子宫部位异位妊娠的处理对策

目的探讨子宫部位异位妊娠的临床特点和处理对策。方法回顾性分析了2000年1月至2006年12月本院收治的子宫部位异位妊娠35例的临床资料，包括一般情况、临床表现、治疗方法等。结果子宫部位异位妊娠的发病率为2．30％，其中剖宫产切口妊娠发病率为0．33％，宫颈妊娠发病率为0．33％，子宫壁（近峡部）妊娠0．13％，残角子宫妊娠1．51％；35例子宫部位异位妊娠术前仅确诊18例（占51．43），误诊48．57％，其中阴道大量出血（〉1000ml）5例，腹腔内严重出血（〉1000ml）5例，2例出血〉2000ml；剖宫产切口妊娠采用药物加切口妊娠病灶清除术及子宫修补术3例，子宫切除2例；宫颈妊娠药物治疗3例，自然排胎1例、宫颈管搔刮1例、失败1例，后行双侧子宫动脉栓塞治疗成功；子宫峡部妊娠药物治疗2例，均行切口妊娠病灶清除术及子宫修补术；残角妊娠开腹行残角子宫切除术13例，腹腔镜残角子宫切除术10例。结论子宫部位异位妊娠发病率近年有增加趋势，术前容易误诊，可能发生严重的出血，甚至丧失生育能力。应引起广大医务人员的重视。有剖宫产史的病人一旦妊娠应排除剖宫产切口妊娠。

Early diagnosis and treatment of ectopic pregnancy in the uterine

Objective To investigate the early diagnosis and treatment of ectopic pregnancy in the uterine. Methods 35 patients who were treated in our hospital with ectopic pregnancy in the uterine were analyzed retrospectively, including medical history,clinical manifestation, auxiliary examination, et al. Results The rate of ectopic pregnancy in the uterine was 2. 30% ,rate of ectopic pregnancy in caesarean scar is 0. 33%, so as in cervical. It was easy to misdiagnose, the rate is 48.57%. Ectopic pregnancy in the uterine caused serious bleeding,including heavy colporrhagia（ 〉 1000ml）in 5 cases, intraperitonium bleeding（ 〉 1000ml）in 5 cases, 2 cases of bleeding more than 2000ml;in. cases of ectopic pregnancy in caesarean scar, 3 had medication plus focal cleaning and uterus neoplasty, 2 had uterus removel; 3 cases of cervical pregnancy were treated with medication, 1 had spontaneous abortion, 1 had scoraping at the cervical canals, 1 failed and turned to uterine arterial embolism on both sides and was successful; 2 cases of ectopic pregnancy in isthmus uteri had medication and focal cleaning and uterus neoplasty; in cases of pregnancy in rudimentary born, 13 had laparotomy and removal of rudimentary born, 10 had laparoscopic removal of rudimentary born. Conclusion The incidence rate of ectopic pregnancy is increasing in recent years and the the misdiagnosis is easy to make, which may cause serious bleeding or even fertility loss. More attention should be paid to the patients with history of previous caesarean section for exclusion of ectopic pregnancy in the uterine.