had been taked uterine artery embolization to stop bleeding in emergency; three of the rest four patients diagnosed CP,they happened massive vaginal bleeding during the conservative drug treatment , and then were brought under the emergency uterine artery embolization;the other one suspected with CP happened massive vaginal bleeding after conservative drug treatment,and then we gave her emergency uterine artery embolization.And we monitored patients' vital signs and puncture site closely after the embolization.In the 72 hours after embolization, all patients who were not given a curettage undrwent artifical abortion.
Results: 1. The volume of vaginal bleeding of all patients in the embolization was significantly reduced, the onset time after UAE is 3.5 to 6.5 minutes,and the average time is 4.5 minutes.2.The bleeding volume in curettage of all patients was about 10～ 50ml, and the bloody vaginal discharge was gone after a week .3. The bloodβ-HCG showed a pro- gressive decline after 1 week ,dropping >80% , and came down to normal in 28～50 days .4.Adverse reactions and complications of UAE included postembolization syndro- me(n=5);urinary irritation (n=0);low fever (n=2);hyporrhea of vagina(n=1); and uri- nary retention (n=1).5.All patients appeared a good recovery of cervix by ultrasound in a month, and their menstruation recoveried in 2 or 3 months, there were no significant chang in menstruation. 7 patients were eventually cured.
Conclusion: 1.Cervical pregnancy may lead to vaginal bleeding, shock and other serious cons- -equences,even life-threatening.Early diagnosis and proper treatment is essential.2. CP is mainly identificated with inevitable abortion and cesarean section scar pre- gnancy.Their clinical symptoms are so similar that we mainly use transvaginal color ultr- asonography in diagnosis.3.Uterine artery embolization has many advantages such as stopping bleeding qu- ickly, rapid recovery,avoiding the trauma and risks of surgery and anesthesia, keeping the reproductive function for young patients,ect. So UAE is feasible and effective for cervical pregnancy.
方法:收集2005年8月～2010年12月间赤峰学院附属医院妇产科收治的7例宫颈妊娠患者的临床资料,所有患者均经彩色超声检查及其它检查方法明确诊断。有3例宫颈妊娠患者伴有多量阴道流血,使用宫缩剂止血效果不佳,宫颈填塞纱布无效,行急诊双侧子宫动脉栓塞术止血;其余4例宫颈妊娠患者中有3例诊断明确后行药物保守治疗过程中阴道多量流血而急行双侧子宫动脉栓塞术,另1例疑诊宫颈妊娠行药物治疗后清宫时出现大量阴道流血而急行双侧子宫动脉栓塞术。栓塞术后严密观察患者的生命体征及局部穿刺部位情况。栓塞术后72小时行清宫术。
结果:1.7例患者UAE治疗后阴道流血均明显减少,术后止血起效时间为3.5～6.5分钟,平均为4.5分钟。2.7例栓塞术后清宫患者于术中出血量约10～50ml,于清宫术后1周内阴道血性分泌物消失。3.所有患者于术后1周复查血β-HCG,均呈进行性下降,下降幅度>80%,28～50天后恢复至正常值以下。4.UAE的副反应及并发症包括不同程度的栓塞后综合症(100%),尿频、尿急、尿痛(0%)和低热(4/7例,43%),阴道少量血性分泌物(1/7例,14%),尿潴留(1/7例,14%)。5.随访:7例患者于1月后复查超声提示宫颈形态恢复良好,于2～3个月内恢复月经,并无明显月经改变。7例患者最终均治愈出院。
结论:1.宫颈妊娠可发生大量阴道流血、失血性休克甚至危及生命等严重后果。因此早期诊断和正确处理至关重要。2.宫颈妊娠主要与难免流产、剖宫产瘢痕部位妊娠鉴别,因临床症状极为相似,主要依靠阴道彩色超声结果更为准确可靠。3.子宫动脉栓塞术具有安全、止血迅速、恢复快、避免了创伤性开腹手术及麻醉风险、保留了年轻患者的生育功能等优点,所以该方法是治疗宫颈妊娠切实、有效的治疗措施,对于有条件的医院应作为首选。
Objective: cervical pregnancy ( CP ) is the zygote implanted and developed in ce- rvix,which is an extremely rare and dangerous type of ectopic pregnancy. It often leads to fatal hemorrhage due to cervical atony. So hysterectomy is always used to save lives. The- refore, early detection of cervical pregnancy and taking effective measures is the key to de- al with this disease. As the transvaginal ultrasound has been used widely, the rate of early diagnosis of cervical pregnancy has been improved.Uterine artery embolization (UAE) has so many advantages such as rapid recovery,rapid controlling bleeding,retention of young patients with fertility function ,so it becomes a new effective treatment of cervical preg- nancy.This paper mainly describes the early diagnosis of cervi- -cal pregnancy and the eff- ect of UAE in curring cervical pregnancy.
