经阴道穿刺治疗宫内外同时妊娠4例

目的 探讨经阴道穿刺在宫内外同时妊娠(HP)治疗中的应用及价值.方法 2004年1月至2009年12月广州医学院第三附属医院生殖医学中心体外授精-胚胎移植(IVF-ET)妊娠患者中,筛选出经阴道穿刺治疗的4例HP患者,分析探讨经阴道穿刺治疗HP的适应证、时机的选择、治疗方法及妊娠结局.结果 经阴道穿刺治疗的4例HP均为宫内妊娠合并输卵管妊娠,4例患者宫内妊娠胚胎及异位妊娠胚胎均见原始心管搏动.3例行经阴道穿刺抽吸异位妊娠胚胎,其中2例治疗时间分别为孕42d、43 d,均足月分娩,1例治疗时间为孕68d,穿刺术后4 h输卵管破裂行开腹手术治疗,术后4d宫内妊娠流产.另1例抽吸胚胎后注射50%葡萄糖2 ml,治疗时间为孕50 d,足月分娩.结论 如果HP患者孕周较小(＜8周),病变输卵管未破裂,无明显的腹腔内出血,术后能够有较长时间定期复诊随访,则可以选择经阴道穿刺治疗HP.

Transvaginal aspiration for treatment of heterotopic pregnancy:a report of 4 cases

Objective To investigate the value and application of transvaginal aspiration for treatment of heterotopic pregnancy(HP). Methods Four cases of HP managed by ultrasound-guided transvaginal aspiration were selected from all pregnancies by IVF-ET between January 2004 and December 2009 at Reproductive Center of the Third Affiliated Hospital of Guangzhou Medical College. The indications, optimal timing, treatment and pregnancy outcomes of transvaginal aspiration in these four cases were studied. Results The four cases of HP managed by transvaginal aspiration were all intrauterine pregnancy complicated with tube pregnancy. Cardiac activity was detected both in the extrauterine and intrauterine embryos of four patients. Three were treated by transvaginal aspiration of ectopic embryos. Two of them were managed on days 42 and 43 of pregnancy respectively, and both had successful full-term delivery. One was treated on day 68 but laparotomy was necessitated due to tube rupture 4 hours later. Spontaneous abortion ensued 4 days after operation. The fourth patient was managed by ultrasound-guided transvaginal aspiration and injection of 2 ml of 50% glucose solution on day 50, and she had uneventful term delivery. Conclusion Ultrasound-guided transvaginal aspiration is an option for early HP patients (less than 8 weeks) without pregnant tube rupture and intraperitoneal hemorrhage, in whom long-term follow-up can be ensured.