약물치료의 예후가 불량한 나팔관임신에서의 초음파 유도하 임신낭내 methotrexate 주입법을 이용한 보존적 치료 2예
The successful conservative management of tubal pregnancy with poor prognosis through ultrasound-guided intraamnionic methotrexate injection: Two case reports
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초록
자궁외임신은 전체 임신의 2% 정도에서 발생하게 되며 모성사망의 중요한 원인이다. 자궁외 여성생식기를 따라 모든 곳에서 임신낭의착상이 가능하며, 그 중 자궁외임신이 가장 흔하게 발생하는 장소는 나팔관이다. 나팔관임신파열의 위험도가 낮은 초기에는 전신적 또는국소적 methotrexate (MTX) 주입을 이용한 약물치료를 보존적 치료방법으로 고려할 수 있다. 특히, 최근 고해상도 초음파의 발달로 인해질식초음파 유도하에 시행되는 약물의 국소적 주입요법이 가능해졌다. 나팔관임신에서 MTX의 국소적 주입을 시행할 경우 수술적 접근 없이 성공적으로 자궁외임신을 치료할 수 있을 뿐 아니라, 전신적 부작용 없이 나팔관을 보존할 수 있다는 장점이 있다. 저자들은 초음파 유도하 MTX 주입으로 성공적으로 치료된 나팔관임신을 경험한바 이를 보고하는 바이다.
Abstract
Ectopic pregnancy occurs in about 2% of pregnant women, and may seriously compromise women’s health. Extra uterine implantation can occur anywhere along the reproductive tract with the most common implantation site in the fallopian tube. At early stages of presentation where the risk of rupture of a tubal pregnancy is minimal, medical therapy using methotrexate (MTX)given systemically or injected directly into the ectopic pregnancy is an option occasionally used with good results. In addition,ultrasound technology, particularly the introduction of high-resolution transvaginal probes, has been the driving force behind the revolutionary change towards conservative management strategies in ectopic pregnancy care. Tubal pregnancy can be successfully managed without surgical intervention through local injection of MTX. This treatment not only ablates the ectopic pregnancy but also preserves the salpinx without systemic side effect. In this report, we present two cases of tubal pregnancy which treated successfully with ultrasound-guided intraamnionic MTX injection.
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