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甲氨蝶呤治疗宫颈妊娠失败后水囊引产作为一种新的替代方法：病例报告及文献综述

Hydrodissection as a Novel Alternative After Failed Management of a Cervical Pregnancy With Methotrexate: Case Report and Literature Review.

作者信息

Cárdenas-Suárez Natalia, Urrutia-Villamil Paulette, Reyes-Jimenez Taymara, Pereira-Diaz Olga

机构信息

Department of Obstetrics and Gynecology, University of Puerto Rico Medical Sciences Campus, San Juan, PRI.

Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, PRI.

出版信息

Cureus. 2024 Jan 19;16(1):e52556. doi: 10.7759/cureus.52556. eCollection 2024 Jan.

DOI:10.7759/cureus.52556
PMID:38249658
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10798570/
Abstract

Cervical ectopic pregnancies (CEPs) are rare and life-threatening diagnoses. Risk factors have been associated with CEPs, yet their etiology and pathogenesis remain unknown. Timely intervention is vital for successful outcomes, yet it is challenged as there is no standardized approach to treatment. We present the case of a 42-year-old woman diagnosed with CEP following five weeks and one day of amenorrhea. The patient was treated with a two-dose regimen of intramuscular methotrexate (MTX) but failed to respond. Ultrasound-guided intrasac MTX injection was considered a secondary treatment. However, spontaneous expulsion was observed after administering lidocaine at different cervical points. Hydrodissection following systemic MTX could present a novel alternative for treating CEP. Expulsion of pregnancy after hydrodissection could be associated with tissue necrosis and/or destabilized implantation of pregnancy, secondary to the effects of MTX. Further research is vital for evaluating the underlying mechanisms for expulsion and the role of hydrodissection following MTX in treating CEP.

摘要

宫颈异位妊娠（CEPs）是罕见且危及生命的诊断。虽然已经确定了与CEPs相关的风险因素，但其病因和发病机制仍然不明。及时干预对于取得成功的治疗结果至关重要，但由于没有标准化的治疗方法，这一过程面临挑战。我们报告一例42岁女性患者，停经5周零1天后被诊断为CEP。该患者接受了两剂肌肉注射甲氨蝶呤（MTX）治疗，但治疗失败。超声引导下向孕囊内注射MTX被视为二线治疗。然而，在宫颈不同部位注射利多卡因后观察到妊娠物自然排出。全身应用MTX后进行水分离术可能是治疗CEP的一种新选择。水分离术后妊娠物排出可能与组织坏死和/或妊娠植入不稳定有关，这是MTX作用的继发结果。进一步的研究对于评估排出的潜在机制以及MTX后水分离术在治疗CEP中的作用至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04d8/10798570/e773dd40405e/cureus-0016-00000052556-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04d8/10798570/68fcd0457c0b/cureus-0016-00000052556-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04d8/10798570/db5c8feeff3b/cureus-0016-00000052556-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04d8/10798570/e773dd40405e/cureus-0016-00000052556-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04d8/10798570/68fcd0457c0b/cureus-0016-00000052556-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04d8/10798570/db5c8feeff3b/cureus-0016-00000052556-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/04d8/10798570/e773dd40405e/cureus-0016-00000052556-i03.jpg

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本文引用的文献

1
Cervical Ectopic Pregnancy: A Multidisciplinary Approach.宫颈异位妊娠：多学科诊疗方法
Cureus. 2021 Oct 29;13(10):e19113. doi: 10.7759/cureus.19113. eCollection 2021 Oct.
2
Management of Cervical Ectopic Pregnancies: A Scoping Review.宫颈异位妊娠的管理：范围综述。
Obstet Gynecol. 2021 Jul 1;138(1):33-41. doi: 10.1097/AOG.0000000000004423.
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Prospective evaluation of impact of post-Cesarean section uterine scarring in perinatal diagnosis of placenta accreta spectrum disorder.前瞻性评估剖宫产术后子宫瘢痕对胎盘植入谱系疾病围产期诊断的影响。
Ultrasound Obstet Gynecol. 2022 Apr;59(4):474-482. doi: 10.1002/uog.23732. Epub 2022 Mar 8.
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Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis.两剂与单剂甲氨蝶呤治疗异位妊娠的疗效比较：一项荟萃分析。
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Obstet Gynecol. 2018 Mar;131(3):e91-e103. doi: 10.1097/AOG.0000000000002560.
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Ectopic pregnancy: a heart beating case.异位妊娠：一例有心跳的病例。
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Effects of methotrexate on trophoblast proliferation and local immune responses.甲氨蝶呤对滋养层细胞增殖及局部免疫反应的影响。
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