IVF-ET术后宫内宫外同时妊娠误诊为阑尾周围脓肿原因分析  

Analysis of the Causes of Heterotopic Pregnancy Misdiagnosed as Appendiceal Abscess after in Vitro Fertilization and Embryo Transfer

作　　者：田万管[1] 孟庆义[1] TIAN Wan-guan;MENG Qing-yi(Department of Emergency Medicine,General Hospital of PLA,Beijing 100853,China)

机构地区：[1]解放军总医院急诊科,北京100853

出　　处：《临床误诊误治》2018年第7期71-75,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)术后宫内宫外同时妊娠误诊为阑尾周围脓肿的原因,并提出防范误诊措施。方法回顾性分析1例IVF-ET术后宫内宫外同时妊娠误诊病例资料。结果患者31岁女性,因停经66 d、右下腹疼痛2 d入院。1个月前曾行IVF-ET术。查体右侧腹肌紧张,右下腹压痛,反跳痛。查血白细胞17.81×10~9/L,中性粒细胞0.948,绒毛膜促性腺激素101 031 U/L。腹部B超检查示:宫内可见孕囊及胎心搏动;右下腹可见一不均质低回声肿物,腹腔可见游离液体。诊断:阑尾周围脓肿;宫内早孕;IVF-ET术后。急诊行腹腔镜探查见腹盆腔内大量陈旧性血凝块,右侧输卵管末端肿物伴出血,阑尾尖端与右侧输卵管肿物粘连紧密,呈黑红色。遂行腹腔镜下右侧输卵管部分切除术+阑尾切除术。术后病理检查示右侧输卵管妊娠、慢性阑尾炎。确诊为:宫内宫外同时妊娠、IVF-ET术后、慢性阑尾炎。术后7 d患者好转出院。术后随访超声检查示宫内胎儿存活良好并成功分娩。结论异位妊娠破裂出血临床表现复杂,易误诊。IVF-ET术后宫内宫外同时妊娠临床少见,详细询问病史及仔细鉴别诊断是避免误诊的关键。Objective To investigate causes of misdiagnosis of heterotopic pregnancy(HP)as appendiceal abscess after in vitro fertilization and embryo transfer(IVF-ET)and its countermeasures.Methods The clinical data of one case of HP misdiagnosed after IVF-ET was retrospectively analyzed.Results A 31-year-old female was admitted for menelipsis for 66 d with right lower abdomen pain for 2 d.She underwent IVF-ET treatment one month before admission.Physical examination showed muscular tension of the right abdomen,with tenderness and rebound tenderness in the right lower quadrant.Blood tests showed the white blood cell count of 17.81×10 9/L,neutrophils of 0.948,and human chorionic gonadotropin(HCG)of 101 031 U/L.The abdominal ultrasonography suggested that a gestational sac could be seen in the uterus,with a fetal heart beat,and an uneven and low echo mass in the right lower abdomen and free fluid in the abdominal cavity.Admission diagnosis was periappendiceal abscess,early intrauterine pregnancy and IVF-ET performed.A large number of outmoded blood clots were found by laparoscopic exploration of the abdominal and pelvic cavity,and the right tubal distal mass was accompanied by bleeding.The tip of the appendix was adhered tightly to the fallopian tube mass,showing a reddish black color.Partial resection of the right fallopian tube and appendectomy were performed,and the postoperative pathological diagnosis was right tubal pregnancy and chronic appendicitis.The patient was diagnosed as HP after IVF-ET and chronic appendicitis.The patient was discharged from hospital with improved condition after 7 days.Two months later,ultrasonography revealed fetus well-being in utero.Conclusion Heterotopic pregnancy after IVF-ET is rare,and may be easily misdiagnosed because of its complicated clinical manifestations.More attention should be paid to history taking and differential diagnosis to avoid misdiagnosis.

关 键 词：体外受精 宫内宫外同时妊娠 误诊 阑尾周围脓肿 

分 类 号：R714.2[医药卫生—妇产科学]