非常见部位异位妊娠36例临床分析

目的探讨非常见部位异位妊娠的临床特征及误诊原因。方法对1994年1月-2004年12月住院的36例非常见部位异位妊娠进行回顾性分析。结果发生率占同期异位妊娠的3．9％，术前误诊率86．1％。除3例患者均急诊剖腹探查，视术中情况行异位妊娠灶切除，必要时连同患侧附件甚至全子宫切除。结论非常见部位异位妊娠临产表现不典型，术前诊断较困难，一旦怀疑本病应及早手术探查明确诊断，治疗效果好。     

非常见异位妊娠的特点与处理

异位妊娠最常见的部位为输卵管，占90％以上，少见的异位妊娠约占5％。其发生的部位不常见，卵巢、腹腔、子宫颈、残角子宫、宫角和剖宫产瘢痕部位等；发生的形式不常见，如双侧输卵管同时妊娠、宫内宫外复合妊娠、辅助生殖技术后异位妊娠、持续性输卵管妊娠、输卵管妊娠部位切除后残端再次妊娠等。由于妊娠部位和形式不同，症状可不典型，易误诊，现对部分少见部位异位妊娠进行讨论。     

54例少见部位异位妊娠临床分析

少见部位异位妊娠往往因病史不典型,症状及体征出现较晚而造成误诊。本文综合云南省人民医院及白求恩医大少见部位异位妊娠54例,就诊治体会加以探讨。临床资料一、少见部位异位妊娠与输卵管妊娠所占之比例云南省人民医院1975年1月至1988年9月期间、白求恩医大1974年10月至1988年10月期间,共收治异位妊娠940例,其中少见部位异位妊娠54例,占同期异位妊娠的5.74%。54例中卵巢妊娠20例(2.13%),输卵管间质部(含子宫角部)妊娠17例(1.18%),子宫残角妊娠7例(0.74%),宫颈妊娠6例(0.64%),双侧输卵管同时妊娠1例,宫内及输卵管同时妊娠2例(0.32%),阔韧带妊娠1例(0.11%)。54例中47例误诊,误诊率为87%。术前明确诊断7例:3例较     

腹腔镜早期诊治可疑异位妊娠的临床意义

目的 评估可疑异位妊娠(ectopic pregrnancy，EP)患者腹腔镜(laparoscopy，LSC)早期诊断和急诊手术的临床价值。方法 回顾分析1998年8月至2003年8月收治的经LSC手术治疗的可疑EP患者186例，均在入院24h内接受急诊LSC手术。结果 185例手术经腹腔镜完成，l例中转开腹，均无并发症发生。术中诊断EP172例(均经病理证实)，术前诊断符合率92．5％；其余病例依次为卵巢囊肿9例(4．8％)，宫内妊娠黄体破裂5例(2．7％)。32例合并不孕患者中25例有盆腔粘连，17例有输卵管卵巢病变，均行相应处理。12例少见异位妊娠(包括4例输卵管间质部妊娠，4例卵巢妊娠，3例腹腔妊娠，l例子宫肌壁间妊娠)，15例休克型异位妊娠，经腹腔镜手术亦获满意治疗效果。结论 急诊LSC手术不仅可早期确诊可疑EP患者，为保守性治疗赢得时间，而且还可同时对不孕症患者进行诊治。急诊LSC手术治疗休克型及少见异位妊娠亦是可行且安全的。     

少见异位妊娠27例临床分析

少见异位妊娠２７例临床分析福建省妇幼保健院（３５０００１）姚宝钗陈端少见部位异位妊娠，往往病史不典型，症状及体征出现较晚，容易造成误诊。本文报道少见部位异位妊娠２７例，现就诊治体会介绍如下。１临床资料１．１我院１９８５至１９９０年共收治异位妊娠２６７...     

