宫角妊娠漏诊引产二例及文献复习

doi:10.12280/gjszjk.20220360

摘要/Abstract

摘要：

回顾2例宫角妊娠患者的临床资料，结合文献分析并总结其临床特点和治疗方案。目前宫角妊娠的病因尚不明确，可能与盆腔炎性疾病、子宫形态异常或宫腔占位、辅助生殖技术等因素有关，妊娠早期易发生误诊及漏诊，超声及磁共振成像可提高诊断的准确率。在生命体征平稳或病灶未出现破裂、大出血之前均可行腹腔镜手术以及腹腔镜直视下宫角妊娠组织清除术。如果患者已出现腹腔内大出血及休克表现，或考虑腹腔有严重粘连者，或孕周较大、胎儿较大时，均应尽快行开腹手术。宫角妊娠治疗后需严格随访，对宫角楔形切除者或吸宫时宫角穿孔者，至少严格避孕6个月，2~3年内受孕最佳。再次妊娠后需警惕重复性宫角妊娠、子宫破裂和胎盘植入。

关键词: 妊娠，宫角, 超声检查, 引产, 诊断, 治疗

Abstract:

The clinical data of 2 cases of cornual pregnancy were reported. The clinical characteristics and treatment plan were summarized, and were analyzed in detail combined with literature review. The etiology of cornual pregnancy may be related to pelvic inflammatory disease, abnormal uterine morphology or uterine space occupying, assisted reproductive technology and other factors. However, it is not clear until now. Cornual pregnancy is prone to misdiagnosis and missed diagnosis during early pregnancy. Ultrasound and magnetic resonance imaging can improve the accuracy of diagnosis. Laparoscopic surgery and laparoscopic direct vision tissue aspiration of cornual pregnancy can be performed before the vital signs are stable or the lesions are not ruptured or bleeding heavily. If the patient has suffered from intraperitoneal hemorrhage and shock, or has serious abdominal adhesions, or has a bigger gestational age or a bigger fetus, open surgery should be performed as soon as possible. After treatment of cornual pregnancy, the strict follow-up is required. For those with cornual wedge resection or cornual perforation during uterine aspiration, strict contraception is required for at least 6 months, and for the best being 2 to 3 years. Watch out for recurrent cornual pregnancy, uterine rupture and placenta implantation after a second pregnancy.

Key words: Pregnancy, cornual, Ultrasonography, Labor, induced, Diagnosis, Therapy

宋建明, 孔为民. 宫角妊娠漏诊引产二例及文献复习[J]. 国际生殖健康/计划生育杂志, 2023, 42(1): 35-39.

SONG Jian-ming, KONG Wei-min. Two Cases of Induced Labor after Missed Diagnosis of Cornual Pregnancy and Literature Review[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(1): 35-39.

图/表 3

图1 妊娠12+4周经腹超声图注：CX 宫颈管。宫颈内口之上可见羊膜囊、羊水及胎儿。

图2 宫腔及左宫角超声图注：A 满宫腔增生的蜕膜组织，未见胎儿及胎盘；B 左宫角可见胎儿及胎膜组织。

图3 手术探查所见注：A 正常宫体位于宫角下方，宫腔内无妊娠组织，胎儿及胎盘完全位于左侧宫角内；B 左侧宫角被动扩大，肌层极薄，分离粘连后浆膜层破裂，胎儿小手穿破宫角。

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