宫角妊娠17例临床分析

宫角妊娠罕见,一旦破裂引起内出血可严重威胁患者生命。因此,及时正确的诊断和治疗,特别是子宫破裂前明确诊断并合理治疗极为重要。现将我院经手术和病理证实的17例宜角妊娠分析如下。1临床资料1．1一般资料1992年1月至1999年10月我院收治异位妊娠815例,其中宫角妊娠17例,占同期异位妊娠的2．1％,21～45岁,平均31．9岁。初次妊娠2例,妊娠2－6次15例。宫内放置节育器5例。有停经史15例（88．2％）,40－110d,平均65.5d.腹痛14例（82．4％）,其中持续隐痛7例,突发性腹痛呈急服症表现7例。阴道出血14例（82．3％）,最短为7b．最长3…     

宫角妊娠20例分析

宫角妊娠是指受精卵种植在子宫角内，为罕见的宫内异位妊娠，据文献报道发病率占异位妊娠的2．6％。因其缺乏典型症状及体征，极易误诊，据文献报道误诊率可高达82．3％，因而导致子宫破裂等严重并发症，甚至危及生命，为做到早期诊断、及时合理处置，现将我院诊治的经验与教训总结如下。     

人工流产中的宫角妊娠——附24例分析

早孕期宫角妊娠因无特殊体征而难于确诊,以致预后较差。本文总结了近三年来在我院因宫角妊娠住院的24例患者的临床诊断和治疗情况,分析其病史、症状、体征及辅助检查的特征,为今后临床诊断和治疗提供依据。1 病例分析1.1 临床资料24例患者的平均年龄为30.9±4.5岁(25～42岁);首次妊娠者占12.5%(3/24),妊娠两次以上者占83.3%(20/24),妊娠次数最多为5次;未生育者占37.5%(9/24),有人流史者占79.2%(19/24),有不孕症和异位妊娠史者各1例。1.2 病史特征24例名患者均有停经史,停经天数<40 d者仅1例,23例(95.9%)停经40～90 d。其中19例(79.2%)来…     

宫腔镜诊治宫角妊娠13例临床分析

目的:探讨宫腔镜在宫角妊娠的诊断及治疗中的应用价值.方法:我院于2002年9月至2008年2月共收治误诊的宫角妊娠患者13例,应用宫腔镜技术对其进行诊断及协助治疗.结果:13例患者均由宫腔镜检确诊.其中12例在B超引导宫腔镜下彻底清除妊娠组织,另1例联合腹腔镜行患侧宫角楔切及同侧输卵管切除术.所有患者手术过程均顺利,出血少,疗效满意.结论:宫腔镜技术是诊断及保守治疗宫角妊娠的一种非常有价值的方法.     

足月宫角妊娠12例临床分析

目的:探讨足月宫角妊娠的临床特点及处理。方法:回顾分析2016年6月至12月在湖南省妇幼保健院分娩的12例足月宫角妊娠的临床特点。结果:12例足月宫角妊娠患者中,剖宫产7例,平均出血量(257.7±78.6)ml;阴道分娩5例,平均出血量(784.0±678.4)ml,两组比较差异有统计学意义(P0.05),2例阴道分娩患者出血量达1500ml并予输血。既往有多次人工流产病史及早孕期间有阴道流血史患者的宫角妊娠发生率升高。结论:多次人工流产史及早孕期阴道流血为宫角妊娠的高危因素,应尽早行B超检查。对于有强烈生育要求的宫角妊娠患者,需在严密监测下继续妊娠,分娩方式以剖宫产为宜。     

宫颈妊娠22例临床分析

本文对 2 2例宫颈妊娠诊治情况作一回顾性分析 ,报道如下。1　临床资料1 1　一般资料　收集 1982年 1月至 1999年 12月经我院确诊并治疗的 2 2例宫颈妊娠病例。患者年龄 2 2～ 43岁 ,平均年龄 (31 2 0± 6 31)岁。初孕妇 1例 ,孕 2～ 4次 2 1例。1 2　临床特征　①停经后无痛性阴道流血为其主要特征。所有病例均有阴道不规则出血 ;出血时间最早的在闭经 33天 ,最晚的在闭经 70天 ,出血量多少不一。②所有病例均无腹部疼痛 ;因宫颈妊娠出血系胚胎附着部位胎盘绒毛分离所致 ,血液直接外流 ,无宫缩发生 ,故阴道流血常不伴有腹痛。③多数患者均…     

