9例宫颈妊娠的误诊分析

The Misdiagnosis of Cervical Pregnancy in 9 Cases

目的:分析宫颈妊娠的临床特点和误诊原因。方法: 收集桂洲医门诊或外院1990年1月1日-2004年7月30日曾误诊过的9例宫颈妊娠,根据临床特点及辅助检查之临床资料进行回顾性分析。结果:发现除1例外,余8例确诊前均行1次或1次以上清宫术,行清宫术时1例阴道出血超过800mL致失血性休克, 3例发生阴道大量流血约500mL左右,其中余4例出血约300mL左右。6例依临床表现及妇检直接诊为“宫内早孕”或“流产”, 3例行B超检查误认为“宫内妊娠”。3例复查B超诊为“宫颈妊娠”, 3例B超仍诊为“宫内妊娠”, 1例B超示“宫内未见异常回声”, 2例未复查B超。经入院后再进一步妇科检查和B超检查将曾误诊的9例均确诊为宫颈妊娠。结论:及时而准确地诊断宫颈妊娠至关重要,可避免错误治疗和严重并发症。

Objective:To investigate the clinical characteristics and the causes of misdiagnosis of cervical pregnancy.Methods:9 cases of misdiagnosed cervical pregnancy were studied retrospectively and were treated in Guizhou hospital or from Jan.1, 1990 to Jul.30,2004.Result:All the patients have been given more than one time of dilatation and curettage except one. And among these cases, one had experienced over 800 mL bleeding via vagina and shock when accepting the operations, 3 cases about 500 mL bleeding, and the other 4 cases about 300 mL. Six cases were directly diagnosed as “intrauterine pregnancy” or “abortion” based on clinical manifestation and gynecologic examination. And three were misdiagnosed as intrauterine pregnancy though checked by ultrasonography beforehand. Among the seven cases re-examined by ultrasonography, only three were re-diagnosed as cervical pregnancy, there were still three cases diagnosed as “intrauterine pregnancy” and one case as “unremarkable intrauterine findings”. However, all the cases were properly diagnosed after admitted to our hospital and accepted advanced gynecologic examinations as well as ultrasonography.Conclusion: Timely and exact diagnosis of cervical pregnancy is vital to the prognosis of patients, which can avoid mistreatments and severe complications.