子宫全切术后迟发异位妊娠临床特点及诊治——1例病案报道及文献复习

Clinical characteristics and treatment of late post-hysterectomy ectopic pregnancy: a case report and literature review

目的:探讨子宫全切术后异位妊娠临床特点,为减少发病率和误诊率提供参考资料。方法:报道1例子宫全切除术后异位妊娠并搜集国内外有关资料的文献报道,汇总分析子宫切除术手术方式、术后异位妊娠发生的时间、临床表现和转归等临床资料。结果:共搜集到33篇相关文献,涉及34个病例,被纳入分析,其中33例是文献报道,1例为本文报道。发病时间从子宫全切术后22 d到12年不等,无特异临床表现,常见为腹痛、盆腔痛、恶心、呕吐,部分患者可有少量阴道流血、流液,术前确诊率低,大多为术中探查确诊,67.6%(23/34)就诊时已发生异位妊娠破裂,经阴道子宫全切术后异位妊娠发生率高于经腹子宫切除术。结论:育龄期妇女即使子宫切除术后也有异位妊娠可能,易误诊和延误治疗,可出现危及生命的异位妊娠破裂,患者出现腹痛、盆腔痛,阴道流血、流液,恶心、呕吐等症状时,应排除是否有异位妊娠可能,子宫切除术同时行双侧输卵管切除术可减少术后异位妊娠发生的可能。

Objective： To discuss the clinical feature, diagnosis, treatment and prognosis of late post- hysterectomy ectopic pregnancy. Methods： A case was reported, 6 cases of domestic and 27 cases of abroad of late post-hysterectomy ectopic pregnancy were collected, the clinical datum of surgical method, post-operative ectopic pregnancy occurrence time, clinical manifestation and outcome were retrospectively analyzed. Results： Totally 34 cases were included in the analysis. The presentation was 22 d to 12 years after hysterectomy. There was no specific clinical manifestations. The most common complain was abdominal or pelvic pain, nausea, vomiting, some patients may have a small amount ＆vaginal bleeding or flow fluid. The pre- operative confirmed diagnosis rate was low, 67.6% （23/34） cases had ruptured occurred during treatment. The incidence of ectopic pregnancy after transvaginal hysterectomy was higher than that of through abdominal hysterectomy. Conclusion： Even after hysterectomy without oophorectomy there still has been the possibility of ectopic pregnancy in childbearing women, it was easily misdiagnozed and treatment may be delayed. Ectopic pregnancy rupture is life-threatening, ectopic pregnancy should be ruled out when the symptoms such as abdominal pain, pelvic pain, vaginal bleeding, fluid flow, nausea and vomiting in childbearing women with post-hysterectomy occurred, hysterectomy and bilateral salpingectomy may reduce post-operative ectopic pregnancy.