Primary Ovarian Pregnancy: A Case Report of a Rare Form of Ectopic Pregnancy

原發性卵巢子宮外孕：一種罕見的子宮外孕

魏琦峰(Chi-Feng Wei)

《輔仁醫學期刊》 13卷2期 (2015/06) Pp. 105-110

https://doi.org/10.3966/181020932015061302006

摘要

子宮外孕在美國推測約佔所有懷孕的1.3%－2%，而原發性卵巢子宮外孕為妊娠囊著床在卵巢內，是一種罕見的子宮外孕，約佔所有子宮外孕的1%－3%。近年來原發性卵巢子宮外孕發生率認為有增加的趨勢，推測可能跟診斷的儀器與人工生殖科技進步有關。另外與檢驗科偵測β-hCG敏感度與陰道超音波解析度增加，讓早期診斷卵巢子宮外孕變得更可能。我們報導一個個案懷孕7週，突然肚子悶痛了三天，至婦產科診所求治，被告知是子宮間質懷孕，是一種罕見子宮外孕，需要開刀。所以病人到我們醫院急診尋求治療，抽血驗β-hCG是11000mIU/ml，陰道超音波顯示右卵巢內有一個具有心跳，約莫7週大小的胎兒，診斷為更罕見的子宮外孕－卵巢外孕。因為病人不想再生育子女，所以幫病人進行腹腔鏡手術做右卵巢切除及輸卵管結紮。傳統治療方式為剖腹探查診斷及行患側卵巢或卵巢輸卵管切除，然而因為腹腔鏡儀器及開刀技術的進步，保留手術更變得可行。特別是病人還年輕或還想要生育子女，保留手術行卵巢楔狀切除或只將懷孕組織移除反而是第一選擇的治療方式，但是術後一定要抽血追蹤β-hCG到小於5mIU/ml，才算是治療成功。本文針對此卵巢子宮外孕病例的臨床症狀、超音波表現與不同治療方式有所探討。

關鍵字

子宮外孕 ； 卵巢子宮外孕 ； 剖腹探查手術 ； 腹腔鏡手術

並列摘要

The incidence of ectopic pregnancy in the United States is estimated at 1.3%-2% of all pregnancies. Primary ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted in the ovary in the United States. The reported incidence is estimated at 1%-3% of all diagnosed ectopic pregnancies. However, improvements in diagnostic techniques and assisted reproductive technology are believed to be increasing the diagnosis of ovarian pregnancy. In addition, because of the availability of sensitive assays for β-hCG and increasing transvaginal ultrasound resolution, early diagnosis of ovarian pregnancy has become more feasible. We report a case of a 26-year-old woman, gravid 4, para 2, artificial abortion 1, with low abdominal fullness and dull pain for 3 days. She stated that an OB-GYN physician had diagnosed her with interstitial pregnancy. Her last menstrual period was approximately 7 weeks before admission. Laboratory data showed serumβ-hCG of 11000mIU/mL. Transvaginal sonography demonstrated an echocomplex mass within the right ovary with one living fetus with a fetal crownrump length of 0.91 cm. The cul-de-sac was clear with no accumulated fluid. The patient expressed no more desire for fertility; therefore, a laparoscopic right oophorectomy and elective bilateral tubal ligation were performed. The traditional treatment for ovarian pregnancy was oophorectomy or salpingo-oophorectomy by laparotomy. However, because of the development of laparoscopic techniques, conservative laparoscopic surgery is now preferred. Conservative laparoscopic techniques, such as wedge resection or the removal of gestational tissues, should be the first choice of treatment, particular if a patient is young and desires children. Clinical presentation, sonographic findings, and different modes of treatment are also discussed.

並列關鍵字

ectopic pregnancy ； ovarian pregnancy ； laparotomy ； laparoscopy