摘要
目的探讨原发性腹腔妊娠的临床特点。方法报道1例原发性腹腔妊娠患者的诊治经过,并以"原发性腹腔妊娠"为关键词,在中国期刊全文数据库(CNKI)、万方数据知识服务平台检索相关文献,收集并分析检索到的原发性腹腔妊娠患者资料。结果该例为33岁女性,因停经、腹痛收入院。宫颈举痛阳性,后穹隆穿刺出不凝血12 ml。实验室检查血红蛋白87 g/L,血人绒毛膜促性腺激素(hCG)阳性,急诊彩色多普勒超声示右上腹包块,行腹腔镜检查,术中见大网膜包裹陈旧性血块,在其中找到绒毛组织,诊断为原发性腹腔大网膜妊娠,术后患者恢复良好,血hCG及血红蛋白均恢复至正常。检索文献后收集到已被报道的原发性腹腔妊娠46例,所有病例的共同主诉为腹痛,行剖腹探查术31例、腹腔镜检查术15例,大网膜妊娠36例、腹腔其余部位(子宫直肠凹、子宫骶韧带、直肠表面)妊娠10例,孕14周以上均为大网膜妊娠,误诊6例,分别误诊为宫内妊娠、阑尾炎、肠粘连、梗阻,肠胃炎等。结论原发性腹腔妊娠极其罕见,临床表现不典型,术前确诊较困难,手术是最主要的诊断及治疗方式。
Objective To investigate the clinical characteristics of patients with primary abdominal pregnancy.Methods The diagnosis and treatment of one case of primary abdominal pregnancy were reported.Literature review was performed using the keyword of primary abdominal pregnancy in the CNKI and Wanfang database.Clinical data of primary abdominal pregnancy patients retrieved from the databases were collected and analyzed.Results A 33-year old female woman was hospitalized due to menopause and abdominal pain.She was positive for cervical compression test.A portion of 12 ml non-coagulant blood was obtained via vaginal pos-terior fornix puncture.Laboratory examinations revealed a low level of hemoglobin （87 g/L）and positive hu-man chorionic gonadotrophin （hCG）.Color Doppler ultrasound at the emergency department demonstrated the sign of masses in the right upper abdomen.Laparoscopy was subsequently performed.Intraoperatively,old blood clot enveloped by the greater omentum was observed and villi tissue was then identified.She was eventu-ally diagnosed with primary abdominal pregnancy located at the greater omentum.After surgery,she was well recovered.The levels of hCG and hemoglobin restored to normal range.A total of 46 cases of primary abdomi-nal pregnancy were retrieved from literature review.All patients reported the chief complaints of abdominal pain.Thirty one cases underwent exploratory laparotomy and 15 received laparoscopy.Thirty six women were diagnosed with the greater omentum pregnancy and 10 with pregnancy at the other sites （recto-uterine pouch, ligamentum uterosacralis and rectal surface）.Those with ＆gt;14 weeks of pregnant were all diagnosed with the greater omentum pregnancy.Six cases were misdiagnosed with uterine pregnancy,appendicitis,intestinal adhe-sion and obstruction and enterogastritis,etc.Conclusions Primary abdominal pregnancy is extremely rare with atypical clinical manifestations.It is difficult to confirm the diagnosis before surgery.Surgery remains the primary tool for the diagnos
出处
《新医学》
2016年第11期766-769,共4页
Journal of New Medicine
关键词
原发性腹腔妊娠
腹腔镜
治疗
Primary abdominal pregnancy
Laparoscope
Treatment
