163例特殊部位异位妊娠的诊治分析

Diagnosis and treatment of 163 patients with ectopic pregnancy in exceptional site

目的探讨特殊部位异位妊娠的临床特征、误诊原因及诊疗方法。方法对解放军总医院2007年1月-2012年6月诊治的163例特殊部位异位妊娠患者的临床特征、分类、术前诊断、误诊率、治疗及转归情况进行回顾性分析。结果特殊部位异位妊娠占同期异位妊娠的14.82%(163/1100),术前诊断率49.7%,误诊率50.3%。163例中宫颈妊娠8例,腹腔妊娠3例,剖宫产术后瘢痕妊娠37例,宫角妊娠44例,输卵管间质部妊娠54例,腹膜后妊娠1例,卵巢妊娠15例,子宫肌壁间妊娠1例。结论特殊部位异位妊娠临床表现不典型,诊断较困难,应提高对特殊部位异位妊娠的认识,以便及时诊治,减少误诊以及由此带来的严重后果。

Objective To explore the clinical characteristics, reasons for misdiagnosis and treatment ofectopic pregnancies in exceptional sites. Methods A retrospective analysis was performed based on the clinical data of 163 patients with ectopic pregnancy in exceptional site concerning clinical characteristics, type of ectopic pregnancy, preoperative diagnosis and misdiagnosis rate, and treatment and outcomes in our hospital from Jan. 2007 to Jun. 2012. Results The incidence of exceptional site ectopic pregnancy accounted for 14.82% （163/1100） of the total number of ectopic pregnancy occurring during the same period, and the preoperative diagnosis rate was 49.7%, the misdiagnosis rate was 50.3%. Of the exceptional site ectopic pregnancy, 8 cases were cervical pregnancy, 3 were abdominal pregnancy） 37 cesarean section scar pregnancy, 44 uterine horn pregnancy, 54 interstitial part of Fallopian tube pregnancy, 1 retroperitoneal pregnancy, 15 ovarian pregnancy and 1 uterine intramural pregnancy. Conclusion Ectopic pregnancy in exceptional sites is usually accompanied by atypical clinical features, so it is hard to diagnose exactly. It is necessary to raise our ability to recognize the characteristic of ectopic pregnancy in an exceptional site, so as to make a right diagnosis and treatment, and reduce misdiagnosis and serious consequences.