特殊部位异位妊娠诊治方法探讨

目的探讨特殊部位异位妊娠的诊断和治疗方法。方法对57例特殊部位异位妊娠患者的临床资料进行回顾性分析。结果特殊部位异位妊娠57例,占异位妊娠总人数的6.77%;以输卵管间质部妊娠最多见占57.89%（33/57）,宫颈妊娠26.32%（15/57）,剖宫产瘢痕妊娠14.04%（8/57）,卵巢妊娠1.8%（1/57）;57例患术前定位诊断率为87.72%;治疗方式开腹手术52.73%（30/57）,腹腔镜手术5.27%（3/57）,药物保守治疗35.09%（20/57）;20例药物保守治疗中宫腔镜下注射MTX2例,药物治疗结合清宫术2例,57例均治疗成功,无手术并发症。结论特殊类型异位妊娠因其临床特征多变且隐匿致诊断困难,提高术前定位诊断率能明显提高预后;药物保守治疗结合手术治疗是处理特殊部位异位妊娠的主要方法。

Diagnosis and treatment in 57 cases with specific type of ectopic pregnancy

Objective To investigate the diagnosis and treatment of specific type of ectopic pregnancy.Methods There were 842 ectopic patients in our hospital from January 2004 to April 2009,including 57 cases of specific types,all of them were analyzed ret-rospectively.Results The incidence of specific type of ectopic pregnancy was 6.77% （ 57/842） .The most of them was cornual preg-nancy （ 33/57,57.89% ） ,the others were cervical pregnancy cesarean scar pregnancy （ 15/57,26.32% ） ,cesarean scar pregnancy （ 8/57,14.04%） ,and ovarian pregnancy （ 1/57,1.8%） .Pre-operative location diagnosis rate was 87.72%.More than half of them （ 52.73%） was successfully treated by laparotomy.And other methods for treatment were diagnostic curettage after uterine arterial embo-ligation,laparotomy and conservative drug therapy.There were no severe complications.Conclusions B ultrasound scan is an important screening method for the early location diagnosis before operation in specific types of ectopic pregnancy,and laparoscopic surgery be-comes main therapeutic tool for these patients in our hospital,diagnostic curettage after uterine arterial emboligation,laparotomy and conservative drug therapy are also useful.