Hysteroscopic Treatment Of Unruptured Cornual Pregnancy

Background:Cornual pregnancy(CP) means the nidation of oosperm locates in the opening of the oviduct close to the uterine cavity,or in the interstitial portion of the oviduct,but grow towards the uterine cavity.The incidence of CP was much low,but the incidence increases a lot along with the development of assisted re-productive technology recently.The nidation of the oosperm is abnormal,and the blood supply is quite abundant,if the uterine cornu ruprured,the hemorrhage would be very active,which may induce hemorrhagic shock that threats to the patient's life.So it is important to make a definite diagnosis early and give the patient an appropriate treatment in time.For the past few years,the rate of early diagnosis of CP increases obviously along with the development of ultrasonic diagnosis and endoscopic technique,which supply multiple choices for the treatment of CP. Traditional laparotomy has been replaced by various kinds of new expectant treatment methods,such as drug treatment,dilatation and curet-tage under the ultrasonic guidance,cornu resection through laparoscope, uterine artery embolization,hysteroscope and so on.These new treatment methods re-duce the injury of the patients to a great extent.Objective:Analyze different treatment methods of cornual pregnancy,discuss the clinical value of hysteroscopic treatment of cornual pregnancy.Method:Retrospective analysis of clinical and pathological results of 45 cornual pregnancy cases in our hospital, the First hospital of Jilin University,the Third hospital of Jilin University and obstetric hospital of Changchun city from Jan 1st, 2001 to Dec 31st, 2008,ages from 24 to 41,and the average age is 34.5.All of the patients conceived many times except three cases,and the average is 3.The times of induced abortion range from zero to four. Cases are divided into 4 groups: Group 1: removed cornu and the fallopian tube,cornu wedge resec-tion or subtotal hysterectomy through laparotomy; Group 2: dilatation and cu-rettage(D&C) under B-ultrasound; Group 3: operated by laparoscopy to re-move the foetus,cornu and the oviduct or cornu;Group 4: remove the embry-onic tissue through Hysteroscopic.Observe the differences of the time of opera-tion,realease gas,out-of-bed activity,reservation of the urinary canal, volume of blood during operation, application of painkiller and antibiotic and the length of stay among the four groups.Results:There are 10 patients in group 1,among them,2 patients were removed foetus only,4 cases were resected the cornu and oviduct,3 patients were given cornu wedge resection after the failure of medicine abortion,1 patient were given subtotal hysterectomy.Group 2 contains 9 patients,6 of them succeeded after D&C once,the others were cured by D&C twice, HCG of blood reduced to normal level quickly after the operation.11 patients were taken laparoscopic operations,2 of them ,who had uterine myomas,were removed the foetus and the myomas at the same time,1 case that had chocolate cyst of ovary were re-sected the embryonic tissue and the cyst.3 of them were given cornu wedge re-section after the D&C,5 cases were resected the cornu and oviduct.Group 4 contains 15 cases,8 patients were removed all the remain embryonic tissue after the induced abortion,one of them were resected submucous myoma at the same time,2 of the cases were given accretion solution as well,the GS could be seen in 3 patients,and they were given induced abortion under the hysteroscope,the embryonic tissue were clearly removed by mechanical scoraping.All the col-lections were checked by pathology,and the reports showed that villus could be seen in all the collections.After the statistical treatment,we can seen that the time of opera-tion,releasing gas,out-of-bed activity, reservation of the urinary canal and the length of stay of group 4 is much shorter than group 1(P<0.05);the volume of blood during the operation,application of antibiotic and painkiller of group 4 is less than group 1(P<0.05).The volume of blood during the operation of group 4 is less than group 2(P<0.05).The time of operation,releasing gas, out-of-bed activity, reservation of the urinary canal and the length of stay of group 4 is much shorter than group 3(P<0.05),the volume of blood during the operation, application of antibiotic and painkiller of group 4 is much less than group 3(P<0.05).All the patients(except 2 cases) went to our hospital to recheck one to three months after the operations,there were no complication at all,and then we had been following up by telephone or clinic service for 3 months to 4 years,the contents contained menstruation,the time of HCG returned to normal and the rate of pregnancy.All the patients recovered the normal menstruation 1 to 3 months after the operations except 1 patient who had subtotal hysterec-tomy. After the statistical treatment ,we can see that the HCG level of group 4 returned to nornal as quickly as group 1 and 3(P>0.05),which was much short-ter than group 2(P<0.05),the pregnancy rate of group 4 was higher than the others.Conclusions:(1) Hysteroscopy can identify the diagnosis of unruptured cornual preg-nancy further and discover the other diseases in uterine cavity and give a proper treatment at the same.(2)The length of stay of the patients who are treated by hysteroscope is much less than the others,which lessens the eco-nomic burden of the patients.(3)The patients treated by hysteroscope recover fast,HCG level reduce quickly,and the rate of pregnancy is higher than the oth-ers, so the therapeutic efficacy is better.(4)The patients treated by Hysteroscope could avoid laparotomy and D&C many times, and can reserve breeding func-tion, the complication is fewer than the other methods, The hysteroscopic treatment of cornual pregnancy is safety and effective. It is the best treatment method of the unruptured cornual pregnancy.