Methods: We collected the seven cases of cervical pregnancy in the Affiliated Hospital of Chifeng University from August 2005 to December 2010. All seven patients were diagnosed specifically with color Doppler ultrasound and other examination methods.The- re are 3 patients with massive vaginal bleeding, Oxytocin and cervical packing was invalid and ineffective,so they had been taked uterine artery embolization to stop bleeding in emergency; three of the rest four patients diagnosed CP,they happened massive vaginal bleeding during the conservative drug treatment , and then were brought under the emergency uterine artery embolization;the other one suspected with CP happened massive vaginal bleeding after conservative drug treatment,and then we gave her emergency uterine artery embolization.And we monitored patients' vital signs and puncture site closely after the embolization.In the 72 hours after embolization, all patients who were not given a curettage undrwent artifical abortion.
Results: 1. The volume of vaginal bleeding of all patients in the embolization was significantly reduced, the onset time after UAE is 3.5 to 6.5 minutes,and the average time is 4.5 minutes.2.The bleeding volume in curettage of all patients was about 10～ 50ml, and the bloody vaginal discharge was gone after a week .3. The bloodβ-HCG showed a pro- gressive decline after 1 week ,dropping >80% , and came down to normal in 28～50 days .4.Adverse reactions and complications of UAE included postembolization syndro- me(n=5);urinary irritation (n=0);low fever (n=2);hyporrhea of vagina(n=1); and uri- nary retention (n=1).5.All patients appeared a good recovery of cervix by ultrasound in a month, and their menstruation recoveried in 2 or 3 months, there were no significant chang in menstruation. 7 patients were eventually cured.
Conclusion: 1.Cervical pregnancy may lead to vaginal bleeding, shock and other serious cons- -equences,even life-threatening.Early diagnosis and proper treatment is essential.2. CP is mainly identificated with inevitable abortion and cesarean section scar pre- gnancy.Their clinical symptoms are so similar that we mainly use transvaginal color ultr- asonography in diagnosis.3.Uterine artery embolization has many advantages such as stopping bleeding qu- ickly, rapid recovery,avoiding the trauma and risks of surgery and anesthesia, keeping the reproductive function for young patients,ect. So UAE is feasible and effective for cervical pregnancy.
引文
1.谢欢宇,方芳.宫颈妊娠[J].实用妇产科杂志.2009, 25( 4):196-198.
2.李桂兰.宫颈妊娠22例临床分析[J].中国实用妇科与产科杂志.2001,17(11):122.
3.Sonmez AS,Kafkasli A,Balat O,et al.Cervical pregnancy:can age and parity be predisposing factors[J].Acta Obstet Gynecol Scand 1994,73(9):734-736.
4.Knutzen V,St rat ton CJ,Ster G,et al Mock embryotansfer in early luteal phase,the cycle before in vitro fertilization and embryotransfer.A descriptive study.FertilSteril 1992 57:156.
5.Mashiach S,Admon D,Oelsner G,et al.Cervical Shirodkar cerclage may be the treatment modality of choice for cervical pregnancy[J].Hum Reprod,2002,17(2):493-496.
6.Marcovici I,Rosenzweig BA,BrillA I,et al.Cervical pregnancy:case reports and a current literature review.Obstet Gynecol Surv,1994,49.
7.Hung TH,Jeng CJ,YangYC,et al,Treatment of cervical pregnancy with methotrexate [J] .Int J Gynecol Obstet 1996 53:243-247.
8.吕俊,牟琴.宫颈妊娠的诊治进展.国外医学:妇幼保健分册,2005,16(5):302.
9.王世阆.剖宫产瘢痕部位妊娠[J].实用妇产科杂志.2009,25 (4):195-196.
10.KirK E,Condous G,Haider Z,et al.The conservative managemeng of cervical ectopic pregnancies[J].Ultrasound Obstet Gynecol,2006,27(4):430-437.
11.Wolcott HD,Kaunitz AM,Nuss RC,et al,Successful pregnancy after previous conservative treatment of an advanced cervical pregnancy[J].Obstet Gynecol,1998,71:1023-1025.
12.钱芳.米非司酮对胎儿的影响.中国计划生育学杂志.2004,99(1):59.
13.Ash S,Farrell SA.Hysteroscopic resection of a cervical ectopic pregnancy[J].Fertil Steil,1996,66(5):842-844.
14.谢春明,薛耀勤,冯对平.子宫动脉栓塞术治疗子宫颈妊娠的临床效果观察[J]中华妇产科杂志,2005,40:853.
15.李麟荪主编.介入放射学[M].北京:中国科学技术出版,1990.103
16.胡琢瑛,卞度宏.宫颈妊娠的保守治疗[J].实用妇产科杂志,2006,22(4):202-204.