宫腔镜诊治早期输卵管间质部妊娠9例临床分析

目的:探讨宫腔镜在诊治早期输卵管间质部妊娠(IP)中的临床价值。方法:回顾分析2015年3月至2019年3月于湘雅三医院成功应用宫腔镜诊治的9例早期IP患者的临床资料。结果:9例患者术前B超均诊断为宫角妊娠,经宫腔镜检查协助明确诊断为IP;9例患者均在宫腔镜下完成手术操作,其中4例因孕囊较大同时行腹腔镜监护。术中出血20～100ml,术中、术后无明显的手术并发症发生。结论:宫腔镜手术可用于诊断和治疗早期IP,具有简单、安全、有效、微创等优势。     

宫腔镜诊治宫角妊娠的临床应用

目的:探讨宫腔镜在宫角妊娠诊治中的应用价值。方法:对我院2004年10月至2006年7月收治的14例宫角妊娠病例进行回顾性分析。结果:宫腔镜诊断宫角妊娠,确诊率100%,联合B超进行治疗,必要时分次手术,治疗成功率100%,术中、术后均无严重并发症。结论:宫腔镜诊治宫角妊娠,安全、高效、微创,值得推广。     

子宫颈妊娠10例临床分析

宫颈妊娠甚为少见。青岛市经济技术开发区第一人民医院妇产科及伊春市中心医院妇产科 ,自 1985年 8月至1998年 6月 ,共收治宫颈妊娠 10例 ,占同期两家医院异位妊娠的 1 5 %。现将 10例宫颈妊娠的诊断、保守治疗及手术治疗等分析如下。一、资料与方法1.研究对象 :667例异位妊娠中宫颈妊娠 10例 ,占异位妊娠的 1 5 % ;年龄 2 0～ 3 0岁 6例 ,3 0～ 4 0岁 4例 ,平均 2 8岁。初次妊娠 2例 ,有流产史 8例。均有停经 ,停经 6～ 8周 6例 ,9～ 10周 3例 ,12周 1例。妊娠早期无痛性阴道流血 8例 ,其中有 2例阴道流血较多。另 2例为早孕药物流产术后阴…     

子宫颈妊娠八例临床分析

宫颈妊娠临床上比较少见 ,我院于 1998年 12月至 2 0 0 0年 8月共收治宫颈妊娠患者 8例。为探讨宫颈妊娠的临床特点和治疗方法 ,我们对这 8例宫颈妊娠患者的临床资料进行回顾性分析 ,现将结果报道如下。一、临床资料与分析1.一般情况 :我院 1998年 12月至 2 0 0 0年 8月共收治异位妊娠患者 376例 ,其中宫颈妊娠 8例。 8例患者年龄最大45岁 ,最小 2 5岁。初产妇 5例 ,经产妇 3例。有 1次人工流产史者 4例 ,2次以上人工流产史者 3例 ,无人工流产而有剖宫产史者 1例。 8例患者均有停经史 ;均伴有阴道出血 1～30ｄ ,量不等。2 .临床特点 :1例停…     

Recurrent cornual pregnancy after heterotopic cornual pregnancy successfully treated with systemic methotrexate

This report concerns a recurrent spontaneous cornual pregnancy 2 years after selective feticide of a heterotopic cornual pregnancy which occurred after IVF for tubal pathology. The recurrent cornual pregnancy was treated successfully with systemic methotrexate. Assisted reproductive techniques, especially in patients with tubal pathology, and non-invasive management of cornual pregnancies may lead to a higher incidence of recurrence.     

Open cornual resection versus laparoscopic cornual resection in patients with interstitial ectopic pregnancies

Objective

To compare laparotomy and laparoscopic management of interstitial ectopic pregnancies.

Study design

The medical records of 109 patients diagnosed with interstitial ectopic pregnancies at the Korea University Medical Center, the Republic of South Korea, between January 1998 and October 2009 were reviewed retrospectively. Eighty-eight women were treated by open cornual resection or laparoscopic cornual resection. A case-controlled study was performed. The outcomes were operative time, length of hospital stay, estimated blood loss, blood transfusion, and complication. Nominal variables were analyzed by the Fisher's exact test or the χ² test.

