特殊部位异位妊娠的临床特征及误漏诊原因分析

Clinical characteristics and misdiagnosis reasons of the ectopic pregnancies in unusual locations

目的探讨特殊部位异位妊娠的临床特征、治疗方法与预后,重点分析误诊漏诊情况。方法回顾性分析解放军第一七五医院2000年1月至2013年12月特殊部位异位妊娠66例患者的超声、实验室诊断特征与误漏诊情况,记录治疗方法与预后情况。结果 45例超声示异位妊娠,12例治疗前明确特殊部位异位妊娠,9例误诊漏诊,占13.63%。55例查血人体绒毛膜促性腺激素(HCG)阳性,11例查尿妊娠试验阳性。采用保守治疗7例,行病灶清除术、患侧输卵管切除术等手术治疗59例,除1例保守治疗转院失访外均治愈。结论特殊部位异位妊娠临床表现不典型,术前诊断较困难,医师需详细询问病史及仔细妇科检查,对病情需全面分析,认真鉴别诊断,减少误漏诊情况的发生,改善患者的预后。

Objective To investigate the clinical characteristics,treatment methods and prognosis of ectopic pregnancies in unusual locations,and to analysis the misdiagnosis and missed diagnosis situation. Methods Retrospective study was used from January 2000 to December 2013. 66 cases of ectopic pregnancies in unusual locations in our hospital were selected. The ultrasound characteristics and laboratory diagnosis in the patients were recorded,and the misdiagnosis,treatment and prognosis were also recorded.Results 45 cases were diagnosed by ultrasound of ectopic pregnancy. 12 cases with ectopic pregnancies in unusual locations were diagnosed before treatment and 9 cases were misdiagnosed which accounted for 13.63%. 55 cases of the total showed blood HCG was positive and 11 cases showed urine pregnancy test was positive. 7 cases of conservative treatment and 59 cases of surgical treatment were cured excluding 1 case of transferring to other hospital. Conclusion The clinical manifestations of ectopic pregnancies in unusual locations is not typical. The diagnosis is difficult before surgery so doctors should ask detailed history and be careful about gynecological examination,comprehensive analysis of the disease,differential diagnosis so as to reduce misdiagnosis cases and improve the prognosis.