Wu M Y, Chen H F, Chen S U, Chao K H, Yang Y S, Huang S C, Lee T Y, Ho H N
Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University Hospital, Taipei, ROC.
J Formos Med Assoc. 1995 Oct;94(10):600-4.
Eight cases of heterotopic pregnancy following assisted reproductive techniques (ART) were reviewed. One cervical, three cornual and four tubal pregnancies were combined with intrauterine pregnancies. The cervical ectopy was successfully treated with a local injection of potassium chloride (KCl) into the gestational sac. A viable baby was produced from the intrauterine gestation. Cornual metroplasties were performed on two ruptured and one unruptured cornual heterotopic pregnancies. One of these three cases was maintained till term. All four tubal heterotopic pregnancies were aborted. Widespread application of ART in recent years has meant that heterotopic pregnancies are no longer a rarity. Both physicians and patients should be made aware that the existence of an intrauterine gestation does not preclude the risk of nidation of other fetuses in ectopic sites. The authors recommend that detailed ultrasound studies, preferably via the vaginal route, should be performed on patients in ART programs. During the examination, the adnexae should be carefully evaluated, even if an intrauterine gestational sac is already present. If a heterotopic pregnancy is diagnosed, the appropriate treatment depends on the location of ectopic pregnancy. Local injection with KCl or methotrexate is effective in certain types of cervical or cornual ectopic pregnancy, as it may allow the conservation of the intrauterine pregnancy.
回顾了8例辅助生殖技术（ART）后发生的异位妊娠病例。其中1例宫颈妊娠、3例宫角妊娠和4例输卵管妊娠合并宫内妊娠。宫颈异位妊娠通过向妊娠囊内局部注射氯化钾（KCl）成功治疗。宫内妊娠产出了一个存活的婴儿。对2例破裂和1例未破裂的宫角异位妊娠进行了宫角修复术。这3例中的1例维持至足月。所有4例输卵管异位妊娠均流产。近年来ART的广泛应用意味着异位妊娠已不再罕见。医生和患者都应意识到，宫内妊娠的存在并不排除其他胎儿在异位着床的风险。作者建议，应对接受ART治疗的患者进行详细的超声检查，最好经阴道途径。检查期间，即使已经发现宫内妊娠囊，也应仔细评估附件情况。如果诊断为异位妊娠，适当的治疗取决于异位妊娠的位置。局部注射KCl或甲氨蝶呤对某些类型的宫颈或宫角异位妊娠有效，因为这样可能保留宫内妊娠。
