婦產(chǎn)科異位妊娠課件

異位妊娠

EctopicPregnancy(宮外孕

extrauterinepregnancy)婦產(chǎn)科異位妊娠IntroductionDefinitionEtiology(themostcommoncause)Pathology(threepathologicalterminations)ClinicalManifestation(theclassictriad)Diagnosis(fourancillarymethods)Treatment(theprimarytreatment)婦產(chǎn)科異位妊娠Definition:

Pregnancyinanylocationotherthanthebodyoftheuterusisconsideredectopic.Incidence:0.5~1%婦產(chǎn)科異位妊娠圖1異位妊娠的發(fā)生部位婦產(chǎn)科異位妊娠TubalPregnancy壺腹部(Ampulla)55~60%峽部(Isthmus)20~25%傘部(Fimbria)少見間質(zhì)部(Interstitialportion)少見婦產(chǎn)科異位妊娠

Chronicsalpingitis

pelvicinflammatorydisease(PID)盆腔炎

sexuallytransmitteddisease(STD)性傳播疾病

Priortubalsurgery

tubalsterilizationorsalpingectomy

絕育輸卵管切除術(shù)

CurrentIUDuse:intrauterinedevice宮內(nèi)節(jié)育器

HistoryofinfertilityEtiology婦產(chǎn)科異位妊娠Pathology一、Terminationsoftubalpregnancy21、輸卵管腔

2、輸卵管內(nèi)血腫

3、絨毛侵犯管壁

4、絨毛膜

5、羊膜圖2輸卵管妊娠剖面示意圖婦產(chǎn)科異位妊娠圖3輸卵管妊娠時(shí)孕卵的著床部位

1、著床于粘膜皺襞內(nèi)常向管腔破裂

2、著床于粘膜皺襞間常穿破管壁婦產(chǎn)科異位妊娠（一）Tubalabortion

圖4輸卵管妊娠流產(chǎn)婦產(chǎn)科異位妊娠（二）Rupture

oftubalpregnancy圖5輸卵管妊娠破裂婦產(chǎn)科異位妊娠ampullarypregnancy:

8-12W(abortion,rupture)isthmicpregnancy:6W(rupture)interstitialportoion:4M(rupture)圖6間質(zhì)部妊娠婦產(chǎn)科異位妊娠(三)Secondaryabdominalpregnancy圖7腹腔妊娠示意圖婦產(chǎn)科異位妊娠二、Uterinechanges（一）Enlargementandsoft:sameasIUP(intrauterinepregnancy)

宮內(nèi)孕

圖8輸卵管妊娠子宮剖面示意圖婦產(chǎn)科異位妊娠（二）Endometrium子宮內(nèi)膜

decidualreactiion蛻膜變

Arias-StellareactionA-S反應(yīng)

proliferativephase增生期

secretoryphase/menstrualperiod

分泌期或月經(jīng)期婦產(chǎn)科異位妊娠ClinicalManifestation

一、Symptoms

Amenorrhea停經(jīng)Abdominalpain腹痛Vaginalbleeding

陰道出血Syncopeandshock暈厥與休克婦產(chǎn)科異位妊娠

SymptomsAmenorrhea

(3/4)

mistakeuterinebleedingfortruemenstruation(月經(jīng))lackofamenorrheadonotexcludeAbdominalpain(90-100%)

duetotubalstretching

“tearing”painwithnauseaandvomitingpainintheshouldertenesmus(里急后重)婦產(chǎn)科異位妊娠SymptomsVaginalbleeding(spotting)

externalbleedingscanty,darkintermittentorcontinuousSyncopeandshock

acutehemoperitoneum急性內(nèi)出血

severeabdominalpain劇烈腹痛

hemorrhagicshock失血性休克婦產(chǎn)科異位妊娠（二）Signs

Bloodpressureandpulsehypotension低血壓

hypovolemia血容量減少

AbdominalexaminationAbdominaltendernesswith“rebound”

壓痛、反跳痛

Shiftingdullness移動性濁音婦產(chǎn)科異位妊娠SignsPelvicexamination(onbimanualexamination雙合診)

exquisitetenderness,especiallyonmotionofthecervix宮頸觸痛

aadnexalmass附件腫物

uterineenlargement子宮增大婦產(chǎn)科異位妊娠Ancillary

examinationβ-HCG

UltrasoundCuldocentesisLaparoscopyDiagnosisHistoryPhysicalexamination婦產(chǎn)科異位妊娠Measurementofβ-hCG(humanchorionicgonadotropin)絨毛膜促性腺激素測定

尿β-hCG:false-negative,false-positive血β-hCG(radioimmunoassays)婦產(chǎn)科異位妊娠UltrasonicDiagnosis超聲診斷經(jīng)腹超聲TAS

（TransabdominalSonography）經(jīng)陰超聲TVS(TransvaginalSonography)彩色多普勒超聲CDFI(ColourDopplerFlowImaging)婦產(chǎn)科異位妊娠圖9輸卵管妊娠經(jīng)腹超聲影像婦產(chǎn)科異位妊娠Culdocentesis陰道后穹窿穿刺

techniqueforidentifyinghemoperitoneum

腹腔積血圖10陰道后穹窿穿刺示意圖婦產(chǎn)科異位妊娠L(fēng)aparoscopy腹腔鏡檢查圖11腹腔鏡檢查操作示意圖婦產(chǎn)科異位妊娠Treatment

SurgicaltreatmentNon-operativeapproach婦產(chǎn)科異位妊娠手術(shù)治療(SurgicalTreatment)：

輸卵管切除術(shù)(Salpingectomy)圖