输卵管间质部妊娠术后子宫破裂4例病例报告及文献复习

发布时间：2018-03-02 07:07

本文关键词： 子宫破裂输卵管间质部妊娠危险因素临床特点　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:输卵管间质部妊娠是异位妊娠的一种特殊类型,目前手术多采用腹腔镜下患侧输卵管及部分宫角切除。同时越来越多的术后患者存在生育要求,而间质部妊娠术后患者再次妊娠期间存在子宫破裂风险。因而本文旨在总结输卵管间质部妊娠术后再次妊娠期间子宫破裂的患者的临床特征,从而能够为临床诊治提供参考。方法:回顾性分析我院1999-2016年收治的4例输卵管间质部妊娠术后再次妊娠期间子宫破裂患者的临床资料,结合复习相关文献,探讨输卵管间质部妊娠术后子宫破裂的危险因素、临床特点、处理及预后。结果:1999年11月至2016年10月我院共有283例子宫破裂患者,其中输卵管间质部妊娠术后子宫破裂4例。本文报道的4例患者均为育龄期女性,年龄为28-42岁,既往均有不良孕史,所有患者均曾因输卵管异位妊娠行单侧或双侧输卵管切除史。而4例患者末次妊娠均为输卵管间质部妊娠,并均行腹腔镜下患侧宫角切除术,仅2例官角切除后进行缝合。而此次间质部妊娠术后再次妊娠仅有一例为自然妊娠,其余均为辅助生育妊娠。手术至再次妊娠时间间隔,最短为0.52年,最长为2.25年。4例患者分娩孕周最小17周,最大37+1周,其中2例为双胎妊娠,2例患者存在胎位异常,而4例患者妊娠子宫破裂均在既往宫角瘢痕处。同时4例妊娠子宫破裂患者中2例均无明显不适主诉,1例由B超提示,1例由术中探查发现;1例患者仅有轻微腹痛主诉,一例患者主诉为持续剧烈腹痛伴恶心腹泻,于首诊时被误诊为消化道疾病。最终4例患者均仅采取子宫修补术,其中2例胎儿死亡。术后均顺利出院,恢复可,无月经改变,仅有1例患者有再生育要求。结论:输卵管间质部术后再次妊娠期间存在子宫破裂的风险,在临床上虽然并不多见,但一旦发生,其临床症状并不明显,易误诊漏诊,对母婴威胁较大。因而对输卵管间质部妊娠的患者,需选择合适的治疗方式,并注意术中的操作和术后的避孕时间,再次妊娠期间需加强监测,警惕子宫破裂风险,必要时行剖官产术终止妊娠。
[Abstract]:Objective: interstitial tubal pregnancy is a special type of ectopic pregnancy. However, there is a risk of uterine rupture during secondary pregnancy in patients with interstitial pregnancy. Therefore, this article aims to summarize the clinical features of patients with uterine rupture during secondary pregnancy after tubal interstitial pregnancy. Methods: the clinical data of 4 cases of uterine rupture during secondary pregnancy after tubal interstitial pregnancy in our hospital from 1999 to 2016 were analyzed retrospectively. To investigate the risk factors, clinical features, management and prognosis of uterine rupture after tubal interstitial pregnancy. Results: from November 1999 to October 2016, there were 283 cases of uterine rupture in our hospital. There were 4 cases of uterine rupture after tubal interstitial pregnancy. All the patients had undergone unilateral or bilateral salpingotomy because of ectopic tubal pregnancy. Only 2 cases were sutured after keratectomy. However, only one case of secondary pregnancy after interstitial pregnancy was natural pregnancy, and the rest were assisted pregnancy. The interval between operation and re-pregnancy was 0.52 years, the shortest time interval between operation and re-pregnancy was 0.52 years, and the time interval between operation and re-pregnancy was 0.52 years. The longest pregnancy was 2.25 years. The gestational age was 17 weeks and the maximum was 37.1 weeks. Among them, 2 cases were twin pregnancy and 2 cases had abnormal fetal position. However, 4 cases of pregnancy uterine rupture were located in the scar of the previous uterine horn, and 2 of the 4 cases of pregnancy with uterine rupture had no obvious complaints of discomfort, 1 case was revealed by B-ultrasound, 1 case was found to have mild abdominal pain by intraoperative exploration, and 1 case was found to have only mild abdominal pain. One patient complained of persistent severe abdominal pain with nausea and diarrhea, which was misdiagnosed as digestive tract disease at the first visit. In the end, all the 4 patients were treated with uterine repair only, 2 of them died of fetal death. Conclusion: there is a risk of uterine rupture during the second pregnancy after tubal tubal interstitial surgery. Although it is rare in clinic, its clinical symptoms are not obvious, and it is easy to be misdiagnosed and missed. Therefore, the patients with tubal interstitial pregnancy should choose the appropriate treatment method, pay attention to the operation during operation and the time of contraception after operation, strengthen the monitoring during the second pregnancy, and be on guard against the risk of uterine rupture. Termination of pregnancy by dissection if necessary.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.8

【相似文献】