异位妊娠误诊为急性胃肠炎15例分析

Analysis of Ectopic Pregnancy Misdiagnosed as Acute Gastroenteritis (15 Cases)

目的探讨异位妊娠误诊为急性胃肠炎的原因，并提出防范对策。方法对我院收治并误诊的异位妊娠15例的临床资料进行回顾性分析。结果本组均以上腹痛为首发症状，其中9例病初按急性胃肠炎观察治疗，期间病情加重，出现失血性休克，拟诊异位妊娠行手术治疗而明确诊断为输卵管妊娠破裂出血，出血量2000～30000ml；1例发病后在当地曾3次就诊，均按急性胃肠炎处理，后因失血过多到我院，经抢救无效死亡，后导尿查绒毛膜促性腺激素（HCG）阳性，腹穿抽出不凝血而明确诊断为异位妊娠破裂出血；5例病初曾就诊2或3次，均按急性胃肠炎治疗症状未缓解，后行盆腹腔B超检查发现附件包块、盆腹腔积液，请妇科会诊拟诊为异位妊娠，手术后确诊为输卵管妊娠破裂，术中失血1000～1500ml。本组除1例死亡外，余14例均痊愈出院。结论异位妊娠破裂出血临床表现复杂，易误诊。注意病史及鉴别诊断是避免误诊的关键。

Objective To investigate the cause of ectopic pregnancy misdiagnosed as acute gastroenteritis, and to propose preventive measures. Methods The clinical data of 15 cases of ectopic pregnancy misdiagnosed in our hospital was retrospectively analyzed. Results All patients had the initial symptom of abdominal pain. 9 cases was observed as acute gastroenteritis at primary period, during which hemorrhagic shock appeared after treatment, so ectopic pregnancy was sus- pected and surgery was performed and then it was later confirmed as ruptured ectopic pregnancy with a blood loss of 2000 ~ 30 000 ml ; 1 case was treated as acute gastroenteritis for 3 times in the local hospital, but died frum excessive bleeding in our hospital. Urinary HCG of the patient was positive, intraperitoneal blood was drawn and confirmed as ruptured entopic pregnancy and hemorrhage shock; 5 cases was treated as acute gastroenteritis 2 or 3 times without remission, diagnosed as tubal pregnancy through gynecological consultation after abdominal B-ultrasound showed adnexal mass and abdominal effu- sion. The blood loss was 1000 ~ 1500 ml in the surgery. 1 patient died, and 14 patients were cured and discharged. Conclusion Ectopic pregnancy may be easily misdiagnosed because of its complicated clinical manifestations, and more attention should be paid to history and differential diagnosis to avoid misdiagnosis.