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題名 | Primary Peritoneal Pregnancy Implanted in the Uterine Myoma Following Artificial Insemination=罕見的人工授孕後原發性腹膜懷孕著床於子宮肌瘤 |
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作 者 | 陳智賢; 賈永芳; 謝保群; | 書刊名 | 臺灣婦產科醫學會會刊雜誌 |
卷期 | 42:3 2003.09[民92.09] |
頁次 | 頁193-197 |
分類號 | 417.347 |
關鍵詞 | 腹膜; 子宮肌瘤; 子宮外孕; 不孕症; Ectopic pregnancy; Peritoneal pregnancy; Uterine myoma; Infertility; |
語文 | 英文(English) |
中文摘要 | 目的:原發性腹膜懷孕是相當罕見的情況,我們報告此一首例發生在人工授孕後,原發性腹膜懷孕著床於子宮肌瘤病兆。病例報告:一位32歲已婚女性曾有3年原發性不孕及子宮肌瘤的病史,此次她接受卵巢刺激藥物及人工授孕而懷孕。但在懷孕6周時,經陰道超音波檢查並未發現子宮腔內有胚囊存在,反而在子宮外肌瘤旁偵測出有一複雜回音的腫塊,在此腫塊內可見完整的胚囊及胎兒心跳。母血中定量分析乙型人類絨毛膜性腺促進激素的濃度為22242.6 mIU / ml。因此在子宮外孕的診斷下,病患接受了腹腔鏡手術處理,術中並無發現有內出血的現象,雙側輸卵管的外觀均正常,兩側的卵巢有稍微腫大的現象乃是由於卵巢刺激藥物的關係,在腹腔鏡下可見一4 公分的漿膜下子宮肌瘤位於子宮右前壁,在子宮肌瘤下側表面有一3 × 3公分暗紅色腫塊,很明顯的為子宮外懷孕的產物。在腹腔鏡下以雙極電燒將子宮肌瘤的蒂部止血後,順利的將子宮肌瘤切除,且連同著床在上面的子宮外孕腫塊一起由陰道後穹隆切開,移出體外。病理組織報告証實為肌瘤的異位懷孕,在肌瘤壁上可見有絨毛膜組織的侵入。結論:臨床醫師在不孕病患治療後懷孕的案例,要提高警覺其有子宮外孕的可能。腹腔鏡手術提供一個診斷和治療子宮外孕的良好工具,即使在此相當罕見的腹膜懷孕,也可獲致滿意的結果。 |
英文摘要 | Objective: Primary peritoneal pregnancy is very rare. We report the first case of primary peritoneal pregnancy with implantation in the uterine myoma following artificial insemination. Case Report(s): The patient was a 32-year-old infertile woman with history of uterine myoma. Pregnancy was achieved by controlled ovarian hyperstimulation and artificial insemination. Transvaginal sonogram evaluation at six weeks revealed no gestational sac in the uterine cavity. An echocomplex mass beyond the uterine myoma lesion was noted, however, with a well-defined sac and cardiac activity detected. Quantitative assay of the 13-subunit of human chorionic gonadotropin (β-HOG) was 22242.6 mlU/ml. Under the impression of ectopic pregnancy, operative laparoscopy was performed. Entering the abdominal cavity, no internal bleeding was noted. Gross appearance of the bilateral oviducts was normal. Mild enlargement of the bilateral ovaries was determined and attributed to ovulation stimulation, with a right anterior-wall subserosal myoma noted (4 cm in diameter). A dark-reddish mass (3×3 cm) over the lower part of the surface of the myoma was suggestive of the products of conception. Myomectomy was performed laparoscopically after bipolar coagulation of the myoma pedicle, while the myoma associated with the ectopic mass was removed via colpotomy incision. Histopathology revealed ectopic myoma pregnancy with trophoblast and villi invasion in the wall of myoma lesion. Conclusion(s): Clinicians must retain a high index of suspicion and should counsel the patients regarding the possibility of ectopic pregnancy after infertility management. Laparoscopy provides superior diagnosis and management for ectopic pregnancy, with this advantage extending to even this rare primary peritoneal variant. |
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