少见类型异位妊娠超声声像学特征及诊断

随着经阴道超声检查的普及及技术的提高,常见类型异位妊娠(如输卵管异位妊娠)的早期检出率得到极大提高。然而近年来少见部位异位妊娠(如有剖宫产史的瘢痕妊娠等)的发病率逐渐上升,因其少见,超声声像变化大,成为导致生育期女性失血抢救及死亡的主要原因。经阴道超声是诊断异位妊娠的首选方法。文章总结少见类型异位妊娠的超声声像学特征及超声诊断要点,旨在提高对少见部位异位妊娠的重视,提高早期检出率,以利于临床制定合理治疗方案,减少异位妊娠破裂大出血的风险。     

卵巢妊娠22例临床分析

卵巢妊娠是一种少见的异位妊娠，因其缺乏典型的临床症状与体征，术前很难确诊，多因突发急腹症和／或伴休克而就诊，最后确诊需根据术中所见及病理检查诊断才能明确。我院1993年1月～2003年12月间共收治卵巢妊娠22例，占同期异位妊娠(1280例)的1．72％，其中前6年占1．33％(8／602)，后5年占2．06％(14／678)，现分析报告如下。     

卵巢妊娠40例分析

卵巢妊娠４０例分析郁霞秋卵巢妊娠是一种少见的异位妊娠，在手术前一般多诊断为输卵管妊娠，均因出现急腹症、休克症状后施行剖腹探查术，根据术中所见和病检后才得到明确诊断。总结我院自１９８４～１９９５年４０例卵巢妊娠显示卵巢妊娠的早期诊断有赖于病史、体征的仔...     

阴道超声引导胚胎减灭术在少见部位异位妊娠中的应用

目的 探讨阴道超声引导胚胎减灭术在少见部位异位妊娠治疗中的应用价值。方法 2005年1月～2006年10月在北京大学第三医院生殖医学中心10例少见部位异位妊娠行阴道超声引导胚胎减灭术，并对治疗结局进行追踪和分析。结果 患者年龄25～37岁，妊娠周数7～8周。宫颈妊娠4例（宫颈合并宫腔内妊娠1例），输卵管间质部妊娠4例，宫角妊娠2例。6例超声显示异位妊娠囊内胎心搏动。hCG水平范围为4826～122300IU／L。术后1周血清hcG升高3例，其余术后血清hCG逐渐下降。1例间质部妊娠术后1周hCG水平升高，行第2次穿刺术时出现腹腔内出血症状和体征，急行腹腔镜探查和一侧输卵管切除术。其余患者血hCG4～8周降至正常，异位病灶3～5个月恢复正常。结论 阴道超声引导胚胎减灭术合并局部注射MTX作为一种微创技术，可安全有效地应用于非常见部位异位妊娠的保守治疗。     

输卵管妊娠保守性手术96例手术

目的：探讨输卵管妊娠保守性手术及不同手术方式的近期效果及妊娠结局。方法：对96例未破裂型输卵管妊娠中77例行输卵管线型切开术，19例行输卵管伞端胚囊挤出术。绒毛肿植部位注射甲氨蝶呤20－30mg。结果：2．4％的患者发生持续性异位妊娠，均为行伞端挤出术患者。宫内妊娠率为41．5％，重复异位妊娠率为25．6％。对侧输卵管正常者，宫内妊娠率及重复异位妊娠率分别为70．5％和22．8％；当时侧输卵管异常或已被切除者，宫内妊娠率又重复异位妊娠率为7．9％和28．8％。结论：绒毛种植部位注射甲氨蝶呤可降低持续性异位妊娠率，而伞端绒毛挤出术后发生持续性异位妊娠的可能性较大，应尽量避免。     

剖宫产后切口妊娠的临床诊治分析

目的:研究剖宫产后子宫切口妊娠的临床表现及治疗方法等特征,为临床医生早期诊断、早期处理本病提供依据。方法:对25例患者的病史、临床表现、诊断方法以及治疗方法进行回顾性分析。结果:25例患者中有23例经阴道超声检查或彩色多普勒超声检查确诊;本病初诊误诊19例,误诊率76%,25例患者中保守治疗22例,21例痊愈,占95.45%;2例治疗失败而行全子宫切除术。结论:有剖宫产史的妇女因停经就诊时,要常规行阴道超声检查,对阴道超声怀疑切口妊娠的病例,有必要行彩色多普勒超声检查;彩色多普勒超声检查可作为诊断切口妊娠的主要方法;甲氨蝶呤加清宫术可作为治疗切口妊娠的主要方法,可有效地避免子宫切除。     

各孕周宫角妊娠38例临床分析

目的 探讨各孕周宫角妊娠的临床特点、诊断和治疗方法.方法 对2006年1月至2010年8月郑州大学第一附属医院收治的38例宫角妊娠的患者进行回顾性的分析.结果 38例宫角妊娠的患者中,停经38例(100%)、不规则阴道出血27例(71.1%)和腹痛22例(57.9%).宫角妊娠术前诊断困难,误诊率近50%.38例患者中...     

