异 位 妊 娠 ectopic pregnancy
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异 位 妊 娠 Ectopic Pregnancy. ( 宫 外 孕 extrauterine pregnancy). 主讲人: 于 冰 单位:山西医科大学第二医院 妇产科教研室. Introduction. Definition Etiology (the most common cause) Pathology (three pathological terminations) Clinical Manifestation (the classic triad) - PowerPoint PPT PresentationTRANSCRIPT
异 位 妊 娠 异 位 妊 娠 Ectopic PregnancyEctopic Pregnancy
主讲人: 于 冰单位:山西医科大学第二医院 妇产科教研室
( 宫 外 孕 extrauterine pregnancy)
IntroductionIntroduction
DefinitionEtiology (the most common cause)Pathology (three pathological terminations)Clinical Manifestation (the classic triad)Diagnosis (four ancillary methods)Treatment (the primary treatment)
Definition:Definition:
Pregnancy in any location other than the body of the uterus is considered ectopic.
Incidence: 0.5~1%
图 1 异位妊娠的发生部位
Tubal Pregnancy
壶腹部 (Ampulla) 55~60%
峡部 (Isthmus) 20~25%
伞部 (Fimbria) 少见
间质部 (Interstitial portion) 少见
Chronic salpingitis
pelvic inflammatory disease (PID) 盆腔炎 sexually transmitted disease(STD) 性传播疾病
Prior tubal surgery
tubal sterilization or salpingectomy
绝育 输卵管切除术
Current IUD use:intrauterine device 宫内节育器
History of infertility
EtiologyEtiology
Pathology
一、Terminations of tubal pregnancy
2
1 、输卵管腔 2 、输卵管内血肿 3 、绒毛侵犯管壁 4 、绒毛膜 5 、羊膜
图 2 输卵管妊娠剖面示意图
图 3 输卵管妊娠时孕卵的着床部位 1 、着床于粘膜皱襞内常向管腔破裂 2 、着床于粘膜皱襞间常穿破管壁
(一) Tubal abortion
图 4 输卵管妊娠流产
(二) Rupture of tubal pregnancy
图 5 输卵管妊娠破裂
ampullary pregnancy: 8-12W (abortion,rupture)isthmic pregnancy: 6W (rupture)
interstitial portoion: 4M(rupture)
图 6 间质部妊娠
( 三 )Secondary abdominal pregnancy
图 7 腹腔妊娠 示意图
二、 Uterine changes(一) Enlargement and soft: same as IUP(intrauterine pregnancy) 宫内孕
图 8 输卵管妊娠子宫剖面示意图
(二) Endometrium 子宫内膜
decidual reactiion 蜕膜变
Arias-Stella reaction A-S 反应
proliferative phase 增生期 secretory phase/menstrual period 分泌期或月经期
Clinical Manifestation
一、 Symptoms Amenorrhea Amenorrhea 停经停经
Abdominal pain 腹痛
Vaginal bleeding 阴道出血
Syncope and shock 晕厥与休克
SymptomsAmenorrhea (3/4) mistake uterine bleeding for true menstruation( 月经 ) lack of amenorrhea do not exclude
Abdominal pain(90-100%) due to tubal stretching “tearing”pain with nausea and vomiting pain in the shoulder tenesmus( 里急后重 )
Symptoms
Vaginal bleeding (spotting) external bleeding scanty,dark intermittent or continuous
Syncope and shock acute hemoperitoneum 急性内出血 severe abdominal pain 剧 烈 腹 痛 hemorrhagic shock 失血性休克
(二) (二) SignsSigns
Blood pressure and pulse
hypotension 低血压 hypovolemia 血容量减少
Abdominal examination
Abdominal tenderness with “rebound”
压痛、反跳痛
Shifting dullness 移动性浊音
SignsSigns
Pelvic examinationPelvic examination (on bimanual examination (on bimanual examination 双合双合诊诊 ))
exquisite tenderness , especially on motion exquisite tenderness , especially on motion
of the cervix of the cervix 宫颈触痛宫颈触痛 aadnexal mass aadnexal mass 附件肿物附件肿物 uterine enlargement uterine enlargement 子宫增大子宫增大
Ancillary examination
β-HCG
Ultrasound
Culdocentesis
Laparoscopy
Diagnosis
History
Physical examination
Measurement of β-hCG(human chorionic gonadotropin)
绒毛膜促性腺激素测定
尿β-hCG: false-negative,false-positive血β-hCG(radioimmunoassays)
Ultrasonic Diagnosis 超声诊断
经腹超声 TAS ( Transabdominal Sonography )
经阴超声 TVS (Transvaginal Sonography)
彩色多普勒超声 CDFI (Colour Doppler Flow Imaging)
图 9 输卵管妊娠经腹超声影像
Culdocentesis 阴道后穹窿穿刺 technique for identifying hemoperitoneum
腹腔积血
图 10 阴道后穹窿穿刺示意图
Laparoscopy 腹腔镜检查
图 11 腹腔镜检查操作示意图
Treatment
Surgical treatment
Non-operative approach
手术治疗 (Surgical Treatment) : 输卵管切除术 (Salpingectomy)
图 12 输卵管妊娠切除术
图 13 输卵管妊娠术后所见
Preliminary SummaryPreliminary Summary
the most common cause
three pathological terminations
the classic triad
four basic ancillary methods
primary treatment