摘要
目的探讨腹腔妊娠(AP)的临床特点,为其诊断、治疗及管理提供临床参考依据。方法选择2008年1月至2018年12月,四川大学华西第二医院收治的37例AP患者为研究对象。其中,早、中孕期AP患者分别为36例、1例。采用回顾性分析方法,收集其一般临床资料、临床表现、辅助检查结果、诊断与治疗方法、孕囊种植部位、术后病理学检查结果及预后,对其临床特点进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果这36例早孕期AP患者的临床特点如下。①一般临床资料:术前血清β-人绒毛膜促性腺激素(hCG)值为2594.9 mIU/mL(179.1~173450.0 mIU/mL);自然妊娠者为34例(94.4%),采取体外受精-胚胎移植技术妊娠者为2例(5.6%);1例(2.8%)为AP合并带器妊娠,1例(2.8%)合并宫内妊娠,其余34例(94.4%)仅为AP。②临床表现:35例(97.2%)停经时间为29~76 d,1例(2.8%)停经时间不明;出现不同程度腹痛为33例(91.7%);发生少量阴道流血为26例(72.2%)。③术前诊断结果:对受试者采用超声检查结合血清β-hCG及临床表现进行诊断的结果显示,仅3例(8.3%)被诊断为脾脏妊娠,其中2例于外院被误诊为输卵管妊娠(FTP),并且已行患侧输卵管切除术;33例(91.7%)未被确诊。④治疗:34例(94.4%)接受腹腔镜手术治疗,1例(2.8%)进行开腹脾切除术,1例(2.8%)因腹腔镜手术中手术视野暴露困难,而采取中转开腹脾切除术。⑤术后切除组织标本的病理学检查结果显示,35例(97.2%)可见妊娠组织;1例(2.8%)未见妊娠组织,但是术后其血清β-hCG值进行性下降,术后14 d降至正常水平。⑥预后:所有患者术后均恢复良好,无严重手术并发症发生,术后第1次(手术后第1~3天)复查血清β-hCG值均明显下降。1例中孕期AP患者的临床特点:①术前超声检查被误诊为宫内妊娠,于本院先后采取药物引产、超声监测下钳夹术均未成功,最终采取开腹探
Objective To explore the characteristics of abdominal pregnancy(AP)and provide clinical reference for its diagnosis,treatment and management.Methods From January 2008 to December 2018,a total of 37 patients with AP who were admitted to West China Second University Hospital,Sichuan University were selected as research subjects.Among them,there were 36 cases and 1 case of AP in the first and second trimester,respectively.General clinical data,clinical manifestations,auxiliary examination results,diagnosis,treatments,gestational sac implantation site,postoperative pathology and recovery of AP were collected by retrospective method,and their clinical characteristics were analyzed.This study was in accordance with World Medical Association Declaration of Helsinki revised in 2013.Results The clinical characteristics of 36 cases in the first trimester were as follows.①General clinical data:preoperative serumβ-human chorionic gonadotropin(hCG)value was 2594.9 mIU/mL(179.1-173450.0 mIU/mL);34 cases(94.4%)were natural pregnancy and 2 cases(5.6%)were by fertilization in vitro-embryo transfer;there were 1 case of pregnancy with intrauterine device in situ and 1 case with intrauterine pregnancy,the other 34 cases(94.4%)were not combined with other kind of pregnancy.②Clinical manifestations:35 cases(97.2%)had a period of amenorrhea ranging from 29 to 76 d,1 case(2.8%)had an unknown period of amenorrhea;33 cases(91.7%)had varying degrees of abdominal pain;26 cases(72.2%)had vaginal bleeding.③Preoperative diagnosis results:only 3 cases(8.3%)were diagnosed as spleen pregnancy by ultrasound combined with serumβ-hCG and clinical manifestations before operation,but 2 cases were misdiagnosed as fallopian tubal pregnancy(FTP)in other hospital institutions,and salpingectomy has been performed on the affected side.The other 33 cases(91.7%)were not diagnosed before operation.④Treatments:34 cases(94.4%)underwent laparoscopy;as to the other 2 cases,1 case(2.8%)underwent laparotomy,1 case(2.8%)was converted to laparotomy for extre
作者
李欣哲
谭世桥
徐瑞涓
王煦
王佳
胡颖
Li Xinzhe;Tan Shiqiao;Xu Ruijuan;Wang Xu;Wang Jia;Hu Ying(Department of Obstetrics and Gynecology,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Laboratory of Reproductive Endocrine and Reproductive Regulation,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China;West China School of Medicine,Sichuan University,Chengdu 610041,Sichuan Province,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Department of Gynecology,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2020年第2期227-233,共7页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
国家自然科学基金青年基金项目(21507094)
成都市科技局项目(2018-YFYF-00078-SN)。
关键词
妊娠
腹腔
妊娠
异位
妊娠
脾脏
种植部位
临床分析
孕妇
Pregnancy,abdominal
Pregnancy,ectopic
Pregnancy,spleen
Implantation site
Clinical analysis
Pregnant women
