宫内宫外同时妊娠误诊一例

来源:用户上传      作者:

　　【摘要】宫内宫外同时妊娠(HP)极为罕见,易被忽视,一般术前诊断较困难。本病例经再次追问病史及家族史,该患者两年前曾因宫内孕63天双胎行人工流产一次,其姐姐有双胎妊娠史。因此,临床医生行人工流产术前应做详细的妇科检查,以了解子宫,附件及盆腔情况,详细询问病史,避免仅考虑宫内妊娠而忽略了宫外妊娠的可能,超声医生对宫内妊娠者,还应该详细检查双侧附件区,以防漏诊。
　　【关键词】宫内宫外;同时妊娠;误诊
　　In the palace outside the palace simultaneously the pregnancy misdiagnoses an example
　　Zhang Lanfen
　　【Abstract】In palace outside palace simultaneously pregnancy (HP) extremely rare, is neglected easily, before generally the technique, diagnoses difficultly. This case after presses the medical history and the family history once more, because this patient two years ago once in the palace was pregnant 63 day of dual tire line of induced abortion one time, his/her elder sister has the twin pregnancy history. Therefore, before clinician the line of induced abortion technique, should make the detailed gynecological examination, understands the womb, the appendix and the pelvic cavity situation, inquires the medical history in detail, avoids only considering that in the palace the pregnancy has neglected outside the palace the pregnancy possibility, supersonic doctor to palace in pregnancy, but should also inspect the two-sided appendix area in detail, examines by the antidrip.
　　【Key words】In palace outside palace; Simultaneously pregnancy; Error diagnostic
　　【中图分类号】R220.4【文献标识码】B【文章编号】1002-574X(2010)09-0210-02
　　1病例报告
　　患者:35岁.主因人工流产术后2天,下腹疼痛5小时,伴头晕恶心于2008-7-21日23:00急诊入院。患者平时月经规律,末次月经2008-5-23日。两天前因停经56天,B超检查提示宫内孕8周,可见胎心、胎芽,于当天行手术前常规检查并行人工流产术,术中探测宫腔10cm,术后宫腔8cm,手术顺利,术中出血不多,术后常规检查,见绒毛组织,阴道流血不多。入院前5小时患者抱小孩时,突然下腹疼痛伴头晕恶心出汗,无呕吐,在家给予菌必治、甲硝唑治疗无好转而急诊入院。入院查体:体温36.70c脉博120/次,呼吸22次/分,血压70/50mmHg,急性痛苦面容,面色苍白,四肢湿冷,神志欠清晰,查体不合作,下腹部微隆起,全腹压痛反跳痛,腹肌紧张,移动性浊音阳性。妇科检查: 经产型外阴,阴道畅,少量血迹,后穹窿饱满,宫颈I度糜烂,着色明显,宫颈举疼及摇摆痛明显,后穹窿触痛,后穹窿穿刺抽出不凝血4ml,子宫水平位,稍大,活动,无压痛,左附件区可触及一4×3cm大小的包块,压痛明显,血色素77g/L,术前诊断:(1)宫外孕?(2)失血性休克。3黄体破裂?在补液抗休克输血治疗的同时,急行剖腹探查术,术中打开腹膜见大量暗红色血液流出,腹腔内积血约1500ml,子宫稍大于正常,形态规则,与周围无粘连,右输卵管、卵巢正常,左侧卵巢正常,左侧输卵管壶腹部有一破裂口,长约2cm,有活动性出血,并有胚胎组织和绒毛组织堵塞于破裂口处,行左侧输卵管切除术,术中术后输血8u,术后给予支持抗感染治疗,术后七天拆线,切口一期愈合,出院。术后病理报告:左输卵管妊娠 出院诊断:(1)左侧输卵管壶腹部妊娠破裂;(2)失血性休克;(3)宫内宫外同时妊娠。
　　2讨论
　　本病例停经56天,平时月经规律,B超提示宫内孕8周,可见胎心胎芽,行人流术后常规检查,可见绒毛组织,诊断为宫内孕8周是成立的。患者人流术后2天,抱小孩时突然出现下腹疼痛,后穹窿穿刺抽出不凝血4ml,宫颈举痛,摇摆痛,有可能为宫外孕或卵巢黄体破例,最后手术和病理均证实为输卵管妊娠。
　　宫内宫外同时妊娠(heterotopic pregnancy,Hp)是指宫腔内妊娠(intrauterine pregnancy,IUP)与异位妊娠(ectopic pregnancy,EP)同时存在的一种病理妊娠性疾病,其发生率为1∶15000-1∶30000.近年来,性传播疾病的蔓延、促排卵治疗的应用及辅助生育技术的开展,使HP的发病率提高了100倍 。因此,临床中早期的诊断并及时治疗极为重要,避免误诊。
　　宫内宫外同时妊娠(HP)极为罕见,易被忽视,一般术前诊断较困难。本病例经再次追问病史及家族史,该患者两年前曾因宫内孕63天双胎行人工流产一次,其姐姐有双胎妊娠史。因此,临床医生行人工流产术前应做详细的妇科检查,以了解子宫,附件及盆腔情况,详细询问病史,避免仅考虑宫内妊娠而忽略了宫外妊娠的可能,超声医生对宫内妊娠者,还应该详细检查双侧附件区,以防漏诊。
　　参考文献
　　[1]张惜阴.实用妇产科学.第二版.北京 :人民卫生出版社,2008:178
　　[2]程洁,徐苑苑,冯晶,等.体外受精胚胎移植致宫内外复合妊娠.实用医学杂志,2005,21(6):557

转载注明来源:https://www.xzbu.com/1/view-14612935.htm