Results

The frequency of cornual ectopic pregnancies was 4.31% at this medical center. In patients with a cornual resection, primary laparotomy was performed in 49 women and laparoscopy was performed in 39 women. Laparoscopy was converted to laparotomy in five patients. There were no statistically significant differences between the two groups for the mean operation time, estimated blood loss, blood loss of more than 1000 mL, blood transfusion requirements, and complications. The mean number of postoperative hospital days was shorter in the laparoscopy group than in the laparotomy group (4.53 ± 1.44 days versus 5.89 ± 1.86 days, respectively; P < 0.001).

Conclusion

Laparoscopic cornual resection is a safe and less invasive procedure with a reasonable complication rate and shorter hospital stay.     

Ovarian pregnancy resulting from cornual fistulae in a woman who had undergone bilateral salpingectomy

OBJECTIVE: To report a case of ovarian pregnancy following in vitro fertilization-embryo transfer (IVF-ET) treatment for which the cornual fistulae was the most probable explanation of the cause. DESIGN: Case report. SETTING: University department and assisted reproduction unit. PATIENT(S): A 29-year-old woman with primary infertility. INTERVENTION(S): Hydrosalpinx of the bilateral fallopian tubes has been noted in patients who have decreased pregnancy rates in the IVF-ET treatment cycles. Salpingectomy before IVF cycles has been suggested to increase the pregnancy rate. We report a patient who presented with bilateral hydrosalpinx for whom bilateral salpingectomy was performed before IVF treatment. MAIN OUTCOME MEASURE(S): Clinical pregnancy. RESULT(S): The treatment cycle resulted in a primary ovarian pregnancy and required laparoscopic operation. A cornual fistulae was found that have might led to ectopic implantation of the embryos. CONCLUSION(S): Ovarian pregnancy may be an unexpected complication of those receiving bilateral salpingectomy before IVF treatment. The presence of cornual fistulae after salpingectomy was probably the cause of the ectopic pregnancy.     

妊娠合并卵巢肿瘤及瘤样病变58例临床分析

目的探讨妊娠合并卵巢肿瘤及瘤样病变患者的临床特征和处理对策。方法回顾性分析2009年1月至2010年12月福建省妇幼保健院收治的58例经手术病理诊断的妊娠合并卵巢肿瘤及瘤样病变患者的临床资料。结果 58例妊娠合并卵巢肿瘤及瘤样病变患者占同期妊娠的0.24%(58/23756),其中卵巢良性肿瘤及瘤样病变56例(96.6%),卵巢恶性肿瘤2例(3.4%)。妊娠前首次发现者5例(8.6%);孕早期发现者22例(37.9%),孕中期发现者18例(31.0%),孕晚期发现者13例(22.4%);孕早、中期均为超声检查发现,孕晚期均为剖宫产术中发现。56例卵巢良性肿瘤及瘤样病变患者中,50例(89.3%)行卵巢囊肿切除术,6例(10.7%)行附件切除术,随访8～18个月未见复发。2例妊娠合并卵巢恶性肿瘤患者中,1例卵巢浆液性囊腺癌行肿瘤细胞减灭术,术后辅助化疗8个疗程,随访12个月无瘤生存;1例卵巢肿瘤切除术后病理诊断卵巢幼年性颗粒细胞瘤,拒绝再次手术及化疗,术后2个月死亡。58例患者中,妊娠合并卵巢肿瘤蒂扭转行急诊手术8例,发生率为13.8%。58例患者的病理类型为成熟畸胎瘤24例(41.4%),浆液性囊腺瘤22例(37.9%),黄体囊肿10例(17.2%),颗粒细胞瘤1例(1.7%),浆液性乳头状囊腺癌1例(1.7%)。结论超声检查可以诊断和监测妊娠期卵巢肿瘤及瘤样病变,而剖宫产术中常规行双侧附件探查亦很重要。妊娠合并卵巢肿瘤蒂扭转患者以成熟畸胎瘤为最多见。     

Laparoscopic management of a cornual ectopic pregnancy associated with persistant gestational throphoblastic disease: a case report

A 30-year-old woman underwent laparoscopy for diagnosis and treatment of ectopic pregnancy. A dark-red bulging mass was observed in the right uterine horn. Laparoscopic hysterotomy was performed. The histological examination revealed a hydatidiform mole, which was confirmed by DNA ploidy analysis showing triploidy (69 XXY) as apartial hydatidiform mole after the cytogenetic examination. On the third postoperative day, the thoracic computed tomography scan revealed punctuate lesions. These lesions disappeared after single-agent chemotherapy with methothrexate. To the best of our knowledge, this is the first case of cornual persistent gestational trophoblastic neoplasia managed by laparoscopic surgery.