受精卵在子宫体腔以外的其它地方着床称为异位妊娠(ectopic pregnancy, EP),属于病理妊娠,是妊娠前3个月孕妇死亡的主要原因,而腹膜后异位妊娠(retroperitoneal ectopic pregnancy, REP)是异位妊娠的特殊类型,腹膜后异位妊娠十分罕见,发生率很低,发病机制尚且不明确,且目前无明确统一的诊疗方案。因其位置相对特殊:靠近大血管,故超声检查不易探查,这为临床诊断增加了难度,容易误诊、漏诊。因此对于不能明确的肿块位置应该扩大超声探查范围,并由高年资有经验的超声医生进行检查,或行CT以及MRI检查,必要时行多学科协作(MDT),充分进行术前评估,保障病人生命安全。治疗方案目前多考虑手术治疗,对术者要求较高,术者应充分了解女性生殖系统解剖关系及其与周围大血管之间的关系,这样才能避免不必要的损伤进而成功救治该疾病。 The implantation of fertilized eggs in other places other than the body cavity of the uterus is called ectopic pregnancy, which belongs to pathological pregnancy and is the main cause of maternal death in the first 3 months of pregnancy, and retroperitoneal ectopic pregnancy is a special type of ectopic pregnancy. Retroperitoneal ectopic pregnancy is very rare, the incidence is very low, the pathogenesis is not clear, and there is no clear and unified diagnosis and treatment plan. Due to its relatively special location: close to the great blood vessels, it is not easy to detect by ultrasound, which increases the difficulty of clinical diagnosis, easy to miss diagnosis and misdiagnosis. There-fore, if the location of the mass is not clear, the scope of ultrasound exploration should be expanded, and the examination should be carried out by senior and experienced sonographers, or CT and magnetic resonance examination should be performed. When necessary, multidisciplinary cooper-ation should be carried out to fully carry out preoperative evaluation, so as to ensure the patient’s life safety. Surgical treatment is often considered in the treatment plan, which is highly demanding for the surgeon. The surgeon should fully understand the anatomical relationship of the female re-productive system and its relationship with the surrounding great vessels, so as to avoid unneces-sary injury and successfully treat the disease.
受精卵在子宫体腔以外的其它地方着床称为异位妊娠(ectopic pregnancy, EP),属于病理妊娠,是妊娠前3个月孕妇死亡的主要原因,而腹膜后异位妊娠(retroperitoneal ectopic pregnancy, REP)是异位妊娠的特殊类型,腹膜后异位妊娠十分罕见,发生率很低,发病机制尚且不明确,且目前无明确统一的诊疗方案。因其位置相对特殊:靠近大血管,故超声检查不易探查,这为临床诊断增加了难度,容易误诊、漏诊。因此对于不能明确的肿块位置应该扩大超声探查范围,并由高年资有经验的超声医生进行检查,或行CT以及MRI检查,必要时行多学科协作(MDT),充分进行术前评估,保障病人生命安全。治疗方案目前多考虑手术治疗,对术者要求较高,术者应充分了解女性生殖系统解剖关系及其与周围大血管之间的关系,这样才能避免不必要的损伤进而成功救治该疾病。
异位妊娠,腹膜后异位妊娠,诊断,文献复习
Haiping Zhou1, Yaqin Wang2, Xiangyang Jiang2, Cuipei Hao2
1Xi’an Medical University, Xi’an Shaanxi
2Shaanxi Provincial People’s Hospital, Xi’an Shaanxi
Received: Oct. 16th, 2022; accepted: Nov. 10th, 2022; published: Nov. 21st, 2022
The implantation of fertilized eggs in other places other than the body cavity of the uterus is called ectopic pregnancy, which belongs to pathological pregnancy and is the main cause of maternal death in the first 3 months of pregnancy, and retroperitoneal ectopic pregnancy is a special type of ectopic pregnancy. Retroperitoneal ectopic pregnancy is very rare, the incidence is very low, the pathogenesis is not clear, and there is no clear and unified diagnosis and treatment plan. Due to its relatively special location: close to the great blood vessels, it is not easy to detect by ultrasound, which increases the difficulty of clinical diagnosis, easy to miss diagnosis and misdiagnosis. Therefore, if the location of the mass is not clear, the scope of ultrasound exploration should be expanded, and the examination should be carried out by senior and experienced sonographers, or CT and magnetic resonance examination should be performed. When necessary, multidisciplinary cooperation should be carried out to fully carry out preoperative evaluation, so as to ensure the patient’s life safety. Surgical treatment is often considered in the treatment plan, which is highly demanding for the surgeon. The surgeon should fully understand the anatomical relationship of the female reproductive system and its relationship with the surrounding great vessels, so as to avoid unnecessary injury and successfully treat the disease.
Keywords:Ectopic Gestation, Retroperitoneal Ectopic Pregnancy, Diagnosis, Literature Review
Copyright © 2022 by author(s) and Hans Publishers Inc.
