阴道反复大流血5天

1病例报告患者,37岁,因“阴道反复大流血5天”于2006年6月23日入院。5天前(6月18日,即月经干净第1天)无诱因出现无痛性阴道大流血,色鲜,伴大量血凝块,在当地医院保守治疗无效(治疗情况不详),于4天前行诊刮术,刮出少量组织,病理检查示:腺体部分呈增生期改变,部分呈分泌早期改变,间质水肿、出血。诊刮术后半天又出现阴道大流血,伴头昏、心悸,查Hb52 g/L,予输血、止血、抗感染等治疗无效,即再次诊刮,未刮出组织,流血仍多,颈管填塞纱条后流血停止,3天前取出纱条后6小时又阴道大流血,再次宫颈管填塞纱条,填塞近48小时,又大量阴道流血约500 ml,取…     

宫颈妊娠5例分析

目的:对5例宫颈妊娠的诊断治疗进行分析探讨方法:回顾性分析5例宫颈妊娠病例,讨论其结局及介绍几种保守治疗的方法结果:2例明确诊断者用MTX+米非司酮并辅以中药保守治疗成功;3例误诊者清宫时阴道大量出血,2例行子宫动脉栓塞治疗、1例行宫颈纱布填塞后均再行MTX药物保守治疗成功。结论B超对宫颈妊娠的早期诊断有重要价值,早期确诊药物保守治疗、宫颈妊娠大出血时子宫动脉栓塞治疗避免了子宫切除,保全了患者的生育功能。     

甲氨蝶呤联合宫腔镜保守治疗宫颈妊娠9例临床分析

目的:探讨宫颈注射甲氨蝶呤(MIX)联合宫腔镜技术保守治疗宫颈妊娠的临床价值.方法:回顾性分析9例宫颈妊娠患者应用宫颈注射MTX联合宫腔镜技术保守治疗患者的临床资料.结果:9例宫颈妊娠患者均成功保留子宫及生育能力,一次性清宫干净,术中出血少,疗效满意.结论:宫颈注射MTX联合宫腔镜技术是治疗宫颈妊娠的一种具有临床价值的保守治疗方法.     

氨甲喋呤治疗宫颈妊娠1例

患者 40岁 ,住院号 97843 ,于 1998年 4月 10日因停经5 0天 ,阴道少量不规则出血 13天 ,诊为先兆流产。在外院行人工流产术 ,术中未见绒毛组织。当时因大出血 ,宫颈注射催产素及麦角新碱、纱布填塞后血止。于人流术后 13天 ,无任何诱因突然阴道出血 ,以不全流产入本院行清宫术 ,当探查宫腔时即开始有出血。继之用刮匙搔刮宫腔极浅部位 ,触及宫颈管后壁 ,即发生大出血约 5 0 0ｍｌ,即给予碘伏纱条填塞压迫宫颈管后血止。　　既往月经规则 ,末次月经 1998年 2月 2 0日 ,1988年因前置胎盘行剖宫产术 ,曾人流 3次 ,末次人流 1996年 6月 8日。　…     

剖宫产术后子宫切口部位妊娠保守治疗16例疗效分析

目的:探讨宫颈注射甲氨蝶呤(MTX)联合宫腔镜技术保守治疗剖宫产术后子宫切口部位妊娠(CSP)的临床价值.方法:回顾性分析16例CSP患者应用宫颈注射MTX联合宫腔镜技术保守治疗的临床资料.结果:16例CSP患者均成功保留子宫及生育能力,一次性清宫干净,术中出血少,疗效满意.结论:宫颈注射MTX联合宫腔镜技术是治疗CSP的一种具有临床价值的保守治疗方法.     

米非司酮配伍米索前列醇终止妊娠12～14周未产妇钳刮术中的应用

目的探讨避免、减少钳刮术对要求晚期流产的未产妇不良结局的有效方法.方法对35例妊娠12～14周未产妇要求终止妊娠,实施钳刮术前,给予米非司酮及米索前列醇.结果35例病人术中均无任何痛苦,手术顺利,宫颈扩张充分,组织易于钳刮,出血少,术时短,术后阴道出血时间短,月经按期恢复,术后随访无闭经及月经稀发等优点.     

