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子宫壁内异位妊娠手术后异位妊娠持续存在:一例报告。

Persistence of ectopic pregnancy after intramural ectopic pregnancy surgery: A case report.

作者信息

Yang Wen-Xiu, Wang Ting-Ting, Zhao Shuai

机构信息

Department of Reproduction and Genetics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.

First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.

出版信息

Int J Surg Case Rep. 2025 Jan;126:110623. doi: 10.1016/j.ijscr.2024.110623. Epub 2024 Nov 20.

Abstract

INTRODUCTION

Intramural ectopic pregnancy (IMP) refers to the implantation and implantation of a gestational sac in the uterine muscle layer, which is a rare and potentially life-threatening disease. Early detection and diagnosis are significant, and treatment methods are often challenging.

PRESENTATION OF CASE

We report a case of IMP after embryo transfer in a 38-year-old woman. The patient developed persistent ectopic pregnancy after combined hysteroscopic and laparoscopic surgery. Intramuscular injection of methotrexate did not have a significant effect, and transabdominal ultrasound-guided in situ injection of methotrexate at the site of the lesion was performed with a significant impact.

DISCUSSION

This case emphasizes the complexity of the treatment of IMP. Surgery alone may not allow complete excision of the lesion, and residual chorionic tissue may invade the muscular vessels; this case emphasizes the importance of postoperative drug therapy.

CONCLUSION

IMP invades the myometrium in a widely spreading manner, and methotrexate injection in situ at the site of the lesion after conservative surgery may become an efficacious treatment modality.

摘要

引言

壁间异位妊娠(IMP)是指妊娠囊在子宫肌层着床并植入,这是一种罕见且可能危及生命的疾病。早期检测和诊断意义重大,而治疗方法往往具有挑战性。

病例介绍

我们报告一例38岁女性胚胎移植后发生壁间异位妊娠的病例。该患者在宫腔镜和腹腔镜联合手术后发生持续性异位妊娠。肌内注射甲氨蝶呤效果不显著,遂在经腹超声引导下在病灶部位进行甲氨蝶呤原位注射,效果显著。

讨论

该病例强调了壁间异位妊娠治疗的复杂性。单纯手术可能无法完全切除病灶,残留的绒毛组织可能侵入肌层血管;该病例强调了术后药物治疗的重要性。

结论

壁间异位妊娠以广泛扩散的方式侵入子宫肌层,保守手术后在病灶部位进行甲氨蝶呤原位注射可能成为一种有效的治疗方式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/409b/11647785/0d886fc9f911/gr1.jpg

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