Gao Bingsi, Cheng Chunxia, Pan Qiong, Johnson Grace, Qin Xian, Xu Dabao
Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
JSLS. 2019 Apr-Jun;23(2). doi: 10.4293/JSLS.2018.00109.
Heterotopic interstitial pregnancy (HIP) is a rare but potentially life-threatening condition that occurs more commonly in the setting of assisted reproductive technology (ART). It is significant to introduce a safe and effective laparoscopic strategy to manage HIP following the use of ART.
This study included 9 cases of patients with HIP who underwent laparoscopic management in our department. Our approach involves placement of a purse-string suture around the cornua of the uterus followed by removal of the interstitial pregnancy using a flushing technique. This is followed by repair of the uterine cornua, leaving the intrauterine pregnancy (IUP) undisturbed. The outcomes were reported regarding surgical complications during the procedure as well as outcomes for the remaining IUP including gestational age at delivery and any neonatal adverse events.
Five of the 9 cases were asymptomatic at presentation. All cases underwent laparoscopic management with successful removal of the interstitial gestational product and preservation of the IUP. With the exception of one case that was lost to followup, all cases resulted in full-term delivery. The average intraoperative blood loss was 24.44 ± 14.23 mL and the average operation time was 70.44 ± 22.48 minutes. There were no postoperative complications, including persistent ectopic pregnancy, rupture of the uterus, spontaneous abortion, or preterm delivery. All newborns for whom data was available were healthy.
This laparoscopic strategy is a safe, relatively simple, effective, and minimally invasive approach to address the challenging case of HIP after ART in the first trimester.
异位间质部妊娠（HIP）是一种罕见但可能危及生命的情况，在辅助生殖技术（ART）背景下更为常见。引入一种安全有效的腹腔镜策略来处理ART后发生的HIP具有重要意义。
本研究纳入了9例在我科接受腹腔镜治疗的HIP患者。我们的方法包括在子宫角周围放置荷包缝合线，然后使用冲洗技术取出间质部妊娠。随后修复子宫角，不干扰宫内妊娠（IUP）。报告了手术过程中的手术并发症以及剩余IUP的结局，包括分娩时的孕周和任何新生儿不良事件。
9例中有5例在就诊时无症状。所有病例均接受了腹腔镜治疗，成功取出间质部妊娠产物并保留了IUP。除1例失访外，所有病例均足月分娩。术中平均出血量为24.44±14.23 mL，平均手术时间为70.44±22.48分钟。无术后并发症，包括持续性异位妊娠、子宫破裂、自然流产或早产。所有有数据的新生儿均健康。
这种腹腔镜策略是一种安全、相对简单、有效且微创的方法，可用于处理孕早期ART后具有挑战性的HIP病例。
