II型残角子宫妊娠的临床诊疗分析一例

Clinical Diagnosis and Treatment of a Case of Type II Rudimentary Horn Pregnancy

摘要: 残角子宫是一种罕见的先天性子宫畸形，表现为一侧子宫发育正常，另一侧发育不全。残角子宫妊娠属于罕见异位妊娠，其中II型残角子宫(有宫腔但与单角子宫不相通)因临床表现缺乏特异性，极易被误诊或延误治疗。临床资料显示，其术前确诊率较低，早期发现困难，常与宫角妊娠或输卵管间质部妊娠混淆，严重者可致子宫破裂和大出血。本例患者女，30岁，停经约50天后因阴道出血入院，入院时血β-人绒毛膜促性腺激素(β-HCG)水平为27,662 mIU/ml。影像学检查提示II型残角子宫妊娠。患者术前行米非司酮药物预处理后，顺利接受宫腔镜联合腹腔镜下残角子宫切除术及左侧输卵管切除术，术后恢复良好。提示：II型残角子宫妊娠的早期诊断主要依赖超声和MRI检查，并需与宫角妊娠鉴别。治疗以手术为主，腹腔镜切除残角子宫为首选方案。早期影像学评估及及时手术干预对于降低严重并发症风险具有重要临床意义。

Abstract: A rudimentary horn uterus is a rare congenital uterine malformation, characterized by normal development on one side and underdevelopment on the other. Rudimentary horn pregnancy is an uncommon type of ectopic pregnancy. Type II rudimentary horn (with a cavity but no communication with the unicornuate uterus) is especially prone to misdiagnosis or delayed treatment due to its lack of specific clinical manifestations. Clinical experience has shown that the preoperative diagnostic rate is low, and early detection remains difficult. It is often confused with cornual pregnancy or interstitial tubal pregnancy, and in severe cases may lead to uterine rupture and massive hemorrhage. In this case, a 30-year-old woman was admitted after approximately 50 days of amenorrhea with vaginal bleeding. Her serum β-human chorionic gonadotropin (β-HCG) level on admission was 27,662 mIU/ml. Imaging examination suggested type II rudimentary horn pregnancy. After preoperative medical management with mifepristone, the patient successfully underwent combined hysteroscopic and laparoscopic excision of the rudimentary horn and ipsilateral fallopian tube, and recovered well postoperatively. This case highlights that the early diagnosis of type II rudimentary horn pregnancy mainly relies on ultrasonography and MRI, with careful differentiation from cornual pregnancy; medical pretreatment combined with minimally invasive surgery provides an effective treatment approach. Early imaging evaluation, individualized treatment, and timely surgical intervention are of great clinical significance in reducing the risk of severe complications.