腹膜后妊娠的诊断及治疗分析  

Analysis on diagnosis and treatment of retroperitoneal pregnancy

作　　者：欧阳振波[1] 魏世远 吴嘉雯 万子贤 李群 张敏 李凤[1] 钟碧婷 张秋实[1] OUYANG Zhen-bo;WEI Shi-yuan;WU Jia-wen;WAN Zi-xian;LI Qun;ZHANG Min;LI Feng;ZHONG Bi-ting;ZHANG Qiu-shi(Department of Gynecology,Guangdong Second Prorincial General Hospial,Guangzhou,Guangdong 510317,China)

机构地区：[1]广东省第二人民医院妇科,广东广州510317

出　　处：《中国妇幼保健》2023年第8期1365-1369,共5页Maternal and Child Health Care of China

基　　金：广东省医学科学技术研究基金项目(A2020244)。

摘　　要：目的总结分析腹膜后妊娠的临床表现、诊断、治疗及预后等,从而为临床诊治提供参考。方法利用PubMed数据库、万方数据库及中国期刊全文数据库检索关于腹膜后妊娠的所有文献报道。通过阅读全文,总结分析腹膜后妊娠的临床表现及诊断方法,并重点探讨其治疗与预后。结果共收集到文献报道42篇,腹膜后妊娠43例,46.2%的患者有输卵管妊娠史,76.7%的患者为自然妊娠,就诊时的平均停经天数为53.6 d。阴道流血和腹痛是腹膜后妊娠的主要症状,其中以腹痛最常见(62.8%)。超声是诊断腹膜后妊娠的主要方法,初诊时仅有30.2%的患者被诊断为腹膜后妊娠,有30.2%的患者被误诊并进行了不必要的有创性治疗。腹膜后妊娠的妊娠部位复杂多变,可简单将其分为盆腔段腹膜后妊娠型和腹腔段腹膜后妊娠型。由于术前误诊,有34.9%的腹膜后妊娠患者经历了两次手术。除2例患者采用了妊娠囊内局部甲氨蝶呤注射外,其余41例均进行了手术治疗,所有患者均预后良好。结论腹膜后妊娠是一种罕见的异位妊娠,由于认识不足,临床误诊率、误治率高。诊断腹膜后妊娠的关键是考虑到腹膜后妊娠的可能以及检查时的扫描野能够涵盖到妊娠部位。妊娠囊内甲氨蝶呤注射及手术切除是治疗腹膜后妊娠的有效方法。Objective To summarize and analyze the clinical manifestations,diagnosis,treatment,and prognosis of retroperitoneal pregnancy,provide a reference for clinical diagnosis and treatment.Methods PubMed Database,Wanfang Database,and Chinese Journal Full-text Database were searched to obtain the literatures about retroperitoneal pregnancy,the full articles were read to summarize and analyze the clinical manifestations and diagnosis,explore the treatment and prognosis.Results A total of 42 literatures were collected,including 43 cases of retroperitoneal pregnancy,46.2%of the patients had the history of tubal pregnancy,spontaneous pregnancy occurred in 76.7%of the patients,the mean time of menelipsis was 53.6 days.Vaginal bleeding and abdominal pain were the main symptoms of retroperitoneal pregnancy,abdominal pain was the most common symptom(62.8%).Ultrasound was the main method to diagnose retroperitoneal pregnancy,only 30.2%of the patients were diagnosed as retroperitoneal pregnancy during the first visit,30.2%of the patients were misdiagnosed,and unnecessary invasive therapy was carried out.The gestational site of retroperitoneal pregnancy was complicated and changeable,which was divided into pelvic segment retroperitoneal pregnancy and abdominal segment retroperitoneal pregnancy.Due to the misdiagnosis before therapy,34.9%of the patients underwent surgery twice.Two patients underwent gestational sac local methotrexate injection,and the other patients underwent surgery,the prognosis of all the patients was good.Conclusion Retroperitoneal pregnancy is a rare type of ectopic pregnancy,insufficient recognition induces high missed diagnostic rate and misdiagnostic rate,the key point of diagnosis is consideration of the possibility of retroperitoneal pregnancy and large scan area including pregnancy site,gestational sac local methotrexate injection and surgery are effective methods.

关 键 词：腹膜后妊娠 异位妊娠 腹腔妊娠 

分 类 号：R714.22[医药卫生—妇产科学]