ECTOPIC PREGNANCY: EPIDEMIOLOGY,ADVANCES IN DIAGNOSIS AND MANAGEMENT

Ectopic pregnancy was first clearly described by Abulcasis, a famous Arabic writer on surgical topics.¹ Although maternal deaths from ectopic pregnancy have declined, it is still the leading cause of death in the first trimester and accounts for 6–11% of all maternal deaths. From 1982 to 1984, 14 women died in England and Wales from this condition.² The presence of ectopic pregnancy subjects women to the uncertainties of intra-abdominal bleeding, laparotomy, extended hospital stay and fetal loss. Furthermore, they could face reduced future fertility.³     

应用电视腹腔镜保守治疗异位妊娠

目的：探讨腹腔镜下氨甲喋呤（MTX）注药水及输卵管开窗术的疗效及副作用。方法：对30例行腹腔镜保守性手术治疗异位妊娠的资料进行回顾分析。结果：30例中行腹腔镜下MTX注药水24例，成功22例（91．6％），镜下输卵管“开窗”术6例均成功。在MTX注药水中；本前异位包块＜3cm的成功率为100％（18／18）；包决＞3cm的成功率66．7％（4／6）．停经＜45d的成功率100％（19／19）；停经＞45d的成功率60％（3／5），行镜下输卵管开窗术虽异位包块≥3cm，停经≥45d但均成功。结论：1．治疗成功的关键在于本式的选择，本前异位包决＜3cm，停经＜45d首选镜下MTX注药术，此法简单易行，本程短，恢复快；当包块＞3cm，停经≥45d行镜下输卵管开窗术更保险，此法虽复杂，但成功率高。2．术后严密随访，一旦血HCG下降缓慢，14d尿HCG仍未转阴，极丰追加MTX肌注一疗程可能得到补救。3．MTX治疗个别病例有轻度胃肠道反应，无其他副作用。     

AN UNUSUAL PRESENTATION OF BILATERAL TUBAL ECTOPIC PREGNANCY

The diagnosis of ectopic pregnancy is sometimes difficult on clinical grounds because of the varied presentation. The clinical triad of amenorrhoea, abnormal vaginal bleeding and lower abdominal pain often raises the suspicion of the diagnosis. There are, however, instances where one or other feature of the triad may be absent. The present case report illustrates an example of bilateral tubal ectopic pregnancies presenting without amenorrhoea. In this case the presentation was similar to an acute gastrointestinal problem.     

MTX治疗少见部位异位妊娠的B超监测

通过B超型超声辅助明确诊断异位妊娠.异位妊娠是妇科急腹症中常见而危重的疾病,尤其罕见部位的异位妊娠,诊治若有延误,危及生命安全.B型超声指导局部注射MTX和治疗效果动态监视及估测预后也起了决定作用.     

多指标联合监测对不典型异位妊娠早期诊断的价值

目的探讨多指标联合监测对不典型异位妊娠早期诊断的价值。方法 160例疑似异位妊娠病人,测定其血清孕酮、人绒毛膜促性腺激素β亚单位（β-hCG）水平,经阴道B超测量子宫内膜厚度,并于48 h后重复测定血清β-hCG水平。根据妊娠结局分为异位妊娠组69例、宫内妊娠组48例、难免流产组43例,对3组上述指标进行比较。结果异位妊娠组血清孕酮水平显著低于宫内妊娠组和难免流产组（F=434.82,q=41.70、16.89,P〈0.01）,子宫内膜厚度也显著低于宫内妊娠组和难免流产组（F=314.86,q=35.49、14.25,P〈0.01）。异位妊娠组48 h血清β-hCG水平上升幅度低于宫内妊娠组（χ^2=5.129,P〈0.05）,其下降幅度低于难免流产组（χ^2=9.699,P〈0.05）。3项指标联合应用可将不典型异位妊娠诊断准确率提高至92.4%。结论单次血清β-hCG和孕酮水平是确定妊娠的指标,但对于尚未形成B超可见孕囊的异位妊娠和宫内妊娠则难以鉴别。间隔48 h复查血清β-hCG观察其上升或下降幅度,同时结合子宫内膜厚度则可显著提高不典型异位妊娠早期诊断的准确性。     

