子宫全切术后迟发异位妊娠临床特点及诊治——1例病案报道及文献复习

发布时间：2018-09-08 09:35

【摘要】：目的:探讨子宫全切术后异位妊娠临床特点,为减少发病率和误诊率提供参考资料。方法:报道1例子宫全切除术后异位妊娠并搜集国内外有关资料的文献报道,汇总分析子宫切除术手术方式、术后异位妊娠发生的时间、临床表现和转归等临床资料。结果:共搜集到33篇相关文献,涉及34个病例,被纳入分析,其中33例是文献报道,1例为本文报道。发病时间从子宫全切术后22 d到12年不等,无特异临床表现,常见为腹痛、盆腔痛、恶心、呕吐,部分患者可有少量阴道流血、流液,术前确诊率低,大多为术中探查确诊,67.6%(23/34)就诊时已发生异位妊娠破裂,经阴道子宫全切术后异位妊娠发生率高于经腹子宫切除术。结论:育龄期妇女即使子宫切除术后也有异位妊娠可能,易误诊和延误治疗,可出现危及生命的异位妊娠破裂,患者出现腹痛、盆腔痛,阴道流血、流液,恶心、呕吐等症状时,应排除是否有异位妊娠可能,子宫切除术同时行双侧输卵管切除术可减少术后异位妊娠发生的可能。
[Abstract]:Objective: to investigate the clinical characteristics of ectopic pregnancy after hysterectomy, and to provide reference for reducing incidence and misdiagnosis rate. Methods: a case of ectopic pregnancy after total hysterectomy was reported and literature reports were collected. The surgical methods, time, clinical manifestation and outcome of ectopic pregnancy after hysterectomy were collected and analyzed. Results: a total of 33 articles involving 34 cases were collected and analyzed, of which 33 cases were reported in the literature and 1 case was reported in this paper. The onset time ranged from 22 days to 12 years after total hysterectomy. There was no specific clinical manifestation. The common symptoms were abdominal pain, pelvic pain, nausea and vomiting. Some patients could have a small amount of vaginal bleeding and fluid, and the rate of diagnosis before operation was low. Ectopic pregnancy rupture occurred in 67.6% (23 / 34) of the patients who were diagnosed by intraoperative exploration. The incidence of ectopic pregnancy after transvaginal hysterectomy was higher than that after abdominal hysterectomy. Conclusion: ectopic pregnancy may occur in women of childbearing age even after hysterectomy. It is easy to misdiagnose and delay treatment, and may lead to life-threatening ectopic pregnancy rupture, abdominal pain, pelvic pain, vaginal bleeding, fluid flow, nausea, etc. The possibility of ectopic pregnancy should be excluded when vomiting and other symptoms. Hysterectomy and bilateral salpingotomy can reduce the possibility of ectopic pregnancy.
【作者单位】：新疆克拉玛依市中心医院妇产科;
【分类号】：R714.222

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