异 位 妊 娠

异位妊娠EctopicPregnancy包医二附院妇产科教研室(宫外孕extrauterinepregnancy)IntroductionDefinitionEtiology(themostcommoncause)Pathology(threepathologicalterminations)ClinicalManifestation(theclassictriad)Diagnosis(fourancillarymethods)Treatment(theprimarytreatment)Definition:Pregnancyinanylocationotherthanthebodyoftheuterusisconsideredectopic.Incidence:0.5~1%图1异位妊娠的发生部位TubalPregnancy壶腹部(Ampulla)55~60%峡部(Isthmus)20~25%伞部(Fimbria)少见间质部(Interstitialportion)少见Chronicsalpingitispelvicinflammatorydisease(PID)盆腔炎sexuallytransmitteddisease(STD)性传播疾病Priortubalsurgerytubalsterilizationorsalpingectomy绝育输卵管切除术CurrentIUDuse:intrauterinedevice宫内节育器HistoryofinfertilityEtiologyPathology一、Terminationsoftubalpregnancy21、输卵管腔2、输卵管内血肿3、绒毛侵犯管壁4、绒毛膜5、羊膜图2输卵管妊娠剖面示意图图3输卵管妊娠时孕卵的着床部位1、着床于粘膜皱襞内常向管腔破裂2、着床于粘膜皱襞间常穿破管壁（一）Tubalabortion图4输卵管妊娠流产（二）Ruptureoftubalpregnancy图5输卵管妊娠破裂ampullarypregnancy:8-12W(abortion,rupture)isthmicpregnancy:6W(rupture)interstitialportoion:4M(rupture)图6间质部妊娠(三)Secondaryabdominalpregnancy图7腹腔妊娠示意图二、Uterinechanges（一）Enlargementandsoft:sameasIUP(intrauterinepregnancy)宫内孕图8输卵管妊娠子宫剖面示意图（二）Endometrium子宫内膜decidualreactiion蜕膜变Arias-StellareactionA-S反应proliferativephase增生期secretoryphase/menstrualperiod分泌期或月经期ClinicalManifestation一、SymptomsAmenorrhea停经Abdominalpain腹痛Vaginalbleeding阴道出血Syncopeandshock晕厥与休克SymptomsAmenorrhea(3/4)mistakeuterinebleedingfortruemenstruation(月经)lackofamenorrheadonotexcludeAbdominalpain(90-100%)duetotubalstretching“tearing”painwithnauseaandvomitingpainintheshouldertenesmus(里急后重)SymptomsVaginalbleeding(spotting)externalbleedingscanty,darkintermittentorcontinuousSyncopeandshockacutehemoperitoneum急性内出血severeabdominalpain剧烈腹痛hemorrhagicshock失血性休克（二）SignsBloodpressureandpulsehypotension低血压hypovolemia血容量减少AbdominalexaminationAbdominaltendernesswith“rebound”压痛、反跳痛Shiftingdullness移动性浊音SignsPelvicexamination(onbimanualexamination双合诊)exquisitetenderness,especiallyonmotionofthecervix宫颈触痛aadnexalmass附件肿物uterineenlargement子宫增大Ancillaryexaminationβ-HCGUltrasoundCuldocentesisLaparoscopyDiagnosisHistoryPhysicalexaminationMeasurementofβ-hCG(humanchorionicgonadotropin)绒毛膜促性腺激素测定尿β-hCG:false-negative,false-positive血β-hCG(radioimmunoassays)UltrasonicDiagnosis超声诊断经腹超声TAS（TransabdominalSonography）经阴超声TVS(TransvaginalSonography)彩色多普勒超声CDFI(ColourDopplerFlowImaging)图9输卵管妊娠经腹超声影像Culdocentesis阴道后穹窿穿刺techniqueforidentifyinghemoperitoneum腹腔积血图10阴道后穹窿穿刺示意图Laparoscopy腹腔镜检查图11腹腔镜检查操作示意图TreatmentSurgicaltreatmentNon-operativeapproach手术治疗(SurgicalTreatment)：输卵管切除术(Salpingectomy)图12输卵管妊娠切除术图13输卵管妊娠术后所见PreliminarySummarythemostcommoncausethreepathologicalterminationstheclassictriadfourbasicancillarymethodsprimarytreatment