FALSE-NEGATIVE LAPAROSCOPY: A PITFALL IN THE DIAGNOSIS OF EARLY ECTOPIC PREGNANCY

SUMMARY This case highlights the problems and possibilites in the early diagnosis of ectopic pregnancy.     

可疑异位妊娠患者腹腔镜早期诊断和急诊手术的临床意义

目的：评估我院可疑异位妊娠(Ectopic pregnancy,EP)患者腹腔镜(Laparoscopy,LSC)早期诊断和急诊手术的临床价值。方法：87例可疑EP患者均在入院24h内接受急诊LSC手术。结果：所有病例手术顺利，无中转开腹和并发症发生。术中诊断EP患者76例(均病理证实)。术前诊断符合率87．4％；其余病例依次为卵巢囊肿8例(9．2％)、宫内妊娠黄体破裂3例(3.4％)。施行输卵管切除术70例(80．1％)、输卵管开窗术6例(6．9％)。卵巢囊肿刺除术8例(9．2％)。卵巢部分切除术3例(3.4％)。12例合并不孕症患者发现；10例盆腔粘连、5例输卵管卵巢病变，均行相应处理。结论：急诊LSC技术不仅可早期确诊可疑EP患者。为保守性治疗赢得时间；而且还可同时不不孕症患者进行诊治，提高受孕率。     

米非司酮保守治疗异位妊娠30例疗效观察

应用米非司酮治疗早期异位妊娠30例，结果术非司酮组的治愈率76.67％．与MTX对照组对比无显著差异（P＞0．05）；米非司酮的治疗效果随治疗前血β-HCG的水平增加而递减，增加米非司酮总用量不能提高治愈率，对妊娠囊已形成的早期异位妊娠，药物保守治疗效果较差．     

异位妊娠所致失血性休克的电视腹腔镜处理

目的：探讨电视腹腔镜手术治疗异位妊娠所致失血性休克的临床应用价值。方法：回顾性分析了17例电视腹腔镜手术治疗异位妊娠所致失血性休克(＞l000ml)患者的手术方法，手术时间，术中出血，排气平均时间，术后住院天数等。结果：17例休克患者均抢救成功，无l例死亡，无1例中转开腹。结论：电视腹腔镜手术治疗异住妊娠所致失血性休克在条件具备的医院，是可行的，随着腹腔镜技术的逐步完善和发展，医生手术技能的不断提高，使用电视腹腔镜手术治疗异住妊娠所致失血性休克将可能成为今后主要手术方法。     

DIFFICULTIES AND DILEMMAS IN THE MANAGEMENT OF CONGENITAL ANOMALIES IN TWIN PREGNANCY

Both the incidence of twin pregnancy and the demand for prenatal diagnosis are increasing. Unfortunately, biochemical screening and ultrasound scanning are less reliable for prenatal diagnosis in twin pregnancies than in singletons. Amniocentesis and chorionic villous biopsy are usually diagnostic in singleton pregnancies but may be marred by sampling errors in twin gestations. Where a congenital anomaly has been diagnosed in a twin pregnancy, difficult decisions may have to be made, especially if one twin is unaffected. In these cases, special skills are required to ensure that adequate information, psychological support and optimal medical care are provided.     

