宫腔妊娠合并异位妊娠及卵巢囊肿1例

患者 女，31岁。停经48天。因右下腹疼3h就诊。以腹痈原因待查收入院。体检：T37.1℃，R20次／min，BP     

宫内外同时妊娠9例临床分析

目的:分析宫内外同时妊娠9例。方法:收集本院2001～2005年宫内外同时妊娠病例行诊断分析。结果:术后足月顺产2例,妊娠中5例,流产1例,其他1例。结论:9例妊娠临床表现不典型,易误诊,应引起足够重视。     

异位妊娠并宫腔假妊娠囊1例

患者 女性，32岁，停经56天，阴道少许出血4天，无腹痛，尿HCG（＋）。     

Quadruplet heterotopic pregnancy; ectopic managed successfully with laparotomy with subsequent viable intrauterine pregnancy: A case report

Heterotopic pregnancy is characterized by a concurrent intrauterine and ectopic pregnancy. It can occur after natural conception, however, it is more common with assisted reproductive techniques , when over one embryo is transferred. Quadruplet heterotopic pregnancy is an exceedingly rare subset. Our case describes a woman who presented to the emergency room with amenorrhea for 9 weeks and lower abdominal pain for 3 days. Transvaginal ultrasound revealed three alive intrauterine fetuses and one left tubal ectopic pregnancy (Quadruplet heterotopic pregnancy). Patient benefited from emergent laparotomy with favorable outcome both in the short term and in the long term. In a patient with a history of assisted reproductive techniques, a high index of suspicion is warranted towards extra-uterine pregnancy. Sonologists should precisely look for adnexal mass. The presence of peritoneal free-fluid requires further investigation. The prognosis of intrauterine fetuses is good, provided the ectopic pregnancy is managed timely and in an effective manner.     

MR features of ectopic pregnancy

Ectopic pregnancy (EP), in which a fertilized ovum implants outside the uterine cavity, is the leading cause of pregnancy-related death in the first trimester. EP is usually suspected by a positive pregnancy test and an empty uterus on transvaginal sonography (TVS). Although TVS is the initial modality of choice, it may occasionally fail to demonstrate the implantation site. When TVS findings are indeterminate, magnetic resonance imaging (MRI) may provide better delineation of the focus of EP owing to its excellent tissue contrast. The key MRI features of EP include gestational sac (GS)-like structures that typically appear as a cystic sac-like structure, frequently associated with surrounding acute hematoma of distinct low intensity on T2-weighted images. In tubal pregnancy, an enhanced tubal wall on postcontrast images may be another diagnostic finding. Ruptured EP is inevitably associated with acute hematoma outside these structures. In intrauterine EP, recognition of the relationship between GS-like structure and the myometrium can aid in differentiating from normal pregnancy. Diagnostic pitfalls include heterotopic pregnancy, decidual changes in endometrial cyst and theca lutein cysts mimicking GS-like structures. Knowledge of a spectrum of clinical and MRI features of EP is essential for establishing an accurate diagnosis and determining appropriate management.     

Sonographic evaluation of ectopic pregnancy

Ectopic pregnancy is a high-risk condition that occurs in 1.9% of reported pregnancies. Although the clinical triad of pain, bleeding, and amenorrhea is considered very specific for an ectopic pregnancy, ultrasound plays important role in detecting the exact location of the ectopic pregnancy and also in providing guidance for minimally invasive treatment. This article discusses the main sonographic features of ectopic pregnancy at various common and unusual locations. In addition, it provides insight into the role of hormonal markers in the diagnosis and management of ectopic pregnancy.     

磁共振成像在异位妊娠中的诊断价值

目的:探讨异位妊娠的MRI表现和诊断价值。方法:回顾性分析18例经手术病理证实的异位妊娠的MRI表现。结果:18例中,输卵管妊娠17例,宫颈妊娠1例。宫内未见异常信号。子宫附件区或腹腔血肿,非均质肿块,可伴线状环形低信号的孕囊样结构,盆腔积液及输卵管的扩张及强化是输卵管妊娠的主要征象;血肿和盆腔积液提示流产或破裂,病灶出现环状或管状边缘强化提示病灶位于输卵管内。结论:输卵管妊娠MRI表现较具特征性,MRI可作为检查异位妊娠的重要补充手段。     

Ultrasound evaluation of ectopic pregnancy

The combined use of a serum radioimmunoassay pregnancy test and high resolution utrasonography allows a more direct approach to be made in the diagnosis of ectopic pregnancy. It is important for ultrasonographers to understand the limitations of the more readily available immunologic pregnancy tests in order to avoid misinterpreting ultrasonograms in the event that a pregnancy test is either falsely positive or falsely negative. Clinical suspicion is mandatory if the early diagnosis of ectopic pregnancy is to be made. The referring physician should take advantage of the highly accurate information resulting from the combined findings of a positive serum HCG and the ultrasonographic images. If the statistics regarding diagnostic delay and tubal rupture are to be improved, these tests should be obtained when a patient is initially evaluated. It is important to recognize that the ultrasonographic interpretation rests primarily upon the uterine findings. A normal viable intrauterine pregnancy essentially excludes the diagnosis of ectopic pregnancy. Other uterine appearances may result from an early intrauterine pregnancy, an abnormal intrauterine gestational event, or, as in approximately 1 per cent of pregnancies, an ectopic gestation. Subsequent evaluation in suspicious cases may require a variety of tests including serial HCG determinations, repeat ultrasound examination, uterine dilatation and curettage, culdocentesis, or laparoscopy. It is impossible to recommend a specific schematic approach for any given patient. In part, the pattern of management depends upon availability of tests, the presence or absence of adnexal or cul-de-sac findings, and, of course, the clinical status of the patient.U     

