异位妊娠腹腔内大出血150例临床分析

150 Cases Analysis of Ectopic Pregnancy with Abdominal Cavity Hemorrhage

目的:探讨异位妊娠腹腔内大出血诊断、抢救与预后的关系。方法:回顾性分析2004年1月至2013年12月在湖北省嘉鱼县人民医院和潜江市中心医院收治的150例异位妊娠腹腔内大出血的病例资料。结果:异位妊娠致腹腔内大出血150例均成功实施手术,手术成功率100%。术中证实输卵管间质部妊娠破裂27例(18.0%),行子宫角部楔形切除及输卵管切除术;卵巢妊娠破裂5例(3.3%),行卵巢楔形切除加卵巢修补术;输卵管峡部妊娠破裂51例(34.0%),行患侧输卵管峡部切除术;输卵管壶腹部妊娠破裂43例(28.7%),行患侧输卵管切除术;输卵管壶腹部妊娠流产22例(14.7%),17例无生育要求,行患侧输卵管切除,5例有生育要求,行输卵管切开取胚胎术;腹腔妊娠1例(0.7%),行病灶切除术;输卵管伞部妊娠流产1例(0.7%),行患侧输卵管切除术。150例中148例经过积极抢救并及时手术治疗恢复良好,1例患者术后出现暂时性尿崩症经治疗后好转,1例患者因休克时间长,于术后18天患者家属放弃治疗死亡。结论:异位妊娠腹腔内大出血应及时确诊,迅速抢救,有效的抗休克治疗和输血,积极手术切除异位妊娠灶,可挽救患者生命,减少不良结局的发生。

Objective：To study the relationship between timely diagnosis and active rescue of ectopic pregnancy with abdominal cavity hemorrhage and its prognosis. Methods：The clinical data of 150 cases analysis of ectopic pregnancy with abdominal cavity hemorrhage from January 2004 to December 2013 in Jiayu Hospital of Hubei Province and Qianjiang Central Hospital of Hubei Province were retrospectively analyzed. Results：Among the 150 patients of ectopic pregnancy with abdominal cavity bleeding, all the patients accepted open surgery successfully,27 cases with interstitial tubal pregnancy ruptures,which were treated by salpingectomy and ipsilateral cornual resection,5 cases with ovarian pregnancy,which were treated by ovary wedge resection,51 cases with tubal isthmus pregnancy ruptures,which were treated by ipsilateral salpingectomy,43 cases with tubal ampullary pregnancy ruptures,which were treated by ipsilateral salpingectomy,22 cases with tubal ampullary pregnancy abortion,among which 17 patients without bearing requirement were treated by ipsilateral salpingectomy,5 patients with bearing requirement salpingotomies were treated by salpingotomy and removing embryon,1 cases with abdominal pregnancy, 1 cases with tubal fimbria pregnancy abortion,which was treated by ipsilateral salpingectomy. As to the prognosis,among the 150 patients,148 patients who accepted timely diagnosis and active rescue had excellent prognosis,1 patient who had postoperative temporary diabetes insipidus finally was relieved after treatment,1 patient who had Iongtime shock died because of quiting therapy. Conclusions：Timely diagnosis, active rescue, effective anti-shock treatment, blood transfusion, and controlling the bleeding by surgical removal of the ectopic pregnancy rupture lesion can effectively saving the patients＇ life and prevent the adverse prognosis of ectopic pregnancy with abdominal cavity hemorrhage.