Anderson Paynesha M, Opfer Erin K, Busch Jeanne M, Magann Everett F
Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.
Obstet Gynecol Int. 2009;2009:247452. doi: 10.1155/2009/247452. Epub 2009 Aug 9.
Background. The upper anterior abdominal wall is a very unusual location for an ectopic pregnancy making optimal management uncertain. Case. We report the case of a 26-year-old gravida 4, para 1, aborta 2 with a rising quantitative human chorionic gonadotropin level following a negative diagnostic laparoscopic examination. She was subsequently diagnosed with an abdominal wall ectopic pregnancy 2 cm inferior to the liver. A single percutaneous intralesional injection of methotrexate was successful after initial failure with systemic methotrexate. Conclusion. Systemic methotrexate is a logical first choice for management of a stable early abdominal wall pregnancy. Direct intralesional injection of methotrexate as the next treatment choice may avoid the morbidity linked with operative management.
背景。异位妊娠发生于上腹部前壁是非常罕见的情况，这使得最佳治疗方案难以确定。
病例。我们报告一例26岁孕妇，孕4产1流2，诊断性腹腔镜检查结果为阴性，但血清人绒毛膜促性腺激素水平不断升高。随后她被诊断为肝下2厘米处的腹壁异位妊娠。在全身应用甲氨蝶呤初始治疗失败后，经皮向瘤内单次注射甲氨蝶呤获得成功。
结论。全身应用甲氨蝶呤是稳定型早期腹壁妊娠治疗的合理首选。直接向瘤内注射甲氨蝶呤作为下一步治疗选择可避免手术治疗相关的发病率。
