宫角妊娠36例临床分析

目的 探讨宫角妊娠的临床特点、诊断和治疗方法.方法 对1990年1月～2006年8月北京协和医院收治的36例宫角妊娠进行回顾性分析.结果 在1 717例异位妊娠中,宫角妊娠共36例,占2%,临床表现为停经(100%)、不规则阴道出血(44%)和腹痛(39%).宫角妊娠术前诊断困难,误诊率达50%,易被误诊为输卵管间质部妊娠、绒癌.36例患者中1例(3%)观察治疗,9例(25%)在B超或腹腔镜监测下行清宫术,5例(14%)行全子宫切除术,16例(44%)行开腹或腹腔镜下宫角和/不和同侧输卵管切除术,5例(14%)行开腹或腹腔镜宫角妊娠物清除术.36例患者均预后良好,随访有3例宫内妊娠.结论 宫角妊娠的诊断主要依据B超,治疗以手术为主,治疗方案应个体化.

Clinical analyses of 36 cases of cornual pregnancy

Objective To determine the clinical characteristics, diagnosis and treatment of angular intrauterine pregnancy. Methods During the study period from Jan., 1990 to Aug., 2006, Thirty-six patients with angular intrauterine pregnancy were analyzed retrospectively focusing on clinical characteristics, diagnostic methods and treatment. Results Thirty-six angular intrauterine pregnancy. were incurred, with an incidence of 2%. The clinical characteristics of angular intrauterine pregnancy were cessation of menstruation(100%), vaginal bleeding (44%) and abdominal pain (39%). The incidence of hemorrhage shock was 8%. Angular intrauterine pregnancy was often misdiagnosed as interstitial tubal pregnancy and chorioma carcinoma, so the preoperative diagnosis was difficult. The incidence of misdiagnosis was 50%. Relying on preoperative B ultrasound, 53% patients were diagnosed angular intrauterine pregnancy, 29% patients had adnexal mass or mass close to uterus, and 15% patients had pathological changes in uterus and 3% patients were normal. 17 patients received dilatation and curettage and no embryo was found in 14 patients. The negative incidence was 82%. One patient (3%) was observed, Nine patients (25%)received dilatation and curettage under B ultrasound or laparoscopy, five patients (14%) received hysterectomy, sixteen patients (44%) received cornulrectomy transabdominal or laparoscopy and gestational objection were eliminated form five patients (14%) transabdominal operation or laparoscopy. All thirty-six patients of angular intrauterine pregnancy had optimal results and 3 cases have pregnancy in uterus during follow-up. Conclusion Angular intrauterine pregnancy was rare and the incidence of misdiagnosis was high. If misdiagnosed, its results were relatively severe. The diagnosis of angular intrauterine pregnancy mainly relied on preoperative B ultrasound. Operation was the main treatment and personal treatment was individualized.