Kato Sousuke, Tanaka Tomohito, Terai Yoshito, Yamashita Yoshiki, Ohmichi Masahide
Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan.
J Obstet Gynaecol Res. 2011 Sep;37(9):1250-4. doi: 10.1111/j.1447-0756.2010.01508.x. Epub 2011 Apr 26.
Interstitial pregnancy, which is a rare form of tubal ectopic pregnancy, can grow larger than those within the fallopian tube because the surrounding myometrium is more expandable than the tube; many cases are advanced and treated with surgical resection or a large amount of methotrexate (MTX). This report presents a case of an advanced interstitial pregnancy treated with systemic MTX and laparoscopic local MTX injection combined with transcervical aspiration of the gestational sac. A 27-year-old nulliparous female presented with an interstitial pregnancy. Serum human chorionic gonadotropin (hCG) level was 90000 IU/L. MTX was given systemically (50 mg/m(2) i.m.) and the gestational sac was aspirated transcervically under laparoscopic guidance followed by local injection of 25 mg MTX. The patient received a total of only 95 mg MTX. The gestational sac disappeared and serum hCG became undetectable. The patient became pregnant spontaneously six months later, and delivered a live 2482-g infant in good condition by planned cesarean section at 36 weeks and 3 days of gestation. No defect of the myometrium was seen during the surgery. This therapy may be effective for interstitial pregnancy and can be performed safely with laparoscopy.
间质部妊娠是输卵管异位妊娠的一种罕见形式，由于其周围的子宫肌层比输卵管更具扩展性，所以间质部妊娠可能比输卵管内的妊娠长得更大；许多病例病情进展，需采用手术切除或大量甲氨蝶呤（MTX）治疗。本报告介绍了一例晚期间质部妊娠，采用全身MTX治疗、腹腔镜局部MTX注射并结合经宫颈妊娠囊抽吸术。一名27岁未生育女性诊断为间质部妊娠。血清人绒毛膜促性腺激素（hCG）水平为90000 IU/L。给予全身MTX（50 mg/m²，肌肉注射），在腹腔镜引导下经宫颈抽吸妊娠囊，随后局部注射25 mg MTX。该患者总共仅接受了95 mg MTX。妊娠囊消失，血清hCG检测不到。患者6个月后自然受孕，在妊娠36周零3天时通过计划剖宫产顺利产下一名体重2482 g的健康活婴。手术过程中未见子宫肌层缺损。这种治疗方法可能对间质部妊娠有效，且可通过腹腔镜安全实施。