Chronic volvulus of an ectopic spleen with subcapsular hematoma. CT x-ray aspect

The authors present a case of ectopic spleen complicated by chronic torsion and subcapsular haematoma in an asymptomatic patient. The value of ultrasonography and computed tomography in the diagnosis of these complications is discussed.     

A ruptured ectopic pregnancy in a patient with an intrauterine device: A case report

Intrauterine devices (IUDs) are used worldwide. The 2 types that are used are the levonorgestrel IUD and a copper containing IUD. This is a case study of a 30-year-old female with a levonorgestrel IUD who was diagnosed with a ruptured ectopic pregnancy in the emergency department (ED). Point-of-care urine pregnancy test and point-of-care ultrasound (POCUS) were vital in making this diagnosis and should be utilized in patients assigned female at birth who present with abdominal pain.     

腹腔镜治疗有妇产科手术史的异位妊娠82例

目的 探讨有妇产科手术史的异位妊娠患者行腹腔镜治疗的可行性、适应证、手术方法和临床价值.方法 对82例有妇产科手术史的异位妊娠患者采用腹腔镜手术治疗.其中有1次手术史者60例,2次者21例,3次者1例.根据不同情况所采取的手术方式有:①腹腔镜直视下穿刺注药法;②输卵管切除术;③输卵管妊娠病灶切除术;④腹腔镜下输卵管切开取胚术;⑤输卵管妊娠孕囊吸出术;⑥间质部妊娠手术新方法,包括注射垂体加压素和电凝术式、妊娠组织排出前内套圈套扎术式和妊娠组织排出前荷包缝合术式等.结果 82例异位妊娠患者经腹腔镜探查发现,73例盆腹腔内有不同程度的粘连,粘连率为89.0%(73/82).其中有1次手术史的60例患者中,51例存在盆腹腔粘连,粘连率为85%;有2次以上手术史的22例患者中,全部有盆腹腔粘连,粘连率100%.70例腹腔镜手术成功,成功率85.4%,其余12例因盆腔粘连严重而中转开腹,占14.6%.12例中,合并子宫内膜异位症5例,慢性盆腔炎6例,既往有宫外孕手术史者9例;剖宫产手术史者2例;有复杂妇科手术史者1例.手术并发症包括合并盆腔子宫内膜异位症患者术中肠管损伤1例,转为开腹手术.合并盆腔子宫内膜异位症患者术后3天确诊输尿管损伤1例,转泌尿科手术治疗.腹腔镜手术时间为30～180min.结论 腹腔镜治疗有妇产科手术史的异位妊娠是一种理想的手术方式.慢性盆腔炎、子宫内膜异位症及宫外孕手术史尤其是2次宫外孕手术史会增加手术难度,中转开放手术几率较高,术前应做好相应的准备.     

健康教育在宫外孕患者中的作用

异位妊娠(ectopic pregnancy)是指受精卵着床于正常子宫体腔以外的任何部位。异位妊娠一旦破裂，常引起出血等严重并发证，可危及生命，是一种常见妇科急症，发病年龄以17—25岁为主，主要症状是腹痛、面色苍白，病情发展迅速，这给病人的心理、身体和生活都带来痛苦。由于药物保守治疗有一定的困难，患者常常对手术治疗顾虑重重，既担心手术是否顺利，又担心手术后对身体的影响以及对今后生育能力的影响。为此，我们通过对91例施行手术治疗的宫外孕病人实施健康教育，增加了病人对疾病及相关知识的了解，减少了顾     

MR imaging in clinically suspected acute cholecystitis. A comparison with ultrasonography

Purpose: The diagnostic value of fast pulse sequences in MR imaging was compared with US in patients with clinically suspected acute cholecystitis.Material and Methods: In a prospective study of 94 patients, 35 were examined with both MR and US within 24 h.Results: MR diagnoses were acute cholecystitis in 23, gallbladder and common bile duct stones in 3, other pathologic conditions of the abdomen in 7 and normal in 2 patients. US diagnoses were acute cholecystitis in 17, gallbladder stones in 8, other pathologic conditions of the abdomen in 2, normal in 5 and non-conclusive in 3 patients.Conclusion: MR has a higher sensitivity than US for diagnosing acute cholecystitis and, with increased accessibility, may be the first imaging method.     

Co-existent intrauterine and ectopic tubal pregnancy

A case of co-existent intrauterine and ectopic pregnancy is described in a patient from overseas. The difficulty in diagnosis and management is discussed, together with recent literature.