Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
Fertil Steril. 2023 May;119(5):889-891. doi: 10.1016/j.fertnstert.2023.02.041. Epub 2023 Mar 5.
To perform laparoscopic salpingectomy, including the entire interstitial portion of the fallopian tube, in the management of interstitial pregnancy.
A step-by-step explanation of the surgical procedure using video with narration.
Obstetrics and Gynecology department of a hospital.
PATIENT(S): A 23-year-old woman, gravida 1 para 0, presented asymptomatically to our hospital to undergo a pregnancy test. Her last menstrual period had occurred 6 weeks previously. Transvaginal ultrasound showed an empty uterine cavity and a right interstitial mass of 3.2 × 2.6 × 2.5 cm. It contained a chorionic sac and an embryonic bud of 0.2 cm long with a heartbeat and the presence of an "interstitial line sign." The myometrial layer surrounding the chorionic sac was 1 mm. The patient's beta-human chorionic gonadotropin level was 10,123 mIU/mL.
INTERVENTION(S): On the basis of the anatomy of the interstitial portion of the fallopian tube, we treated interstitial pregnancy using laparoscopic salpingectomy, with complete removal of the interstitial portion containing the product of conception. The interstitial fallopian tube originates at the tubal ostium and follows a tortuous intramural course, progressing laterally away from the uterine cavity toward the isthmic portion. It is lined by muscular layers and an inner epithelium layer. The main blood supply of the interstitial portion is from the uterine artery's ascending branches to the fundus, extending a branch that supplies the cornu and the interstitial portion. Our approach has 3 key steps: 1) dissecting and coagulating the branch extending from the ascending branches to the fundus of the uterine artery, 2) incising the cornual serosa at the junction of the purple-blue interstitial pregnancy and the normal color myometrium, and 3) resecting the interstitial portion containing the product of conception along the outer layer of the oviduct without rupture.
MAIN OUTCOME MEASURE(S): The interstitial portion containing the product of conception was removed entirely along the outer layer of the fallopian tube as a natural capsule without rupture.
RESULTS(S): The surgery lasted for 43 min, and the volume of intraoperative blood loss was 5 mL. The pathology was confirmatory for interstitial pregnancy. The patient's beta-human chorionic gonadotropin levels decreased optimally. She had a normal postoperative course.
CONCLUSION(S): This approach reduces intraoperative blood loss, minimizes myometrial loss and thermal injury, and effectively avoids persistent interstitial ectopic pregnancy. It is not limited by the device used, does not increase the surgery cost, and is greatly useful in treating a selected nonruptured distally or centrally implanted interstitial pregnancy.
在管理间质妊娠时，进行腹腔镜输卵管峡部切除术，包括输卵管的整个间质部分。
使用带旁白的视频逐步解释手术过程。
医院妇产科。
一位 23 岁女性，初产妇，孕 0 产 0，无症状就诊于我院进行妊娠检查。她的末次月经是 6 周前。经阴道超声显示子宫腔空虚，右侧间质肿块大小为 3.2×2.6×2.5cm，包含绒毛膜囊和长 0.2cm 的胚胎芽，有“间质线征”。绒毛膜囊周围的子宫肌层为 1mm。患者的β-人绒毛膜促性腺激素水平为 10,123mIU/mL。
根据输卵管间质部分的解剖结构，我们采用腹腔镜输卵管峡部切除术治疗间质妊娠，完整切除包含妊娠产物的间质部分。间质输卵管起源于输卵管口，呈迂曲的壁内走行，向远离子宫腔的峡部外侧延伸。它由肌肉层和内层上皮层组成。间质部分的主要血液供应来自子宫动脉升支至宫底的分支，延伸出一支供应角部和间质部分的分支。我们的方法有 3 个关键步骤：1）解剖和凝固子宫动脉升支至宫底的分支；2）在紫蓝色间质妊娠与正常颜色子宫肌交界处切开角部浆膜；3）沿着输卵管外层切除包含妊娠产物的间质部分，避免破裂。
沿输卵管外层完整切除包含妊娠产物的间质部分，无破裂。
手术持续 43 分钟，术中出血量 5mL。病理证实为间质妊娠。患者的β-人绒毛膜促性腺激素水平下降理想。她术后恢复正常。
该方法减少术中出血量，最大限度减少子宫肌损失和热损伤，有效避免持续性间质异位妊娠。它不受所用器械的限制，不增加手术费用，对治疗选择的非破裂、远侧或中央植入的间质妊娠非常有用。
