McBroom J W
Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
J Reprod Med. 2000 Jun;45(6):490-2.
Systemic methotrexate therapy for interstitial pregnancy has an increased failure rate as compared to other ectopic locations. No case of interstitial pregnancy with a retained intrauterine device (IUD) has been reported on before.
An asymptomatic, 21-year-old woman presented with a positive pregnancy test and a retained IUD. Vaginal ultrasound revealed a left interstitial pregnancy. Diagnostic laparoscopy was followed by a single dose of methotrexate (50 mg/m2). Five days later, a marked increase in the human chorionic gonadotropin level was followed by a second course (four doses) of methotrexate, 1 mg/kg, alternating with 0.1 mg/kg of leucovorin. Concomitant Chlamydia was treated with azithromycin, and the IUD was expelled spontaneously.
Medical management of interstitial pregnancy may prevent surgery that limits future fertility, but the evidence suggests that more than one dose of methotrexate may be required.
与其他异位妊娠部位相比，采用全身甲氨蝶呤治疗间质部妊娠的失败率更高。此前尚无宫内节育器（IUD）留存情况下发生间质部妊娠的病例报道。
一名21岁无症状女性，妊娠试验呈阳性且宫内节育器留存。经阴道超声检查发现左侧间质部妊娠。诊断性腹腔镜检查后给予单剂量甲氨蝶呤（50mg/m²）。五天后，人绒毛膜促性腺激素水平显著升高，随后给予第二个疗程（四剂）甲氨蝶呤，剂量为1mg/kg，与0.1mg/kg亚叶酸交替使用。同时，衣原体感染采用阿奇霉素治疗，宫内节育器自行排出。
间质部妊娠的药物治疗可能避免限制未来生育能力的手术，但有证据表明可能需要不止一剂甲氨蝶呤。