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患者,女,37岁,因“停经42天,下腹坠痛2天,加重2小时”于2021-04-18收入我院妇科。患者平素月经规律,末次月经:2021-03-07,停经后约30余天自测尿妊娠试验为阳性,无其它明显早孕反应,2天前无明显诱因出现下腹坠痛,未在意,未治疗。2小时前无明显诱因出现下腹坠痛加重,急来我院,查B超示:内目前未见明显孕囊回声,左侧附件区厚壁囊样包块,宫后区积液,异位妊娠待排。血HCG:6480 mIU/ml,孕酮示:10.53 ng/ml。多考虑异位妊娠,建议住院治疗,门诊排除新冠肺炎后以“异位妊娠待排”收住入院。患者G4P1,6年前因“社会心理因素”剖宫产1次,既往行人工流产3次。入院生命体征:体温:37.4℃,脉搏79次/分,呼吸:19次/分,血压:100/73 mmHg,心率:79次/分。妇科检查:暂未查。我院妇科B超:左侧卵巢后外侧显示一大小约2.0 × 1.9 cm厚壁囊样包块,边界清,内回声欠均匀,其内可见0.8 × 0.6 cm囊性液暗区,边界清,暗区清晰。宫后区探及深约2.0 cm积液暗区。提示:宫腔内目前未见明显孕囊回声,左侧附件区厚壁囊样包块,宫后区积液,异位妊娠待排,请结合临床。我院血HCG:6480 mIU/ml,孕酮示:10.53 ng/ml。血常规、凝血、胸部CT等检查无明显异常,患者自觉恶心、头晕、肛门坠胀感,综合考虑建议手术治疗,无明显手术禁忌症,于2021-04-18行腹腔镜探查术及患侧输卵管切除术,术中见:盆腹腔暗红色积血300 ml,子宫常大,表面尚光滑,子宫前壁原剖宫产瘢痕处与前腹膜形成致密粘连带,双侧输卵管、卵巢外观未见明显异常。探查肠管表面及上腹腔、肝脏膈肌、脾脏等未见明显异常。于左侧骶韧带外侧腹膜后可见一圆形突起,局部腹膜可见0.3 cm缺损,可见活动性少量血液流出,其内见明显绒毛组织,吸净盆腹腔积血,沿左侧输尿管走形,明确尿管位置,超声刀分离盆腔粘连带,在病灶表面打开腹膜,取匙钳钳夹出绒毛组织及凝血块约15 g,内可见直径约1 cm明显绒毛组织,双极电凝止血,检查无活动性出血,明胶海绵2块局部压迫;检查手术区无活动性出血。0.9%氯化钠注射液冲洗盆腹腔,手术区喷透明质酸钠凝胶,皮内缝合各切口,术毕标本家属过目后送病理检查。术后1天考虑不排除滋养细胞残留,给予肌肉注射甲氨蝶呤80 mg巩固治疗,术后第2天复查血HCG:2017.76 mIU/ml,病情平稳后出院,术后病理回报:(腹膜后)送检凝血块内见绒毛组织,符合妊娠改变,个别绒毛水肿。出院诊断:腹膜后异位妊娠。出院后当地医院随访血HCG降至正常:0.5 mIU/ml。患者现一般情况好,无任何不适。
受精卵在子宫体腔以外的其它地方着床称为异位妊娠(ectopic pregnancy, EP),俗称宫外孕(extrauterine pregnancy),属于病理性妊娠,是妇产科常见病之一。是妊娠前三个月孕产妇死亡的主要原因,占所有孕产妇死亡人数的10%~26.4% [
异位妊娠早期多无临床表现,REP因为妊娠囊着床位置特殊更是如此,随着妊娠囊的增长可能出现腹痛等不适,但一般症状较轻,且因妊娠囊位于腹膜后,即使已经出现大出血,移动性浊音也多为阴性 [
妇科急症中最急的莫过于异位妊娠(ectopic pregnancy, EP),占妇科急腹症的80%,发生率概率为妊娠的0.5%~1% [
综上可见,腹膜后异位妊娠十分罕见,发病机制尚且不明确,且目前无明确统一的诊疗方案,因其位置相对特殊,靠近大血管,故超声检查不易探查,这为临床诊断增加了难度,容易误诊、漏诊,因此对于不能明确的肿块位置应该扩大超声探查范围,并由高年资有经验的超声医生进行检查,必要时行软组织分辨率更高的检查:CT以及MRI检查。必要时(患者病情不稳定,腹腔内出血征象明显或发生失血性休克等危及病人生命的情况时)进行多学科协作(MDT),充分进行术前评估,保障病人生命安全。治疗方案目前多考虑手术治疗,因此对术者要求便较高,术者应充分了解女性生殖系统解剖关系及其与周围大血管之间的关系,这样才能避免不必要的损伤,从而成功诊治该疾病。
周海萍,王亚琴,姜向阳,郝崔培. 腹膜后异位妊娠1例并文献复习Retroperitoneal Ectopic Pregnancy: A Case Report and Literature Review[J]. 临床医学进展, 2022, 12(11): 10405-10409. https://doi.org/10.12677/ACM.2022.12111499