Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
Am J Obstet Gynecol. 2023 Sep;229(3):340-343. doi: 10.1016/j.ajog.2023.04.047. Epub 2023 May 5.
Although cornual pregnancy is a rare form of ectopic pregnancy, the associated mortality rate is considerably higher than that of ectopic pregnancy overall. Historically, cornual ectopic pregnancy has been treated via laparotomy. With advancements in technology, equipment, and technique, laparoscopy offers a safer approach for the management of cornual pregnancy. However, laparoscopy of this nature requires excellent technique. The Vasopressin Injection Purse-String Ectopic Resection technique serves as an effective strategy for the laparoscopic management of cornual ectopic pregnancy. First, dilute vasopressin is administered into the myometrium surrounding the pregnancy. Next, a purse-string stitch is placed in the myometrium circumferential to the pregnancy. Finally, the pregnancy is excised by cornual wedge resection, and the defect is repaired using the attached remaining suture from the purse-string stitch. The Figure shows the graphical depiction of the Vasopressin Injection Purse-String Ectopic Resection technique, and the Video shows a laparoscopic recording of the Vasopressin Injection Purse-String Ectopic Resection technique. Between 2012 and 2022, 17 patients underwent a laparoscopic cornual ectopic pregnancy resection at a high-volume academic hospital and its affiliated community hospital. This case series revealed a mean operative time of 107 minutes, with a mean estimated blood loss of 41 mL for nonruptured ectopic pregnancies and 412 mL for ruptured ectopic pregnancies. No case was converted to laparotomy. Our findings suggest that the integration of the vasopressin administration and the pursue-string stitch placement minimizes blood loss and mitigates the risk of conversion to laparotomy for both nonruptured and ruptured cornual ectopic pregnancies.
虽然宫角妊娠是一种罕见的异位妊娠形式，但相关的死亡率明显高于总体异位妊娠。历史上，宫角妊娠通过剖腹手术治疗。随着技术、设备和技术的进步，腹腔镜为宫角妊娠的管理提供了更安全的方法。然而，这种性质的腹腔镜检查需要精湛的技术。血管加压素注射荷包缝合异位切除术是腹腔镜治疗宫角妊娠的有效策略。首先，将稀释的血管加压素注入妊娠周围的子宫肌层。接下来，在妊娠周围的子宫肌层放置荷包缝合线。最后，通过宫角楔形切除术切除妊娠，并用荷包缝合线的剩余缝线修复缺陷。图显示了血管加压素注射荷包缝合异位切除术的图形描述，视频显示了血管加压素注射荷包缝合异位切除术的腹腔镜记录。2012 年至 2022 年间，一家高容量学术医院及其附属社区医院对 17 例腹腔镜宫角妊娠切除术患者进行了研究。该病例系列研究显示，非破裂型异位妊娠的平均手术时间为 107 分钟，平均估计失血量为 41 毫升，破裂型异位妊娠的平均失血量为 412 毫升。没有病例转为剖腹手术。我们的研究结果表明，血管加压素给药和荷包缝合线放置的结合可最大限度地减少出血，并降低非破裂型和破裂型宫角妊娠转为剖腹手术的风险。
