Hu Wei-Min, Yang Ming-Jie, Chao Kuan-Chong, Wang Peng-Hui
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2007 Sep;46(3):272-5. doi: 10.1016/S1028-4559(08)60033-9.
Cervical pregnancy is a rare life-threatening form of ectopic pregnancy. In the past, hysterectomy was often the only choice available because of profuse hemorrhage that accompanied the attempts of removal of the cervical pregnancy.
We present a case of a successful surgical resection of a cervical pregnancy. Diagnosis of a viable cervical pregnancy was made at 9 weeks by ultrasound. Acute abdominal pain, massive vaginal bleeding, and impending shock occurred suddenly in this patient. In order to preserve her future fertility, we used a series of modified procedures, step-by-step, to minimize and control acute hemorrhaging, including transient ligation of the cervicovaginal branches of the uterine vessels with an 18-Fr Foley catheter, vasopressin use, resection of the ectopic pregnancy mass, compression using a 24-Fr Foley catheter, and finally, wound closure. Intraoperative blood loss was less than 400 mL. This treatment was successful, with resumption of normal menstrual cycles and a normal transvaginal ultrasonographic appearance of the cervical canal documented 3 months after the initial diagnosis.
The use of modified surgical procedures, step-by-step, is a good alternative to total hysterectomy for managing cervical pregnancies that require urgent attention.
宫颈妊娠是一种罕见的、危及生命的异位妊娠形式。过去，由于在尝试切除宫颈妊娠时会伴随大量出血，子宫切除术往往是唯一可行的选择。
我们呈现一例成功手术切除宫颈妊娠的病例。通过超声在孕9周时诊断为存活的宫颈妊娠。该患者突然出现急性腹痛、大量阴道出血及即将休克的症状。为了保留其未来生育能力，我们逐步采用了一系列改良手术，以尽量减少和控制急性出血，包括用18F Foley导管暂时结扎子宫血管的宫颈阴道分支、使用血管加压素、切除异位妊娠包块、用24F Foley导管压迫，最后缝合伤口。术中失血少于400毫升。该治疗取得成功，初始诊断3个月后月经周期恢复正常，宫颈管经阴道超声检查外观正常。
对于需要紧急处理的宫颈妊娠，逐步采用改良手术是全子宫切除术的良好替代方法。
