继发性大网膜妊娠1例

A case of secondary omental pregnancy

大网膜妊娠是一种特殊类型的异位妊娠,属于腹腔妊娠的一种,分为原发性和继发性。原发性大网膜妊娠指受精卵直接着床于大网膜;继发性大网膜妊娠指输卵管妊娠流产、破裂,其他异位妊娠或子宫壁穿孔等原因导致妊娠组织再植入,附着于大网膜重新种植而形成。早期大网膜妊娠临床表现与其他异位妊娠相似,常被误诊为输卵管异位妊娠。由于大网膜妊娠早期诊断比较困难,因此大网膜妊娠的患者死亡率远高于输卵管妊娠。近期我院收治了1例输卵管妊娠患者,在腹腔镜下行患侧输卵管切除术后,β人绒毛膜促性腺激素(β-HCG)下降缓慢,甚至出现再次上升的趋势,再次手术诊断为继发性大网膜妊娠,回顾分析患者的临床资料,探讨引起继发性大网膜妊娠发病的原因及可能预防的措施,以期为临床医师提供参考。

Omental pregnancy is a special type of ectopic pregnancy, which belongs to abdominal pregnancy.It can be divided into primary and secondary types. Primary omental pregnancy refers to the direct implantation of fertilized eggs into the omentum. Secondary omental pregnancy is developed by the secondary implantation of pregnant tissue due to the tubal abortion and rupture of tubal pregnancy, other ectopic pregnancy or perforation of uterine wall, etc., and then attachment to omentum. The clinical manifestation of early omental pregnancy is similar to other ectopic pregnancy, which is often misdiagnosed as tubal ectopic pregnancy. As the early diagnosis of omental pregnancy is difficult, the mortality for patients with omental pregnancy is much higher than that for patients with tubal pregnancy. Recently, a patient with tubal pregnancy was admitted to our hospital.After laparoscopic salpingectomy on the affected side, beta-human chorionic gonadotrophic hormone(β-HCG)decreased slowly and even showed an increase trend again. The patient was diagnosed with secondary omental pregnancy by reoperation. The clinical data of the patient were reviewed and analyzed to explore the causes of secondary omental pregnancy and possible preventive measures, so as to provide reference for clinicians.