Tulandi Togas, Al-Jaroudi Dania
Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Obstet Gynecol. 2004 Jan;103(1):47-50. doi: 10.1097/01.AOG.0000109218.24211.79.
To summarize management of interstitial pregnancy and its outcome among 32 reported cases in the world.
From 1999 to 2002, 32 cases of interstitial pregnancy were reported to the registry of the Society of Reproductive Surgeons. The participants completed a five-page questionnaire regarding when and how diagnosis was made, the characteristics of the pregnancy, treatment modalities, and subsequent reproductive outcome.
History of ipsilateral salpingectomy was encountered in 37.5% of patients, and the diagnosis was made by ultrasound in 71.4% of the patients. Eight women were treated with methotrexate either systemically (n = 4), locally under ultrasound guidance (n = 2), or under laparoscopic guidance (n = 2). Eleven patients were treated by laparoscopy and 13 by laparotomy. Three patients failed systemic methotrexate treatment and subsequently required surgery. Persistently elevated serum beta human chorionic gonadotropin levels were found in one patient after laparoscopic cornual excision, and she was successfully treated with methotrexate. Fourteen cases (43.7%) of rupture of interstitial pregnancy were found. This included five cases (15.6%) of heterotopic pregnancy; all were the results of in vitro fertilization, and all ruptured at the time of diagnosis. Subsequent pregnancy was achieved in ten patients. No uterine rupture was encountered during pregnancy or labor.
Ipsilateral salpingectomy, previous ectopic pregnancy, and in vitro fertilization are predisposing factors for interstitial pregnancy. Contrary to previous belief, rupture of interstitial pregnancy occurs relatively early in pregnancy. In selected patients, laparoscopic cornual excision is a viable treatment option.
总结全球32例间质部妊娠的治疗及结局。
1999年至2002年，向生殖外科学会登记处报告了32例间质部妊娠病例。参与者填写了一份五页的问卷，内容涉及诊断时间和方式、妊娠特征、治疗方式以及后续生殖结局。
37.5%的患者有同侧输卵管切除术史，71.4%的患者通过超声诊断。8名女性接受了甲氨蝶呤治疗，其中4例为全身用药，2例在超声引导下局部用药，2例在腹腔镜引导下局部用药。11例患者接受了腹腔镜手术，13例接受了剖腹手术。3例患者全身应用甲氨蝶呤治疗失败，随后需要手术。1例患者在腹腔镜下切除宫角后血清β-人绒毛膜促性腺激素水平持续升高，经甲氨蝶呤治疗成功。发现14例（43.7%）间质部妊娠破裂。其中包括5例（15.6%）异位妊娠；均为体外受精结果，且均在诊断时破裂。10例患者随后成功妊娠。妊娠或分娩期间未发生子宫破裂。
同侧输卵管切除术、既往异位妊娠和体外受精是间质部妊娠的易感因素。与以往观点相反，间质部妊娠破裂在妊娠早期相对常见。对于部分患者，腹腔镜下宫角切除术是一种可行的治疗选择。
