IVF-ET术后宫颈妊娠同时合并卵巢妊娠一例

doi:10.12280/gjszjk.20220469

摘要/Abstract

摘要：

宫颈妊娠同时合并卵巢妊娠是一种特殊类型的异位妊娠，其发生率远低于输卵管妊娠，但风险极大，诊治不及时可能造成严重不良后果，需尽早识别，力争做到早诊断、早治疗。近年随着辅助生殖技术的快速发展，宫颈妊娠同时合并卵巢妊娠的发生率均较前升高，但彩色超声技术的进步有助于此种类型异位妊娠的早期诊断。现回顾中国人民武装警察部队特色医学中心妇科2022年收治的1例体外受精-胚胎移植术后宫颈妊娠同时合并卵巢妊娠的病例，该患者同时发生两种类型的异位妊娠，极为罕见和特殊，由于该病例早期诊断及时，通过个体化的药物治疗+宫颈管搔刮，避免了有创手术、动脉栓塞等操作，做到了患者副损伤、费用及痛苦的最小化，结局满意。

关键词: 宫颈妊娠, 卵巢妊娠, 异位妊娠, 受精，体外, 胚胎移植

Abstract:

The pregnancy with both cervical pregnancy and ovarian pregnancy is a special type of ectopic pregnancy. The incidence is far lower than that of tubal pregnancy. However, the risk is relatively high, and untimely diagnosis and treatment may cause serious adverse consequences. It is necessary to identify, diagnose and treat as early as possible. In recent years, with the progress of assisted reproductive technology, the incidence of this type of ectopic pregnancy has increased. The color ultrasound technology is helpful to the early diagnosis. In 2022, a woman diagnosed with cervical pregnancy combined with ovarian pregnancy after in vitro fertilization-embryo transfer was diagnosed in the department of gynecology at the Characteristic Medicine Center of the Chinese People′s Armed Police Forces. In this extremely rare and special case, because of the early diagnosis, the woman was cured with minimized side injury, cost and pain by the method of individualized drug and curettage of cervical canal, without any invasive operations such as surgery or arterial embolism. The outcome was very satisfactory.

Key words: Cervical pregnancy, Ovarian pregnancy, Ectopic pregnancy, Fertilization, in vitro, Embryo transfer

王舒芳, 胡梦颖, 董渠龙, 王华, 陈娟, 杨振华. IVF-ET术后宫颈妊娠同时合并卵巢妊娠一例[J]. 国际生殖健康/计划生育杂志, 2023, 42(1): 31-34.

WANG Shu-fang, HU Meng-ying, DONG Qu-long, WANG Hua, CHEN Juan, YANG Zhen-hua. A Case Report on Cervical Pregnancy Combined with Ovarian Pregnancy after IVF-ET[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(1): 31-34.

图/表 2

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治疗时间	治疗方法	血hCG（mIU/mL）	彩色超声结果
2022.4.16	分次口服米非司酮300 mg（50 mg，2次/ d）	未查	未查
2022.4.17	肌内注射50 mg MTX+宫颈局部注射20 mg MTX+宫颈妊娠囊内注射5 mg MTX	未查	未查
2022.4.19	临床密切观察	11 490	未查
2022.4.21	肌内注射25 mg MTX	未查	未查
2022.4.22	临床密切观察	7 880	宫颈管包块范围23 mm×20 mm×18 mm，内见妊娠囊大小7 mm×6 mm×5 mm，周边可探及2支血供；右侧卵巢内包块范围18 mm×17 mm×11 mm，中间部可见暗区，直径3 mm，周边见半环状血流信号。
2022.4.25	肌内注射75 mg MTX+宫颈局部注射25 mg MTX+分次口服米非司酮300 mg（50 mg，2次/d）	2 803	宫颈管内包块范围30 mm×24 mm×23 mm，内见妊娠囊直径约5 mm，周边可探及1支血供；右侧卵巢内包块范围17 mm×16 mm×8 mm，中间部可见暗区，直径3 mm，周边见星点状血流信号。
2022.4.28	临床密切观察	311.4	宫颈管内包块范围32 mm×25 mm×25 mm，内见妊娠囊直径约5 mm，周边未探及明确血供，下缘距宫颈外口8 mm；右侧卵巢内包块范围10 mm×10 mm×2 mm，周边见星点状血流信号。
2022.5.2	宫颈管妊娠物搔刮，刮出少量坏死的胎囊组织，手术顺利，出血约5 mL。	51.76	未查
2022.5.5	出院	19.9	未查
2022.5.12	随访	4.2	子宫及双侧附件未见异常回声

治疗时间	治疗方法	血hCG（mIU/mL）	彩色超声结果
2022.4.16	分次口服米非司酮300 mg（50 mg，2次/ d）	未查	未查
2022.4.17	肌内注射50 mg MTX+宫颈局部注射20 mg MTX+宫颈妊娠囊内注射5 mg MTX	未查	未查
2022.4.19	临床密切观察	11 490	未查
2022.4.21	肌内注射25 mg MTX	未查	未查
2022.4.22	临床密切观察	7 880	宫颈管包块范围23 mm×20 mm×18 mm，内见妊娠囊大小7 mm×6 mm×5 mm，周边可探及2支血供；右侧卵巢内包块范围18 mm×17 mm×11 mm，中间部可见暗区，直径3 mm，周边见半环状血流信号。
2022.4.25	肌内注射75 mg MTX+宫颈局部注射25 mg MTX+分次口服米非司酮300 mg（50 mg，2次/d）	2 803	宫颈管内包块范围30 mm×24 mm×23 mm，内见妊娠囊直径约5 mm，周边可探及1支血供；右侧卵巢内包块范围17 mm×16 mm×8 mm，中间部可见暗区，直径3 mm，周边见星点状血流信号。
2022.4.28	临床密切观察	311.4	宫颈管内包块范围32 mm×25 mm×25 mm，内见妊娠囊直径约5 mm，周边未探及明确血供，下缘距宫颈外口8 mm；右侧卵巢内包块范围10 mm×10 mm×2 mm，周边见星点状血流信号。
2022.5.2	宫颈管妊娠物搔刮，刮出少量坏死的胎囊组织，手术顺利，出血约5 mL。	51.76	未查
2022.5.5	出院	19.9	未查
2022.5.12	随访	4.2	子宫及双侧附件未见异常回声