成功诊治宫内合并宫角妊娠1例及文献复习

doi:10.24920/003793

摘要/Abstract

摘要：

宫内合并宫角妊娠是一种罕见的严重妊娠并发症。本文报告一例33岁妇女,在体外受精-胚胎移植后发生宫内合并宫角妊娠。为了防止宫角妊娠破裂,宫角妊娠物在妊娠7⁺²周时经腹腔镜手术被清除。在妊娠38⁺³周时,此孕妇顺利分娩一名健康男婴。此外,我们还回顾MEDLINE（PubMed）数据库收录的所有关于CHP的病例报告、病例系列和队列研究,分析了CHP的临床表现、危险因素、治疗方法及妊娠结局。

关键词: 宫内合并宫角妊娠, 阴道超声, 腹腔镜, 辅助生殖技术

Abstract:

Cornual heterotopic pregnancy is an extremely rare, life-threatening complication during pregnancy. Here, we report a 33-year-old woman who suffered cornual heterotopic pregnancy afterin vitro fertilization embryo transfer. To prevent rupture during heterotopic pregnancy, she received laparoscopic surgery to remove the ectopic gestational sac at 7⁺²weeks of gestation. Ultimately, she delivered a healthy boy at 38⁺³ weeks of gestation. Here, we also review the clinical presentations, risk factors, treatment options and outcomes of cornual heterotopic pregnancy.

Key words: cornual heterotopic pregnancy, transvaginal ultrasonography, laparoscopy, reproduction technique

Li Chen, Wenjie Sun, Lijuan Hao, Yi Lin. Successfully Managing Cornual Heterotopic Pregnancy:A Case Report and Literature Review[J].Chinese Medical Sciences Journal, 2021, 36(2): 161-170.

