米非司酮配伍米索前列醇治疗未破裂包块型宫角妊娠临床观察.docVIP

米非司酮配伍米索前列醇治疗未破裂包块型宫角妊娠临床观察[摘要] 目的 探讨未破裂包块型宫角妊娠的药物治疗方法。方法 回顾性分析经米非司酮配伍米索前列醇治疗的24例未破裂包块型宫角妊娠患者的临床资料。结果 24例未破裂包块型宫角妊娠患者应用米非司酮配伍米索前列醇药物流产，成功18例,成功率为79.1%，其中孕囊直径2～3cm者成功率最高，达84.6%。未成功的6例中宫角妊娠破裂行患侧宫角楔形切除术1例。结论 米非司酮配伍米索前列醇治疗未破裂的包块型宫角妊娠成功率较高，但适应证和安全性有待进一步研究。 [关键词] 宫角妊娠；米非司酮；米索前列醇；子宫破裂 [中图分类号] R714.22 [文献标识码] B[文章编号]1673-9701（2011）21-147-02 Mifepristone Combined with Misoprostol for Treatment of Unruptured Cornua Uteri Pregnancy:A Clinical Observation SU Xiaomin Department of Obstetrics and Gynecology, Yuyao City People’s Hospital in Zhejiang Province, Yuyao 315400, China [Abstract] Objective To explore the effects of mifepristone combined with misoprostol for treatment of unruptured cornua uteri pregnanc Methods Twenty-four cases of unruptured cornua uteri pregnancy, which administrated with mifepristone combined with misoprostol, were retrospectively analysis. Results Eighteen cases were efficiency. The effectiveness rate was 79.1%. The effectiveness rate was highest when the diameter of gestational sac was 2 to 3cm. 6 cases were failure of treatment. One of 6 was performed cornua uteri wedge resection. Conclusion The efficiency is high of mifepristone combined with misoprostol for treatment of unruptured cornua uteri pregnancy. The indication and safety should be further studied. [Key words] Cornua uteri pregnancy；Mifepristone；Misoprostol；Rupture of uterus 宫角妊娠临床上虽少见，但因其胚胎着床部位血供十分丰富，自发破裂时出血较多，严重者危及生命。以往宫角妊娠一经确诊，多行经腹手术治疗，近年陆续有应用腹腔镜、宫腔镜、药物、介入疗法等治疗宫角妊娠成功的报道。本文通过对24例未破裂的包块型[1]宫角妊娠患者临床资料的回顾性分析，探讨其药物治疗方法。 1资料与方法 1.1临床资料 2003年2月～2010年2月在浙江省余姚市人民医院住院治疗的未破裂包块型宫角妊娠患者24例，占同期宫角妊娠的37.5%。患者年龄20～42岁，平均（ 28±10.3）岁；有停经史23例（占95.8%），停经37～76d,平均（ 46±9.8）d。 1.2辅助检查 1.2.1 血β-HCG 24例入院后查血β-HCG值（2450-99580） IU/L，血清孕酮值（6.55-62.50）nmol/L。 1.2.2 B超 24例患者入院前均行阴腹联合B超检查，B超图像显示表现为宫角处形态较规则，边界较清，宫角处呈轻度膨隆改变者诊断为“宫角妊娠未破裂包块型”[1，2]。 1.3治疗方法及疗效评定标准 24例患者均住院治疗，药物流产前予备血，并严密监测患者生命体征、腹痛情况及阴道流血量。服药方法：第1天晚、第2天早晚各口服米非司酮50mg，第3天晨口服米索前列醇600μg，后24h内排出孕囊为成功，未排出孕囊者次日再次予米索前列