Chronic Ectopic Pregnancy: A Clinical Analysis of 62 Cases

Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy, instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass. Its clinical features are often confusing, and laboratory evaluations are often misleading. Surgery for chronic ectopic pregnancy is frequently difficult since chronic inflammatory changes and adhesions distort the normal anatomy. In the present retrospective study, its incidence was found to be 20.3% (n=62) in a series of 305 ectopic pregnancies. A pelvic mass of varying sonographic appearance, mostly with a nonhomogenous echo pattern, was demonstrated in all 55 patients in whom transvaginal sonographic evaluation was performed preoperatively. Although most of the patients [91.9% (n=57)] had a positive serum beta HCG value, 5 patients had a negative test value. Laparotomy resulted in 40 salpingectomies, 19 salpingo-oophorectomies, and 3 total abdominal hysterectomies with salpingo-oophorec-tomies. One patient had an incidental cystotomy and 2 an incidental colotomy. We conclude that chronic ectopic pregnancy is not rare, although little is mentioned about it as a clinical entity in the gynaecological literature. With increased awareness of its mildly symptomatic and protracted clinical course, and with proper interpretation of laboratory evaluations, a preoperative diagnosis can be made in the majority of the cases.     

Clinical analysis of ovarian pregnancy: a report of 49 cases

Objective

To clinically analyze cases of ectopic ovarian pregnancy and to generate data regarding the evaluation and management of suspected ectopic ovarian pregnancies.

Study design

We retrospectively analyzed 49 ovarian pregnancies that were surgically treated at Cheil General Hospital and Women's Healthcare Center between January 1996 and December 2009. We analyzed patient age, parity, symptoms, risk factors, preoperative diagnosis, and ovarian pregnancy type.

Results

During the study period, the incidence of ovarian pregnancy was 1.59% of all ectopic pregnancies (49/3081); 45/49 (91.8%) were primary ovarian pregnancies. At the time of diagnosis, mean age was 30.7 years (SD: ±4.4 years) and mean parity was 0.63 (SD: ±0.8). The most common presenting symptoms were abdominal pain (42.9%) and vaginal bleeding (28.6%). The most common sonographic findings were fluid surrounding the ovarian pregnancy and ovarian enlargement. In regard to surgical treatment, ovarian wedge resection was most often performed (85.7% of cases), followed by oophorectomy (8.2% of cases). The most common risk factors were endometriosis (16 patients) and a history of abdominal surgery (19 patients).

Conclusions

Ovarian pregnancies are extremely rare and difficult to diagnose both pre- and intra-operatively. Our data may assist surgeons in understanding the clinical presentation of ovarian pregnancy and in counseling patients. Larger studies are warranted to gather more data on this rare form of ectopic pregnancy.     

Diagnosis and laparoscopic management of 11 consecutive cases of cornual ectopic pregnancy

Objective  To determine the pre-operative diagnosis by two dimensional ultrasound scan and the outcome of the laparoscopic management of cornual ectopic pregnancy. Design  Prospective database cohort study. Setting  Whipps Cross University Hospital, UK (District General Hospital). Patients  Eleven patients with cornual ectopic pregnancy presenting in our hospital between January 2003 and December 2007. Interventions  Laparoscopic cornuostomy or cornual resection. Outcome measures  Pre-operative diagnosis by ultrasound scan, conversion rate to laparotomy, successful laparoscopy (not requiring further treatment), complication rate and duration of hospital stay. Results  The mean gestational age was 8 ± 2 weeks. All 11 patients presented with abdominal pain and vaginal bleeding and two (18%) patients became haemodynamically unstable before laparoscopy. There were five (45%) patients with risk factors for ectopic pregnancy. The mean serum β-human chorionic gonadotropin (β-hcg) was15,263 ± 12,045 μm/ml. One patient did not have a transvaginal scan as it was decided to proceed to surgery on clinical grounds. The diagnosis of ectopic pregnancy was correct at initial scan in nine (90%) of the ten patients who had transvaginal scans as one patient was misdiagnosed at the first scan. However, an ectopic pregnancy was diagnosed on a second ultrasound scan assessment. Initial laparoscopy was negative in one of the nine patients diagnosed as having an ectopic pregnancy. The diagnosis was later confirmed following serial serum β-hcg monitoring, a repeat scan and a second laparoscopy. Ten (91%) of the 11 patients had successful operative laparoscopy as one (9%) patient had conversion to laparotomy. Among patients who had laparoscopic surgery, cornuostomy was performed in three (30%) patients while cornual resection was performed in the other seven (70%) patients. One (10%) of the patients who had laparoscopic surgery needed further treatment with systemic methotrexate. This patient had a cornual resection and was the only complication following laparoscopic surgery. The mean hospital stay was 2 days. Conclusion  This presentation of one of the larger series of patients with cornual ectopic pregnancy managed by laparoscopic surgery reveals that experience at ultrasonography and laparoscopic technique can lead to earlier diagnosis and few cases requiring laparotomy or further treatment. In addition laparoscopic surgery for cornual ectopic is safe and lends itself to conservative approach (cornuostomy) in selected cases.     

