误诊为急性阑尾炎的不典型异位妊娠临床分析  

Clinical Analysis of Atypical Ectopic Pregnancy Misdiagnosed as Acute Appendicitis

作　　者：邢丽颖 王秋 XING Liying;WANG Qiu(Department of Obstetrics and Gynecology,the People's Hospital of Langfang City,Langfang,Hebei 065000,China)

机构地区：[1]廊坊市人民医院产科,河北廊坊065000

出　　处：《临床误诊误治》2023年第7期12-14,43,共4页Clinical Misdiagnosis & Mistherapy

基　　金：廊坊市科学技术研究与发展计划项目(2019013148)。

摘　　要：目的 探讨不典型异位妊娠的临床特点、诊断和鉴别诊断方法及误诊原因、防范措施。方法 对2021年4月—2022年7月收治曾误诊的不典型异位妊娠9例的临床资料进行回顾性分析。结果 本组出现突发性腹痛6例,持续性隐痛突然加剧3例;麦氏点压痛6例,右下腹压痛3例,反跳痛5例,腹肌紧张4例;肠鸣音减弱9例,Rovsing’s征阳性4例;腹腔移动性浊音3例。血白细胞升高6例,轻度贫血3例;腹部B超检查均提示右下腹低回声。就诊初期外院均初步诊断急性阑尾炎,拟行手术治疗,遂转我院。误诊时间(14.2±3.1)h。入我院后经进一步询问病史,5例经腹腔穿刺、4例经阴道后穹隆穿刺确诊异位妊娠。9例确诊后皆急行腹腔镜右侧输卵管切除术,术后予抗感染治疗,术后2~3 d痊愈出院。结论 不典型异位妊娠早期易误诊。基层医院接诊医师应加强对其认识,提高对育龄期急腹症女性警惕性,详细问诊,对怀疑异位妊娠者,要及时行相关检查,并需全面分析病情,以减少或避免该病误诊误治。Objective To investigate the clinical characteristics,diagnosis,differential diagnosis,causes of misdiagnosis and preventive measures of atypical ectopic pregnancy.Methods The clinical data of 9 patients with atypical ectopic pregnancy who were misdiagnosed from April 2021 to July 2022 were retrospectively analyzed.Results There were 6 cases of sudden abdominal pain and 3 cases of persistent dull pain.There were 6 cases of McGlover point tenderness,3 cases of right lower abdomen tenderness,5 cases of rebound pain and 4 cases of abdominal muscle tension.Nine cases had reduced bowel sound and 4 cases had positive Rovsing's sign.Three cases had abdominal mobility dullness.There were 6 cases with elevated white blood cells and 3 cases with mild anemia.Abdominal ultrasound examination showed hypoecho in the right lower abdomen.All patients were initially diagnosed with acute appendicitis in other hospitals at the early stage of treatment,and was transferred to our hospital for surgical treatment.The duration of misdiagnosis was(14.2±3.1) h.After admission to our hospital for further medical history inquiry,5 cases were diagnosed with ectopic pregnancy by peritoneal puncture and 4 cases by posterior vaginal fornix puncture.All the 9 patients underwent laparoscopic right salpingectomy after diagnosis,and were treated with anti-infection after surgery.They were cured and discharged from hospital at 2-3 d after surgery.Conclusion Early misdiagnosis of atypical ectopic pregnancy is more likely to occur.The receiving doctors in primary hospitals should strengthen their understanding of the disease,improve the vigilance of women of childbearing age with acute abdomen,make detailed inquiries,conduct relevant examinations in time for those suspected of ectopic pregnancy,and comprehensively analyze the condition,so as to reduce or avoid misdiagnosis and mistreatment of the disease.

关 键 词：妊娠 异位 误诊 阑尾炎 病史 宫腔内节育器 阴道B超 后穹隆穿刺 腹腔穿刺 

分 类 号：R714.22[医药卫生—妇产科学]