子宫动脉栓塞术联合宫腔镜在宫颈妊娠中的应用

目的 探讨子宫动脉化疗灌注栓塞术联合官腔镜治疗官颈妊娠的临床疗效.方法 对12例宫颈妊娠患者行双侧子宫动脉选择性插管,灌注甲氨喋呤(methotrexate,MTX)后应用明胶海绵颗粒栓塞.术后1周内5例患者行官腔镜妊娠组织清除术,4例患者行B超监视下清宫术,3例患者行MTX肌注治疗.结果 12例患者均1次成功施行子官...     

宫颈妊娠及宫内孕合并宫颈妊娠的保守治疗

目的:探讨宫颈妊娠的病因、诊断及保守性治疗方法。方法:回顾分析我院1996年1月1日至2010年12月31日收治的宫颈妊娠及体外授精胚胎移植术后宫内孕合并宫颈妊娠患者36例,探讨宫颈妊娠保守治疗方式的选择,并随访患者术后情况。结果:29例单纯宫颈妊娠:6例外院误诊为"难免流产",误诊率20.69%;10例经阴道B超引导下宫颈妊娠囊局部穿刺+MTX注射治疗,6例行子宫动脉栓塞术,6例MTX肌内注射治疗,7例腰麻下宫腔镜检查宫颈妊娠清除手术。7例宫内孕合并宫颈妊娠:1例阴道B超引导下局部妊娠囊穿刺注入KCl 1ml,3例期待疗法后清除宫颈妊娠物,3例腹部B超引导下宫颈妊娠物清除术。结论:阴道彩超用于宫颈妊娠的早期诊断有较大的价值,术前应充分评估,制定个体化的治疗方案。宫内孕合并宫颈妊娠的患者在腹部B超监测下清除宫颈妊娠物是有效的治疗方式之一,但要及时手术并且加强抗感染治疗。     

子宫动脉化疗灌注加栓塞在宫颈妊娠治疗中的应用

宫颈妊娠是指受精卵在宫颈管内种植,并在此处生长发育,在我院同期异位妊娠中发生率为0.86%.早期临床表现无特异性,B超可发现官颈管内异常回声,从而怀疑或诊断为宫颈妊娠,也可能被误诊为流产,冒然清宫可发生大出血.近年我院利用子宫动脉化疗灌注加栓塞,辅以清宫和MTX、米非司酮治疗宫颈妊娠取得了满意疗效,现报道如下.     

阴道超声引导胚胎减灭术在少见部位异位妊娠中的应用

目的 探讨阴道超声引导胚胎减灭术在少见部位异位妊娠治疗中的应用价值。方法 2005年1月～2006年10月在北京大学第三医院生殖医学中心10例少见部位异位妊娠行阴道超声引导胚胎减灭术，并对治疗结局进行追踪和分析。结果 患者年龄25～37岁，妊娠周数7～8周。宫颈妊娠4例（宫颈合并宫腔内妊娠1例），输卵管间质部妊娠4例，宫角妊娠2例。6例超声显示异位妊娠囊内胎心搏动。hCG水平范围为4826～122300IU／L。术后1周血清hcG升高3例，其余术后血清hCG逐渐下降。1例间质部妊娠术后1周hCG水平升高，行第2次穿刺术时出现腹腔内出血症状和体征，急行腹腔镜探查和一侧输卵管切除术。其余患者血hCG4～8周降至正常，异位病灶3～5个月恢复正常。结论 阴道超声引导胚胎减灭术合并局部注射MTX作为一种微创技术，可安全有效地应用于非常见部位异位妊娠的保守治疗。     

Cervical pregnancy

Until quite recently the diagnosis of cervical pregnancy was an indication for hysterectomy, because of mortality among patients with cervical pregnancy, coming up to 60%. During last 15 years methods of conservative therapy has developed in order to avoid the necessity of hysterectomy and to keep patient's fertility. Among these the most promising method is using of methotrexate (MTX), which is now the most commonly used agent in case of conservative forms for the treatment of cervical pregnancies. It should be stressed successful in treatment of cervical pregnancy in women, who wish to remain fertile, depends on early and proper diagnosis. MTX can be administered up to 13 weeks of gestation, with the highest efficacy between 6-8 weeks of pregnancy. We reported a case of cervical pregnancy treated successfully with methotrexate therapy combined with curettage of the cervical canal and uterine cavity. Serial beta HCG serum determination and ultrasonography were used to diagnose the pregnancy and to monitor therapy. Treatment was effective and the patient reproductive capability was preserved.     

