输卵管切除术后间质部妊娠12例分析  

Analysis of 12 cases of interstitial pregnancy after salpingectomy

作　　者：蒋诗阳 赵峻[1] JINAG Shi-yang;ZHAO Jun(Department of Obstetrics and Gynecology, Peking Union Medical Collage Hospital, Peking Union Medical Collage, Chinese Academy of Medical Sciences, Beijing 100730,P. R. China)

机构地区：[1]中国医学科学院.北京协和医学院北京协和医院妇产科,北京100730

出　　处：《中国计划生育和妇产科》2018年第5期61-65,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨输卵管切除术史与同侧输卵管间质部妊娠的关系。方法回顾性分析2014年1月至2017年10月在中国医学科学院·北京协和医学院北京协和医院诊治的、曾有同侧输卵管切除手术史的输卵管间质部妊娠患者12例的临床特征、既往手术情况与疾病诊治过程。结果 12例患者的平均年龄(33.42±3.40)岁,确诊停经平均(51.58±10.46)d,其中9例为辅助生殖后妊娠。患者既往均进行过同侧输卵管切除(9例)或切断术(3例),手术原因包括输卵管妊娠、输卵管积水、输卵管积脓及卵巢囊肿蒂扭转。患者多以停经后突发阴道流血(3例)或腹痛(8例)为首发症状,仅1例为无任何自觉症状、因停经后超声检查而诊断。12例患者在确诊后均接受了腹腔镜手术治疗,其中8例合并腹腔内出血,平均出血量(2 437.5±979.70)m L,并均在围手术期接受了输血治疗。结论既往有输卵管切除术史的患者再次妊娠时仍应警惕输卵管间质部妊娠的发生。在行输卵管切除术时应对输卵管残端进行仔细缝合及包埋处理,以避免再妊娠时同侧输卵管间质部妊娠的发生。Objective To investigate the relationship between the history of salpingectomy and ipsilateral interstitial tubal pregnancy. Methods 12 interstitial pregnancy patients with the history of ipsilateral salpingectomy were hospitalized in Peking Union Medical Collage Hospital from January 2014 to October 2017. The clinical features,surgery history,diagnosis and treatment were analyzed retrospectively. Results The average age of 12 patients was（ 33. 42 ± 3. 40） years. The average amenorrheic time was（ 51. 58 ± 10. 46） days at the time of diagnosis. 9 cases were secondary to assisted reproductive pregnancy. All patients had a history of ipsilateral salpingectomy（ 9 cases） or salpinx amputation（ 3 cases） due to salpingocyesis,hydrosalpinx,pyosalpinx or ovarian cyst torsion. Sudden vaginal bleeding（ 3 cases） and abdominal pain（ 8 cases） after amenorrhea were the first symptoms. Only one patient without any self-conscious symptoms was diagnosed by amenorrheic ultrasound examination. All 12 patients received laparoscopic surgery after diagnosis. 8 patients with intraperitoneal hemorrhage received blood transfusion during the perioperative period and the average amount of bleeding was（ 2 437. 5 ± 979. 70） mL. Conclusion Patients with salpingectomy history should be alert to the occurrence of interstitial tubal pregnancy. The stump of fallopian tube should be carefully sutured and embedded in the treatment of salpingectomy to avoid the occurrence of the ipsilateral interstitial pregnancy afterwards.

关 键 词：间质部妊娠 输卵管切除术 预防 

分 类 号：R713.8[医药卫生—妇产科学]