Isthmic ectopic pregnancy and salpingitis isthmica nodosa

Two hundred eighty-five charts were reviewed from patients who underwent surgery for ectopic pregnancy. Excluded were patients with previous tubal reparative surgery, linear salpingotomy, or failed sterilization. The incidence of isthmic ectopic pregnancy in the remaining 255 cases was 15.3%. The association of salpingitis isthmica nodosa (SIN) and isthmic ectopic pregnancy was determined by review of resected tubal segments. SIN was noted in 17 of 37 cases (45.9%) of isthmic ectopic pregnancy. SIN places the patient at risk for recurrent ectopic pregnancy or infertility. Recommended conservative management of isthmic ectopic pregnancy is segmental resection with postoperative emphasis on documentation of SIN when present. Postoperative hysterosalpingography is recommended with an abnormal contralateral tube or when SIN is noted in the resected tubal segment. Management options after an isthmic ectopic pregnancy when future fertility is desired are presented.     

Undiagnosed Ectopic Pregnancy: A Retrospective Analysis of 31 'Missed' Ectopic Pregnancies at a Teaching Hospital

Summary: The management of 255 surgically proven cases of ectopic pregnancy, treated at a teaching hospital over a 5-year period, was retrospectively reviewed to determine the proportion of cases where the diagnosis was 'missed' at initial presentation. Thirty-one patients (12%) had presented and been discharged with an incorrect diagnosis, then subsequently readmitted for definitive treatment of a tubal ectopic pregnancy. In this group, the mean time from initial presentation to definitive surgery was 8 days. Ten of the 31 women with 'missed' ectopic pregnancies (32%) underwent salpingectomy, whereas the rate of salpingectomy in those women whose ectopic pregnancy was correctly diagnosed at first presentation was 19.5% (44 of 224). We conclude that delays in the diagnosis of ectopic pregnancy may be associated with an increased rate of salpingectomy, which may in turn reduce prospects for future fertility, a finding not previously canvassed in the literature. The factors contributing to misdiagnosis of ectopic pregnancy are discussed and compared with those reported in other studies.     

异位妊娠他科误诊致失血性休克临床分析

目的探讨异位妊娠他科误诊原因，减少误诊率。方法回顾性分析我院2000年1月-2005年6月收治435例异位妊娠中9例因临床表现异常首诊到内外科室就诊，分析异常临床表现及原因。结果2例腹泻伴下腹隐痛于肠道门诊就诊，2例发热、呕吐、下腹痛于内科就诊，3例胃痛伴呕吐及上腹痛伴呕吐于外科就诊，2例晕厥腹痛于急诊科就诊，经对症处理，最短5h、最长72h内出现休克症状而请妇科会诊，后诊断异位妊娠、失血性休克，急诊手术、积极抢救转危为安。结论生育期妇女要考虑妇科疾患，特别是异位妊娠，常规查尿HCG、盆腔B超可得到及时诊断。     

Ectopic pregnancy: diagnostic dilemma and delay

A retrospective analysis of 1 1 1 consecutive ectopic pregnancies was done regarding diagnostic difficulties and delay. Absence of amenorrhea before onset of symptoms was frequent (44.1%), as was a negative two-minute slide pregnancy test (50.0%). The main factors causing diagnostic delay were the use of therapeutic drug trials and misdiagnosis at curettage. Diagnostic delay can be reduced by early use of more sensitive pregnancy tests in patients predisposed to ectopic pregnancy, more critical use of drug trial therapy in patients with gynecologic diagnostic problems, early resort to laparoscopy and rapid pathologic examination of tissue obtained from curettage done in suspected cases of spontaneous abortion or menorrhagia to detect decidual changes or Arias-Stella phenomenon.