Treatment of cervical pregnancy with cerclage, curettage and balloon tamponade. A report of three cases

BACKGROUND: Cervical pregnancy is a rare form of ectopic pregnancy, historically requiring hysterectomy to control life-threatening hemorrhage. However, with early diagnosis, conservative procedures can preserve the uterus and fertility. CASES: Three cases of cervical pregnancy were treated successfully with curettage. Two cases utilizing precurettage and postcurettage hemostatic techniques were treated with curettage alone. A third case, not employing precurettage hemostatic maneuvers, required uterine artery embolization to control bleeding and avoid hysterectomy. CONCLUSION: Curettage alone, when preceded by cervical infiltration with a vasoconstricting agent, placement of a cerclage suture high on the cervix and followed by cervical canal tamponade with a Foley catheter balloon, can successfully treat early cervical pregnancy.     

Cervical pregnancy: the importance of early diagnosis and treatment

STUDY OBJECTIVE: To report the evolution and outcome of 12 cases of cervical pregnancy. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospitals. PATIENTS: Twelve women with cervical pregnancy. INTERVENTIONS: Methotrexate, uterine artery embolization, curettage, ligation of the descending branch of uterine vessels, or hysterectomy. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was success of conservative management. From January 1985 through December 2005, we encountered 12 cases of cervical pregnancy. The final diagnosis was established by ultrasound, operative findings, and histopathology. We obtained information from the medical records of the patients regarding when and how the diagnosis was made, the characteristics of the pregnancy, and treatment modalities. The prevalence of cervical pregnancy was 1:10,000 deliveries. The patients' history revealed previous curettage in 6 (50%) and cesarean delivery in 2 others (16.7%). Four patients (33.3%) initially not diagnosed to have cervical pregnancy required a hysterectomy. Initial diagnosis of cervical pregnancy was correct in 5 patients. They were treated with methotrexate, uterine artery embolization, curettage, or ligation of the descending branch of uterine vessels. None of these patients required blood transfusion or hysterectomy. CONCLUSION: The success of conservative treatment for cervical pregnancy depends on the diagnostic accuracy of the initial ultrasound. Correct diagnosis would reduce the chance of hysterectomy or blood transfusion.     

Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies

OBJECTIVES: This retrospective study examined the overall efficacy of methotrexate chemotherapy in the treatment of cervical pregnancy and attempted to determine whether differences in the response to methotrexate therapy exist between patients with viable and nonviable cervical pregnancies. STUDY DESIGN: A MEDLINE database search and a bibliographic review of the relevant literature were conducted to find reported cases of cervical pregnancy treated with methotrexate administration during the period from 1983 to 1997. Clinical and demographic characteristics, methotrexate regimen, concomitant invasive procedures, complications, and outcomes in viable and nonviable pregnancy groups were analyzed and compared. RESULTS: A total of 62 reported cases of cervical pregnancy were assessed. There were no statistically significant differences in demographic data, transfusion rate, and human chorionic gonadotropin remission time between viable and nonviable cervical pregnancy groups. Among the 35 cases of viable pregnancy 63% of women received systemic injection alone or a combination of systemic and local (intra-amniotic or intracervical) injection with methotrexate or potassium chloride and 37% had local injection of methotrexate (with or without potassium chloride) alone. Among the 23 cases of nonviable cervical pregnancy 96% of women received systemic methotrexate injection only. The need for >/=1 concomitant surgical procedure (such as simple curettage, dilation and curettage, cervical blocking, or uterine artery embolization) in conjunction with methotrexate therapy was significantly higher (P =.021) in the viable pregnancy group (43%) than in the nonviable pregnancy group (13%). The 94% success rate of preservation of the uterus in the viable pregnancy group was not significantly different from the 91% preservation rate in the nonviable pregnancy group. All patients who had successful uterine preservation returned to normal menstrual patterns. CONCLUSION: This retrospective study found that conservative treatment with methotrexate chemotherapy of patients with either viable or nonviable cervical pregnancies at <12 weeks' gestation carries a 91% success rate for preservation of the uterus. The structure of the cervix was restored and menstruation returned for all patients in whom the uterus was preserved after treatment. There was no evidence to suggest that the reproductive performance of these patients was affected by the treatment.     

