Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Bochum, Germany.
Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Marien Hospital Herne, Hölkeskampring 45, 44625, Herne, Germany.
Arch Gynecol Obstet. 2019 Sep;300(3):651-660. doi: 10.1007/s00404-019-05240-7. Epub 2019 Jul 23.
Chronic ectopic pregnancy (CEP) is a variant of ectopic pregnancy (EP) characterized by low or absent serum human chorionic gonadotropin (hCG) levels, resistance to methotrexate (MTX), and an adnexal mass with fibrosis, necrosis, and blood clots due to repeated and gradual fallopian tube wall disintegration. CEP may complicate the course of patients with EP and is difficult to diagnose.
The case of a 36-year-old woman with EP, low serum hCG levels, a small echogenic adnexal mass, and resistance to MTX is presented. Salpingectomy was performed and histology demonstrated CEP with fibrosis, necrosis, and a hematocele within degenerated chorionic villi.
In a database search, 19 case reports, 3 case-control studies, and 3 case series describing 399 patients with CEP were identified. Serum hCG was negative in 40/124 cases (32%) with reported levels of serum hCG. The most common presenting symptom was abdominal pain (284/399 [71%]), followed by irregular vaginal bleeding (219/399 [55%]), and fever (20/399 [5%]). 73/399 (18%) women were asymptomatic. An adnexal mass was seen in 144/298 (48%) cases with perioperative ultrasound examination and with a mean largest diameter of 6.8 cm. Data on treatment modalities and outcomes were available for 297 women. Of these, 89% underwent surgery as first-line therapy. Laparoscopy was performed in most cases. MTX was the first-line therapy in a minority of cases. Complete resolution was achieved by first-line therapy in 287/297 (97%) cases. Adverse events were reported in 218 patients with CEP. Among those, adverse events ≥ grade 3 were seen in 186/218 (85%) cases. There was no case of treatment-related mortality.
CEP is a variant of EP with low or absent trophoblast activity. A prolonged clinical course is typical and surgery is the mainstay of treatment.
慢性宫外孕（CEP）是宫外孕（EP）的一种变异，其特征为血清人绒毛膜促性腺激素（hCG）水平低或缺失、对甲氨蝶呤（MTX）耐药，以及由于反复、逐渐的输卵管壁破裂导致附件区肿块纤维化、坏死和血栓形成。CEP 可能使 EP 患者的病程复杂化，且难以诊断。
本病例为一名 36 岁 EP 患者，血清 hCG 水平低，附件区有低回声肿块，对 MTX 耐药。行输卵管切除术，组织学显示 CEP 伴纤维化、坏死，退化绒毛内有血肿。
在数据库检索中，共发现 19 例病例报告、3 例病例对照研究和 3 例病例系列研究，共描述了 399 例 CEP 患者。血清 hCG 阴性的 124 例（32%）有报道的血清 hCG 水平。最常见的首发症状为腹痛（284/399 [71%]），其次为不规则阴道出血（219/399 [55%]）和发热（20/399 [5%]）。无症状的患者有 73/399（18%）。在术前超声检查中，144/298（48%）的病例发现附件区肿块，最大直径平均为 6.8cm。297 例患者中，有治疗方式和结局数据。其中，89%的患者行手术作为一线治疗。大多数病例采用腹腔镜治疗。少数病例采用 MTX 作为一线治疗。297 例患者中，287 例（97%）通过一线治疗完全缓解。186/218（85%）的患者发生了不良事件，其中≥3 级不良事件的患者有 186/218（85%）。无治疗相关死亡病例。
CEP 是一种低或无滋养细胞活性的 EP 变异。其典型特点为病程较长，手术是主要治疗手段。
