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目的探讨宫颈环扎术、宫腔镜手术及子宫动脉栓塞术治疗宫颈妊娠的临床疗效。方法收集2009年9月至2013年9月军事医学科学院附属医院妇科5例宫颈妊娠患者,其中3例患者采用宫腔镜电切术;1例患者因大出血、休克急诊入院,纠正休克同时行宫颈环扎术止血,5 d后行子宫动脉栓塞及宫腔镜电切术;1例行宫腔镜电切术联合宫颈环扎术。5例患者均配合甲氨蝶呤局部或全身注射。结果与结论 5例患者均治疗成功,即成功清除宫颈妊娠组织、血人绒膜促性腺激素(HCG)降至正常、恢复正常月经周期。宫腔镜手术联合甲氨蝶呤肌注对于早期宫颈妊娠、血HCG<10 000 mIU/ml、无原始心管搏动者可取得满意疗效;对于停经时间较长、血HCG值>10 000 mIU/ml、有原始心管搏动、孕囊较大、生命体征稳定者,子宫动脉栓塞联合宫腔镜电切术是安全、疗效确切的微创性治疗方法;宫颈环扎术对于宫颈妊娠急性大出血的止血效果确切,为子宫动脉栓塞及宫腔镜手术争取了时间,从而保留子宫及生育功能。三者是安全有效的微创性保守治疗方法,值得推广。
Objective To investigate the clinical effect of cervical cerclage, hysteroscopy and uterine artery embolization in the treatment of cervical pregnancy. Methods A total of 5 cases of cervical pregnancy were collected from the Department of Gynecology, Affiliated Hospital of Academy of Military Medical Sciences from September 2009 to September 2013, of which 3 patients underwent hysteroscopic resection. One patient was admitted to hospital due to hemorrhage and shock, Cerclage surgery to stop bleeding, uterine artery embolization 5 days and hysteroscopic resection; 1 case of hysteroscopic resection combined with cervical cerclage. All 5 patients received methotrexate locally or systemically. RESULTS AND CONCLUSION All five patients were successfully treated, that is, the cervical pregnancy tissue was successfully removed and HCG decreased to normal and normal menstrual cycle was restored. Hysteroscopic surgery combined with methotrexate intramuscular injection for early cervical pregnancy, blood HCG <10 000 mIU / ml, without original cardiac patency can be satisfied with the efficacy; for a longer menopause, blood HCG> 10 000 mIU / ml, a primitive cardiac catheterization, gestational sac larger, stable vital signs, uterine artery embolization combined with hysteroscopic resection is safe and effective minimally invasive treatment; cervical cerclage for acute cervical bleeding pregnancy Hemostatic effect is exact, for the uterine artery embolization and hysteroscopic surgery for the time, so as to retain the uterus and reproductive function. The three are safe and effective minimally invasive conservative treatment, it is worth promoting.