21例剖宫产子宫切口瘢痕部位妊娠临床病例分析

目的　探讨剖宫产子宫切口瘢痕部位妊娠(cesarean scar pregnancy,CSP)的早期诊断和治疗. 方法　收集1995年11月至2005年11月共十年间复旦大学附属妇产科医院收治的所有病例的临床资料,共21例.根据超声检查,血hCG的水平确诊,分析其发病年龄、孕周、症状、治疗方式及预后. 结果 患者平均年龄33岁(26～44岁),均为1次剖宫产术史,此次妊娠距离前次剖宫产的时间为8个月～18年,平均孕龄为47 d(36～70 d).16例(76.2%)患者主诉阴道流血,其中6例(28.6%)伴有腹痛.治疗方式包括单独或联合应用氨甲蝶呤(methotrexate,MTX)全身或局部给药、子宫动脉栓塞术、介入化疗、宫腔镜下病灶切除术、开腹子宫病灶切除术、刮宫术等.所有病例均保守治疗成功,保留了生育功能.平均住院天数为22 d(9～39 d). 结论 CSP的发病呈上升趋势,早期发现多可保守治疗.MTX能有效终止妊娠,介入化疗和子宫动脉栓塞术联合刮宫术是有效的治疗手段.     

Acute Hemorrhage Related to a Residual Cervical Pregnancy: Management with Curettage,Tamponade, and Cerclage

Cervical ectopic pregnancy is uncommon, with no universally accepted protocol for conservative management of acute hemorrhage due to residual cervical ectopic pregnancy. Herein is presented the case of a 33-year-old woman with profuse vaginal bleeding 3 months after receiving treatment including intraamniotic potassium chloride injection, systemic methotrexate, and uterine artery embolization because of a cervical ectopic pregnancy. A residual cervical pregnancy was suspected. Hemorrhage was controlled using curettage, tamponade with a Bakri balloon, and cerclage. The balloon and cerclage were removed on postoperative day 2, with no recurrence of symptoms. Our experience suggests that a combination of curettage, balloon tamponade, and cerclage may be considered in the management of cervical ectopic pregnancies with acute hemorrhage, in particular in patients desiring future childbearing.     

剖宫产后切口妊娠的临床诊治分析

目的:研究剖宫产后子宫切口妊娠的临床表现及治疗方法等特征,为临床医生早期诊断、早期处理本病提供依据。方法:对25例患者的病史、临床表现、诊断方法以及治疗方法进行回顾性分析。结果:25例患者中有23例经阴道超声检查或彩色多普勒超声检查确诊;本病初诊误诊19例,误诊率76%,25例患者中保守治疗22例,21例痊愈,占95.45%;2例治疗失败而行全子宫切除术。结论:有剖宫产史的妇女因停经就诊时,要常规行阴道超声检查,对阴道超声怀疑切口妊娠的病例,有必要行彩色多普勒超声检查;彩色多普勒超声检查可作为诊断切口妊娠的主要方法;甲氨蝶呤加清宫术可作为治疗切口妊娠的主要方法,可有效地避免子宫切除。     

Hysteroscopic management of cesarean scar pregnancy after unsuccessful methotrexate treatment

Current management of cesarean scar pregnancy is conservative and consists of medical treatment with methotrexate (MTX). We present a report on a woman with this type of pregnancy who had continuous vaginal bleeding and persistent serum levels of beta human chorionic gonadotropin after undergoing curettage and MTX. Eventually, the remaining ectopic gestational tissue was removed by operative hysteroscopy.