图/表 5

References	Case no. (fertilization way)	Risk factors	Manifestations and GA at diagnoses (weeks)	Treatment of CHP	Outcome of intrauterine pregnancy
Lower et al.^[8]	1 (IVF-ET)	Left salpingectomy	Cornual rupture (8)	Laparotomy	Term delivery
Gamberdella et al.^[9]	1 (IVF-ET)	No data	Cornual rupture (8)	Laparotomy	Term delivery
Chen et al.^[10]	1 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (10)	Laparotomy	Miscarriage (no fetal heart beats of intrauterine fetuses)
Trma-Tritsch et al.^[11]	1 (IVF-ET)	No data	Free of symptoms (9)	Cornual injection of KCl	Miscarriage
Fernandez et al.^[12]	3 (IVF-ET) 1 (Spontaneous)	Bilateral salpingectomy No tubal history	Free of symptoms (6-8)	1 expectant management, 3 cornual injection of KCl	1 term delivery, 2 miscarriage at 8 and 10 weeks separately, 1 term delivery
Pérezet al.^[13]	1 (IVF-ET)	No data	Free of symptoms (7)	Cornual injection of KCl	Term delivery
Vilos et al.^[14]	1 (ovulation induction)	Bilateral salpingectomy	Free of symptoms (7⁺⁵)	Laparoscopy	Term delivery
Loret de Mola et al.^[15]	2 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (9)	Laparotomy	1 preterm birth at 28 weeks, 1 term delivery
Gaudier et al.^[16]	1 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (7)	Laparotomy	Preterm birth at 34 weeks
Benifla et al.^[17]	2 (IVF-ET)	No data	Free of symptoms (6-7)	Cornual injection of KCl	1 miscarriage, 1 term delivery
Baker et al.^[18]	1 (IVF-ET)	No data	Free of symptoms (7)	TVS injection of MTX	Term delivery
Kasum et al.^[19]	1 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (7)	Laparotomy	Preterm birth at 36 weeks
van der Weiden et al.^[20]	1 (IVF-ET)	Bilateral salpingectomy	Free of symptoms (8)	Cornual injection of KCl	Term delivery
Oyawoye et al.^[21]	1 (IVF-ET)	PCOS	Free of symptoms (6⁺³)	TVS injection of MTX	Term delivery
Chin et al.^[7]	2 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (12 /17)	Laparotomy	2 Term delivery
Bhat et al.^[22]	1 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (12)	laparotomy	Term delivery
Robin et al.^[23]	1 (IVF-ET)	Bilateral salpingectomy	Free of symptoms (8)	Cornual injection of KCl	Term delivery
Ozgur et al. ^[24]	1 (IVF-ET)	Tubal ligation or tuboplasty	Free of symptoms (9)	Cornual injection of KCl	Uterus rupture at 11 weeks
Ben-Ami et al.^[25]	1 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (7)	Laparoscopy	Term delivery
Blazar et al.^[26]	1 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (6)	Laparotomy	Term delivery
Divryet al.^[27]	1 (IVF-ET)	Tubal factor combined with a masculine factor	Cornual rupture (6)	Laparotomy	Preterm birth at 31 weeks
Parket al.^[28]	1 (IVF-ET)	Right salpingectomy	Free of symptoms (6)	Cornual injection of KCl	Term delivery
Poujade et al.^[29]	1 (spontaneous)	No tubal history	Abdominal pain and bleeding (9)	Laparoscopic injection of MTX	Miscarriage
Sentilhes et al.^[30]	1 (IVF-ET)	Endometriosis	Free of symptoms (7)	Expectant management	Term delivery
Soriano et al.^[31]	3 (IVF-ET)	Bilateral salpingectomy	Vaginal bleeding (7-8)	Laparoscopy	3 term delivery
Qiong et al.^[32]	9 (IVF-ET)	3 (bilateral salpingectomy), 6 (no data)	6, abdominal pain; 3, free of symptoms (4-6)	1 laparotomy, 3 expectant management, 5 selective embryo reduction	1 miscarriage, 3 term delivery, 2 miscarriage, 3 term delivery
Lukásová et al.^[33]	1 (IVF-ET)	Bilateral salpingectomy	Vaginal bleeding (6)	Laparoscopy	Term delivery
Mayer et al.^[34]	1 (IVF-ET)	Dissection of uterine septum	Free of symptoms (7)	Expectant management	Preterm birth at 31 weeks (uterine rupture)
Prorocic et al. ^[35]	1 (IVF-ET)	Right salpingectomy	Free of symptoms (7)	Cornual injection of hypertonic NaCl	Term delivery
Alvarez et al.^[36]	1 (IVF-ET)	Left salpingectomy	Cornual rupture (5)	Laparotomy	Term delivery
Oral et al.^[37]	1 (IVF-ET)	Bilateral salpingectomy	Cornual rupture (7)	Laparoscopy	Term delivery
Tufan et al.^[38]	1 (spontaneous)	No tubal history	Cornual rupture (8)	Laparotomy	Miscarriage (intrauterine gestational sac rupture)
Kim et al.^[39]	13 (IVF-ET)	8 (bilateral salpingectomy) 5 (tubal ligation or tuboplasty)	4, abdominal pain; 2, vaginal bleeding; 7, free of symptoms (5⁺⁴-10)	Laparoscopy	7 term delivery, 3 preterm birth, 3 miscarriage
Peker et al.^[40]	1 (IVF-ET)	No data	Abdominal pain (11)	Laparoscopy	Term delivery
Xu et al.^[41]	14 (IVF-ET)	No data	4, cornual rupture; 10, free of symptoms (5-9)	Laparoscopy	All term delivery
Wu et al.^[42]	5 (IVF-ET)	Bilateral salpingectomy	2, abdominal pain and viginal bleeding; 3, free of symptoms (7-9)	Laparoscopy	Term delivery
Eom et al.^[43]	3 (IVF-ET)	Bilateral salpingectomy	1, cornual rupture; 2, free of symptoms (7-8)	Laparoscopy	1 miscarriage, 2 term delivery

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