目的:描述在异位妊娠的外科治疗中意外诊断出苗勒管异常所引起的术中和术后影响。
方法:视频文章。
方法:学术中心。
方法:一位39岁的未妊娠妇女,出现无排卵和月经周期不规则的情况。她的尿液妊娠试验为偶然阳性;血清β-人绒毛膜促性腺激素(β-hCG)水平为5,644mIU/mL。门诊经阴道超声检查(TVUS)显示左附件有2.1x1.7x2.2cm厚壁结构,无宫内妊娠。这些发现对于左输卵管异位妊娠非常可疑。患者同意进行腹腔镜检查并计划进行左输卵管切除术。该视频中包含的患者同意发布视频并在线发布视频,包括社交媒体。期刊网站,科学文献网站(如PubMed,ScienceDirect,Scopus,等。)和其他适用的网站。
方法:诊断性腹腔镜检查未显示明显的左输卵管异位妊娠。相反,可见右单角子宫,左子宫角扩张。输卵管和卵巢均正常。这些腹腔镜检查结果与原始角的异位妊娠一致。然而,在没有知情同意半子宫切除术的情况下,并且没有骨盆内异位破裂或出血的证据,我们决定从子宫角切除异位妊娠。在子宫角前表面做了一个切口,将孕囊从下面的子宫肌层上解剖并全部切除。还进行了左输卵管切除术。病人当天出院回家,在手术后28天内,她的β-hCG水平降至<5mIU/mL。
方法:通过手术切除妊娠囊而不进行半子宫切除术,彻底解决了左子宫角异位妊娠。
结果:术后子宫输卵管造影术(HSG)显示右单眼子宫,右输卵管充盈正常。骨盆的磁共振成像(MRI)证实了右单眼子宫的发现,该子宫具有未沟通的左侧基本子宫角,不含任何子宫内膜组织。因此,患者不需要间期半子宫切除术.她在初次手术后5个月接受了来曲唑和宫腔内授精治疗,导致临床宫内妊娠。然而,由于18三体的发现,该妊娠在妊娠中期早期终止.一年后她自然怀孕了,这次妊娠在妊娠39周时导致足月阴道分娩。
结论:未诊断或意外的Müllerian异常可影响异位妊娠的标准术中和术后处理。
OBJECTIVE: To describe the intraoperative and postoperative implications arising from the unexpected diagnosis of a Müllerian anomaly during the surgical management of an ectopic pregnancy.
METHODS: Video article.
METHODS: Academic Center.
METHODS: A 39-year-old nulligravid woman with anovulation and irregular menstrual cycles presented to the office. Her urine pregnancy test was incidentally positive; serum β-human chorionic gonadotropin (β-hCG) level was 5,644 mIU/mL. Outpatient transvaginal ultrasonography (TVUS) demonstrated a 2.1 x 1.7 x 2.2-cm thick-walled structure in the left adnexa without an intrauterine pregnancy. These findings were highly suspicious for a left tubal ectopic pregnancy. The patient was consented for laparoscopy with planned left salpingectomy. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites.
METHODS: Diagnostic laparoscopy did not show an obvious left tubal ectopic pregnancy. Instead, a right unicornuate uterus with a dilated rudimentary left uterine horn was seen. Both fallopian tubes and ovaries appeared normal. These laparoscopic findings were consistent with an ectopic pregnancy in the rudimentary horn. However, in the absence of informed consent for a hemi-hysterectomy and no evidence of ectopic rupture or bleeding within the pelvis, we decided to proceed with excision of the ectopic pregnancy from the uterine horn. An incision was made over the anterior surface of the uterine horn, and the pregnancy sac was dissected from the underlying myometrium and excised in its entirety. Left salpingectomy was also performed. The patient was discharged home the same day, and her β-hCG levels decreased to <5 mIU/mL within 28 days of surgery.
METHODS: Complete resolution of a left rudimentary uterine horn ectopic pregnancy through surgical excision of the pregnancy sac without hemi-hysterectomy.
RESULTS: Postoperative hysterosalpingography (HSG) demonstrated a right unicornuate uterus with normal fill and spill of the right fallopian tube. Magnetic resonance imaging (MRI) of the pelvis confirmed the findings of a right unicornuate uterus with a non-communicating left rudimentary uterine horn that did not contain any endometrial tissue. Thus, the patient did not require an interval hemihysterectomy. She underwent letrozole and intrauterine insemination treatment 5 months after the initial surgery, which resulted in a clinical intrauterine pregnancy. However, this pregnancy was terminated in the early second trimester due to findings of trisomy 18. She conceived naturally one year later, and this pregnancy resulted in a full-term vaginal birth at 39 weeks gestation.
CONCLUSIONS: Undiagnosed or unexpected Müllerian anomalies can impact the standard intraoperative and postoperative management of ectopic pregnancies.