17.张国福,尚鸣异,田晓梅,等.子宫动脉化疗栓塞术在子宫颈内妊娠中的应用[J].介入放射学杂志,2009,3:182-184.
18.陈春林,刘萍.血管性介入治疗在妇产科领域中的应用[J].中华妇产科杂志.2004,39(2):138-141.
19.Yitzhak M,Orvieto R,Nitke S,et al .Cervical pregnancy:a conservative stepwise approach,Hum Reprod,1999,14:847-849.
1.谢欢宇,方芳.宫颈妊娠[J].实用妇产科杂志2009,25(4):196-198.
2.Hung TH,Jeng CJ,Yang YC,et al,Treatment of cervical pregnancy with methotrexate[J].Int J Gynecol Obstet,1996,53:243-247.
3.Sonmez AS,Kafkasli A,Balat O,et al.Cervical pregnancy:can age and paritybe predisp-osing factors[J].Acta Obstet Gynecol Scand,1994,73(9):734-736.
4.Mashiach S,Admon D,Oelsner G,et al.Cervical Shirodkar cerclage may be the treatme-nt modality of choice for cervical pregnancy[J].Hum Reprod,2002,17(2):493-496.
5.刘箐,王跃莲,赵丽等.米非司酮辅助甲氨蝶呤保守治疗宫颈妊娠的临床观察[J].实用妇产科杂志,2006,22(4):225-226.
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7.李桂兰.宫颈妊娠22例临床分析[J].中国实用妇科与产科杂志,2001,17(11):122.
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28.Pron G,Mocarski E,Bennett J,et al.Tolerance,hospital stay and recovery after uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial[J].J Vasc Interv Radiol,2003,14:1243-1250.
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2.李桂兰.宫颈妊娠22例临床分析[J].中国实用妇科与产科杂志.2001,17(11):122.
3.Sonmez AS,Kafkasli A,Balat O,et al.Cervical pregnancy:can age and parity be predisposing factors[J].Acta Obstet Gynecol Scand 1994,73(9):734-736.
4.Knutzen V,St rat ton CJ,Ster G,et al Mock embryotansfer in early luteal phase,the cycle before in vitro fertilization and embryotransfer.A descriptive study.FertilSteril 1992 57:156.
5.Mashiach S,Admon D,Oelsner G,et al.Cervical Shirodkar cerclage may be the treatment modality of choice for cervical pregnancy[J].Hum Reprod,2002,17(2):493-496.
6.Marcovici I,Rosenzweig BA,BrillA I,et al.Cervical pregnancy:case reports and a current literature review.Obstet Gynecol Surv,1994,49.
7.Hung TH,Jeng CJ,YangYC,et al,Treatment of cervical pregnancy with methotrexate [J] .Int J Gynecol Obstet 1996 53:243-247.
8.吕俊,牟琴.宫颈妊娠的诊治进展.国外医学:妇幼保健分册,2005,16(5):302.
9.王世阆.剖宫产瘢痕部位妊娠[J].实用妇产科杂志.2009,25 (4):195-196.
10.KirK E,Condous G,Haider Z,et al.The conservative managemeng of cervical ectopic pregnancies[J].Ultrasound Obstet Gynecol,2006,27(4):430-437.
11.Wolcott HD,Kaunitz AM,Nuss RC,et al,Successful pregnancy after previous conservative treatment of an advanced cervical pregnancy[J].Obstet Gynecol,1998,71:1023-1025.
12.钱芳.米非司酮对胎儿的影响.中国计划生育学杂志.2004,99(1):59.
13.Ash S,Farrell SA.Hysteroscopic resection of a cervical ectopic pregnancy[J].Fertil Steil,1996,66(5):842-844.
14.谢春明,薛耀勤,冯对平.子宫动脉栓塞术治疗子宫颈妊娠的临床效果观察[J]中华妇产科杂志,2005,40:853.
15.李麟荪主编.介入放射学[M].北京:中国科学技术出版,1990.103
16.胡琢瑛,卞度宏.宫颈妊娠的保守治疗[J].实用妇产科杂志,2006,22(4):202-204.
17.张国福,尚鸣异,田晓梅,等.子宫动脉化疗栓塞术在子宫颈内妊娠中的应用[J].介入放射学杂志,2009,3:182-184.
18.陈春林,刘萍.血管性介入治疗在妇产科领域中的应用[J].中华妇产科杂志.2004,39(2):138-141.
19.Yitzhak M,Orvieto R,Nitke S,et al .Cervical pregnancy:a conservative stepwise approach,Hum Reprod,1999,14:847-849.
1.谢欢宇,方芳.宫颈妊娠[J].实用妇产科杂志2009,25(4):196-198.
2.Hung TH,Jeng CJ,Yang YC,et al,Treatment of cervical pregnancy with methotrexate[J].Int J Gynecol Obstet,1996,53:243-247.
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