Chatterjee Jayanta, Abdullah Asma, Sanusi Fatai Ade, Irvine Laurie, Griffin David
Queen Charlotte and Chelsea Hospital, Obstetrics and Gynaecology, Du Cane Road, London, Middlesex, W12 0HS, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.02.2009.1614. Epub 2009 Jul 14.
One of the major concerns following cornual ectopic pregnancy, as shown in this case, is uterine rupture in future pregnancies. Uterine rupture has been described at 20 weeks gestation in a woman who had a cornual pregnancy treated by salpingectomy at 24 weeks, and as such it has been suggested by some experts that suturing the uterine wall to reinforce the defective area is advisable. Conversely, term deliveries have been described in patients with laparoscopic treatment of cornual pregnancies without reinforcing sutures. There is general agreement that suturing the uterine wall should be performed in cases where the cornual pregnancy sac extends into the endometrial cavity. Long-term follow-up of patients treated with cornual pregnancies with endometrial involvement may reveal the optimum treatment technique. In addition to surgical technique, patient counselling and appropriate debriefing regarding increasing interpregnancy interval is paramount in reducing maternal and fetal morbidity. Proper documentation in operative notes is vitally important for future reference.
如本病例所示,宫角异位妊娠后的一个主要担忧是未来妊娠时子宫破裂。有一名在24周时接受输卵管切除术治疗宫角妊娠的女性,在妊娠20周时发生了子宫破裂,因此一些专家建议缝合子宫壁以加强缺损区域是可取的。相反,有腹腔镜治疗宫角妊娠且未进行加强缝合的患者足月分娩的报道。普遍认为,当宫角妊娠囊延伸至子宫内膜腔时,应进行子宫壁缝合。对有子宫内膜受累的宫角妊娠患者进行长期随访,可能会揭示最佳治疗技术。除了手术技术外,对患者进行咨询并就延长妊娠间隔进行适当的情况说明对于降低母婴发病率至关重要。手术记录中的妥善记录对于未来参考至关重要。