Tanos Vasilios, ElAkhras Sayed, Kaya Baris
Medical School, St Georges University of London, at Nicosia University, Cyprus; Aretaeio Hospital, Nicosia, Cyprus; Omam Hospital Women Health, Cairo, Egypt; European Academy of Gynecological Surgery - Nicosia Branch, Cyprus.
Omam Hospital Women Health, Cairo, Egypt.
J Gynecol Obstet Hum Reprod. 2019 Apr;48(4):247-253. doi: 10.1016/j.jogoh.2018.05.001. Epub 2018 May 3.
To evaluate the hysteroscopic management on cervical pregnancy.
A case series report and literature review on patients with early first trimester cervical pregnancy (CP) treated by hysteroscopy. The symptoms upon admission, β-hCG levels, hysteroscopy technique, blood loss and operation outcomes were presented.
Four patients with early CP between 5 and 7 weeks were successfully managed with operative hysteroscopy. Three out of four patients had at least one risk factor for cervical ectopic pregnancy. Two patients were diagnosed on routine examinations and the other two presented with vaginal spotting and pelvic pain. Mechanical hysteroscopy was used in three patients while one case was managed by a 10mm resectoscope. Three women discharged home on the same day and one patient 24h after the operation. Literature review revealed 16 publications of cervical pregnancy managed with operative hysteroscopy. 14 articles demonstrated single case reports and two papers were CP case series. Hysteroscopic surgery was successfully reported in 12 cases as a sole treatment, in seven cases after failure of methotrexate treatment and in eight cases as a combined treatment with uterine artery embolization.
Our case series demonstrated that operative hysteroscopy can be used as a sole treatment in early, less than 8-week CPs with safety. Literature review demonstrated that most of the early first trimester CP cases were treated by hysteroscopy and the rest after failure of methotrexate treatment or in combination with uterine artery embolization.
评估宫腔镜在宫颈妊娠治疗中的应用。
对经宫腔镜治疗的孕早期宫颈妊娠患者进行病例系列报告及文献综述。介绍患者入院时的症状、β - 人绒毛膜促性腺激素（β - hCG）水平、宫腔镜技术、失血量及手术结果。
4例孕5至7周的早期宫颈妊娠患者经宫腔镜手术成功治疗。4例患者中有3例至少有一项宫颈异位妊娠的危险因素。2例患者经常规检查确诊，另外2例表现为阴道点滴出血和盆腔疼痛。3例患者采用机械宫腔镜，1例采用10mm电切镜治疗。3名女性术后当天出院，1例术后24小时出院。文献综述显示有16篇关于宫腔镜治疗宫颈妊娠的出版物。14篇文章为单病例报告，2篇为宫颈妊娠病例系列。宫腔镜手术作为单一治疗方法成功报道12例，甲氨蝶呤治疗失败后7例，与子宫动脉栓塞联合治疗8例。
我们的病例系列表明，宫腔镜手术可安全地作为孕8周以内早期宫颈妊娠的单一治疗方法。文献综述表明，大多数孕早期宫颈妊娠病例采用宫腔镜治疗，其余病例在甲氨蝶呤治疗失败后或与子宫动脉栓塞联合治疗。
