腹腔镜未确诊10例疑似宫外孕的回顾分析

目的:分析腹腔镜下未能确诊的10例疑似宫外孕患者的特点和原因。方法:对因宫外孕或宫外孕待排行腹腔镜手术529例患者的临床资料进行回顾性分析,对未确诊组与确诊组病例作对照研究。结果:与确诊组比较,未确诊组月经逾期天数短[(12.7±10.15)d vs.(20.84±8.0)d(P=0.01)],三联征发生率低(30%vs.78.13%),后穹窿穿刺抽出不凝血率低(30%vs.93.75%),未确诊组最终诊断为黄体囊肿合并不明位置的妊娠状态6例(1例经术后随访证实为早期输卵管妊娠),黄体囊肿合并宫内早孕或不全流产3例,浆膜下子宫肌瘤变性合并不全流产1例。结论:疑似宫外孕患者如病情稳定,不必按宫外孕急诊手术,有生育要求的患者可用期待疗法,无生育要求的患者可诊刮与宫内妊娠鉴别。

Retrospective analysis of 10 cases with laparoscopically unidentified suspected ectopic pregnancy

Objective:To analyse the features and causes of 10 cases with laparoscopically unidentified suspected ectopic pregnancy.Methods:The clinical data of 529 cases of laparoscopy for ectopic pregnancy or suspected ectopic pregnancy were analyzed retrospectively.Results:In comparison with identified group,unidentified group experienced a shorter cessation of menstruation,fewer triad of pain,vaginal bleeding and amenorrhea,lower ratio of positive culdocentesis.The final diagnosis of unidentified group were as following:corpus luteum cyst combined with pregnancy of unknown location(6 cases,1 case of them were comfirmed by follow-up to be early tubal pregnancy),corpus luteum cyst combined with intrauterine pregnancy or incomplete abortion(3 cases),degenerated subserous myoma combined with incomplete abortion(1 case).Conclusions:Hemodynamically stable patients of suspected ectopic pregnancy should not be operated in a hurry.Expectant management is reasonable for patients who desire a baby.Diagnostic curettage is helpful in differentiating ectopic and entopic pregnancy if the patients have no intention to bear.