Mikhitarian Mark, Goodnight Iii William, Keefe Nicole
Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Semin Intervent Radiol. 2023 Aug 10;40(4):357-361. doi: 10.1055/s-0043-1770712. eCollection 2023 Aug.
Interstitial ectopic pregnancy involves the interstitial portion of the fallopian tube and is among the most hazardous of all ectopic pregnancies, with the highest risk of uterine rupture and maternal mortality. Unlike tubal ectopic pregnancy, management of interstitial pregnancy is not well standardized. Systemic methotrexate (MTX) and surgical resection are the primary treatment options; however, failure rates and risk of bleeding remain high. Alternative minimally invasive techniques have been described-including uterine artery embolization (UAE) and local injection of MTX or potassium chloride-and may confer improved success rates. We report a case of a high-risk 28-year-old female with an interstitial ectopic pregnancy successfully treated with combined local injection of MTX plus UAE. We describe our technique and the unique medical management in the setting of a known bleeding disorder.
间质部异位妊娠累及输卵管间质部，是所有异位妊娠中最危险的类型之一，子宫破裂和孕产妇死亡风险最高。与输卵管异位妊娠不同，间质部妊娠的治疗尚无统一规范。全身应用甲氨蝶呤（MTX）和手术切除是主要的治疗选择；然而，失败率和出血风险仍然很高。已有报道称采用替代的微创技术，包括子宫动脉栓塞术（UAE）和局部注射MTX或氯化钾，可能会提高成功率。我们报告一例28岁高危女性间质部异位妊娠患者，通过联合局部注射MTX加UAE成功治疗。我们描述了我们的技术以及在已知出血性疾病情况下独特的医疗管理方法。
