医学PPT课件宫颈妊娠的诊断与治疗.ppt

宫颈妊娠的诊断与治疗;定义及发病率;病 因;诊 断(一)临床表现;诊断（二）血β-hCG的检测;诊断（三）B超检查;诊断（三）B超检查;治疗—保守治疗;治疗—保守治疗;影响药物成功治疗的因素;影响药物成功治疗的因素;治疗—手术治疗;;;;;全子宫切除;治疗后再妊娠的结局;;? 31 year old, gravida 2, para 1, 5 weeks gestation with painless vaginal bleeding of 2 days duration. ? Medical history:with no previous intrauterine procedures, pelvic inflammatory disease, or intrauterine devices. ? Pelvic examination revealed a barrel-shape uterine cervix with minimal bright bleeding protruding through a closed external os. The uterus was slightly enlarged and had no adnexal masses. ? ultrasound examinations：confirmed the presence of a cervical pregnancy with fetal pole and fetal cardiac activity ? ? HCG： 8620 mIU/ml on admission, 15 800 mIU/ml the next day. ; i.m. MTX 1 mg/kg and folinic acid 0.1 mg/kg given alternately every other day for 4 days. ?HCG level rised (19 690 mIU/ml) and the ultrasound examination revealed an unchanged gestational sac size with persistent fetal cardiac activity. direct intra-arterial MTX administration (Peleg et al., 1994). The following day, the patient underwent percutaneouscatheterization of the femoral artery with a flexible angiographic catheter, which was advanced under fluoroscopy to the left hypogastric artery. MTX 50 mg was administered over 20 min and the catheter was removed. ;?HCG --10 230 mIU/ml at 1 week, with the concomitant disappearance of fetal cardiac activity. HCG continued to decrease for the next 2 weeks and then stabilized around 2700 mIU/ml bright red vaginal bleeding requiring the use of two perineal会阴的 pads 垫during one night reappeared. the following day :prophylactic selective hypogastric artery embolization using the aforementioned technique. Two days later vaginal bleeding ceased and the patient was discharged. One week after discharge, a collapsed gestational sac was demonstrated; coincidental with the commencement of menstruation, the gestational sac disappeared. ; We suggest that MTX, which seems by far the best choice for treatme