妇产科异位妊娠课件

异位妊娠

EctopicPregnancy(宫外孕

extrauterinepregnancy)妇产科异位妊娠IntroductionDefinitionEtiology(themostcommoncause)Pathology(threepathologicalterminations)ClinicalManifestation(theclassictriad)Diagnosis(fourancillarymethods)Treatment(theprimarytreatment)妇产科异位妊娠Definition:

Pregnancyinanylocationotherthanthebodyoftheuterusisconsideredectopic.Incidence:0.5~1%妇产科异位妊娠图1异位妊娠的发生部位妇产科异位妊娠TubalPregnancy壶腹部(Ampulla)55~60%峡部(Isthmus)20~25%伞部(Fimbria)少见间质部(Interstitialportion)少见妇产科异位妊娠

Chronicsalpingitis

pelvicinflammatorydisease(PID)盆腔炎

sexuallytransmitteddisease(STD)性传播疾病

Priortubalsurgery

tubalsterilizationorsalpingectomy

绝育输卵管切除术

CurrentIUDuse:intrauterinedevice宫内节育器

HistoryofinfertilityEtiology妇产科异位妊娠Pathology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妇产科异位妊娠图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妇产科异位妊娠（一）Tubalabortion

图4输卵管妊娠流产妇产科异位妊娠（二）Rupture

oftubalpregnancy图5输卵管妊娠破裂妇产科异位妊娠ampullarypregnancy:

8-12W(abortion,rupture)isthmicpregnancy:6W(rupture)interstitialportoion:4M(rupture)图6间质部妊娠妇产科异位妊娠(三)Secondaryabdominalpregnancy图7腹腔妊娠示意图妇产科异位妊娠二、Uterinechanges（一）Enlargementandsoft:sameasIUP(intrauterinepregnancy)

宫内孕

图8输卵管妊娠子宫剖面示意图妇产科异位妊娠（二）Endometrium子宫内膜

decidualreactiion蜕膜变

Arias-StellareactionA-S反应

proliferativephase增生期

secretoryphase/menstrualperiod

分泌期或月经期妇产科异位妊娠ClinicalManifestation

一、Symptoms

Amenorrhea停经Abdominalpain腹痛Vaginalbleeding

阴道出血Syncopeandshock晕厥与休克妇产科异位妊娠

SymptomsAmenorrhea

(3/4)

mistakeuterinebleedingfortruemenstruation(月经)lackofamenorrheadonotexcludeAbdominalpain(90-100%)

duetotubalstretching

“tearing”painwithnauseaandvomitingpainintheshouldertenesmus(里急后重)妇产科异位妊娠SymptomsVaginalbleeding(spotting)

externalbleedingscanty,darkintermittentorcontinuousSyncopeandshock

acutehemoperitoneum急性内出血

severeabdominalpain剧烈腹痛

hemorrhagicshock失血性休克妇产科异位妊娠（二）Signs

Bloodpressureandpulsehypotension低血压

hypovolemia血容量减少

AbdominalexaminationAbdominaltendernesswith“rebound”

压痛、反跳痛

Shiftingdullness移动性浊音妇产科异位妊娠SignsPelvicexamination(onbimanualexamination双合诊)

exquisitetenderness,especiallyonmotionofthecervix宫颈触痛

aadnexalmass附件肿物

uterineenlargement子宫增大妇产科异位妊娠Ancillary

examinationβ-HCG

UltrasoundCuldocentesisLaparoscopyDiagnosisHistoryPhysicalexamination妇产科异位妊娠Measurementofβ-hCG(humanchorionicgonadotropin)绒毛膜促性腺激素测定

尿β-hCG:false-negative,false-positive血β-hCG(radioimmunoassays)妇产科异位妊娠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)妇产科异位妊娠图9输卵管妊娠经腹超声影像妇产科异位妊娠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妇产科异位妊娠Laparoscopy腹腔镜检查图11腹腔镜检查操作示意图妇产科异位妊娠Treatment

SurgicaltreatmentNon-operativeapproach妇产科异位妊娠手术治疗(SurgicalTreatment)：

输卵管切除术(Salpingectomy)图