CEREBRAL VENOUS THROMBOSIS OCCURRING DURING AN ECTOPIC PREGNANCY AND COMPLICATED BY INTRACRANIAL HYPERTENSION

Thrombosis of the cerebral dural sinuses and veins has been described since the early 19th century.^1,2 Clinically the process is characterised by diverse symptomatology and physical findings and in spite of advances in diagnostic radiological techniques it remains an under-recognised condition. It has been most commonly associated with sepsis, trauma, pregnancy, the puerperium and many other hypercoagulable states. We describe an apparently unique case of sagittal sinus thrombosis occurring during an ectopic pregnancy. This was subsequently complicated by intracranial hypertension in spite of clinical improvement and magnetic resonance imaging (MRI) evidence suggesting a return of venous patency. The clinical presentation, radiological features and management is discussed.     

妊娠并发原发性血小板增多症诊治初探（附1例报告并文献复习）

目的探讨有出血倾向的妊娠晚期并发原发性血小板增多症病人诊治方法。方法回顾性分析1例妊娠晚期并发原发性血小板增多症并有出血倾向病人的临床资料,并结合文献复习,分析该病的诊断和治疗方法。结果该病人应用小剂量羟基脲治疗成功,足月手术分娩,妊娠结局良好。结论妊娠晚期并发原发性血小板增多症并有出血倾向病人,应用羟基脲治疗可能为安全、有效的方法。     

内镜诊断异位胰腺3例

1 病例资料 例1 女,50岁,农民.因反复上腹疼痛,嗳气,反酸20年,伴解黑便1d就诊.胃镜见胃窦大弯侧距幽门口2.0cm处有一广基粘膜隆起,大小1.0cm×1.0cm×0.5cm,顶部见一长约5mm纵行裂隙状开口,表面粘膜光滑,色泽正常,于凹陷开口处活检3次;十二指肠球部前壁见一类圆形约8mm大小凹陷溃疡,疡面覆盖厚污苔,疡周粘膜明显充血水肿.内镜诊断:十二指肠球部前壁溃疡(A1期),胃窦大弯异位胰腺?病理活检示少许正常胃粘膜组织.最终经胃大部分切除术后病理诊断为十二指肠溃疡及胃窦粘膜下及肌层异位胰腺.     

疼痛科的建设与管理

疼痛学科是一门新兴的医学边缘性学科,就其管理而言,既有医学经典学科的共性,同时又具有一些特殊性。作者结合该院疼痛科的发展历程,认识到：多专业合作;稳定的人才队伍;人才梯队形成和人才培养;硬件设施的逐渐完善;重视学科科研教学;加强质量控制是搞好本学科建设和管理的关键性工作。     

宫腔镜、腹腔镜下处理迷路IUD的体会

目的 探讨宫腔镜、腹腔镜下迷路宫内节育器取出术的方法。方法 对44例子宫内迷路IUD患者应用宫腔镜取出，术前宫颈预处理，术时根据类型不同采用不同的手术方法，部分患者为预防子宫穿孔行B超或腹腔镜监护。对5例异位于子宫外IUD患者应用腹腔镜取出。结果 49例迷路IUD均一次取器成功．无并发症发生。结论 对于迷路节育环的处理方案是不定型的。对于子宫内迷路IUD术前须充分扩张子宫颈，手术时视情况采用不同的设备和方法。腹腔镜处理异位于子宫外的IUD优于剖腹手术。     

C-反应蛋白在输卵管妊娠破裂中的回顾性分析

近年来，异位妊娠发生率呈上升趋势，输卵管妊娠占异位妊娠的95％以上；而输卯管妊娠破裂出血是妊娠早期妇女死亡的主要原因之一。尽早诊断破裂出血，争取手术时机，减少大出血和输血的发生迫在眉睫。但目前即使是官内正常妊娠，在妊娠5周前B型超声检杏亦很难得到明确的孕囊图像，异位妊娠的确诊更难以在影像学上得到证据，只能通过一些生化检测指标进一步提供佐证。有资料表明：C-反应蛋白是人体感染的一个重要标志。C-反应蛋白浓度在健康群体中的浓度很低，但在人体受到相应的刺激（如炎症，组织损伤后）C-反应蛋白浓度迅速增加。