Ye Jian-Pei, Gao Yang, Lu Li-Wei, Ye Yong-Ju
Department of Ultrasonography, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China.
Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China.
World J Clin Cases. 2022 Jun 26;10(18):6128-6135. doi: 10.12998/wjcc.v10.i18.6128.
Cervical pregnancy is increasing in morbidity, and a definite diagnosis in early stages is challenging due to its specific onset site. Surgery is the mainstay of treatment for cervical pregnancy, but it may result in the loss of natural fertility. Therefore, it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.
We report the case of a cervical pregnancy successfully treated by ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy. A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy. Transvaginal ultrasound revealed a gestational sac (approximately 22 mm x 13 mm) situated in the cervical canal with a yolk sac and blood flow signals. No cardiac activity was detected. Serum beta progesterone was 17.06 ng/mL, and serum beta human chorionic gonadotropin (β-HCG) was 5077.0 IU/L. The patient was diagnosed with cervical pregnancy. She was treated by ultrasound-guided cervical-intramuscular injections of lauromacrogol (3 mL) in combination with aborting under hysteroscopic visualization. A gradual decrease in β-HCG levels and normal ultrasound findings were observed. Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase. The patient was discharged on day 6, and her β-HCG level was 0.67 mIU/mL after 1 wk. There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function, renal function, and routine blood analysis after treatment. The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy.
Ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.
宫颈妊娠的发病率呈上升趋势，由于其特殊的发病部位，早期明确诊断具有挑战性。手术是宫颈妊娠的主要治疗方法，但可能导致自然生育能力丧失。因此，寻求安全有效的宫颈妊娠治疗方法是一项巨大的挑战。
我们报告了一例通过超声引导下宫颈肌内注射聚桂醇联合宫腔镜成功治疗宫颈妊娠的病例。一名23岁有轻微不规则阴道出血的女性因疑似异位妊娠入住我科。经阴道超声显示宫颈管内有一个妊娠囊（约22 mm×13 mm），伴有卵黄囊和血流信号。未检测到心搏。血清β-孕酮为17.06 ng/mL，血清β-人绒毛膜促性腺激素（β-HCG）为5077.0 IU/L。该患者被诊断为宫颈妊娠。她接受了超声引导下宫颈肌内注射聚桂醇（3 mL）并在宫腔镜直视下清宫治疗。观察到β-HCG水平逐渐下降且超声检查结果正常。术后病理检查显示有绒毛及分泌期子宫内膜改变。患者于第6天出院，1周后β-HCG水平为0.67 mIU/mL。治疗后肝功能、肾功能及血常规等血清指标的基线数据与术后1周数据无统计学差异。该患者随后在2个月后怀孕，孕期常规筛查未发现异常。
超声引导下宫颈肌内注射聚桂醇联合宫腔镜治疗宫颈妊娠可能是有效且安全的。
