腹膜后妊娠1例

Retroperitoneal pregnancy:A case report

腹膜后妊娠是一种特殊类型的异位妊娠,指胚胎种植在腹膜腔以外的腹膜后结构,其发生极其罕见。因腹膜后存在大血管和神经走行,当妊娠囊破裂时可引起腹膜后大出血,甚至危及孕妇生命。2023年12月15日中南大学湘雅医院收治1例位于下腔静脉前方的腹膜后妊娠患者,35岁,因“胚胎移植术后27 d,检查发现盆腔包块2 h”入院。超声检查提示:下腔静脉与腹主动脉交界处前方孕囊声像,腹腔妊娠?计算机断层扫描(computed tomograph,CT)提示:下腔静脉与腹主动脉交界处前方异常密度灶,腹腔妊娠?经多学科会诊评估手术风险后,于12月21日行开腹手术,术中见腹膜后横结肠系膜下方、腹主动脉右侧、下腔静脉前方一大小约3 cm×3 cm×2 cm的孕囊样肿物,打开后腹膜,完整切除肿物。术后病检见绒毛及胚胎结构,符合异位妊娠特征。患者术后恢复良好,β-人绒毛膜促性腺激素呈下降趋势。

Retroperitoneal pregnancy is a special type of ectopic pregnancy,which refers to the embryo planted in the retroperitoneal structures outside the peritoneal cavity,and its occurrence is extremely rare.Due to the presence of large blood vessels and nerve in the retroperitoneum,when the gestational sac ruptures will cause retroperitoneal hemorrhage or even jeopardize the life of the pregnant woman.The patient with retroperitoneal pregnancy located in front of the inferior vena cava was 35 years old and was admitted to Xiangya Hospital,Central South University on December 15,2023 for“27 days after embryo transfer and pelvic mass detected for 2 hours on examination”.Ultrasonography showed an anterior sac at the junction of the inferior vena cava and the abdominal aorta:abdominal pregnancy?Computed tomograph showed abnormal density foci anterior to the junction of inferior vena cava and abdominal aorta:abdominal pregnancy?After a multidisciplinary consultation to assess the risk of surgery,open surgery was performed on December 21,during which a gestational sac-like mass of about 3 cm×3 cm×2 cm in size was seen below the retroperitoneal transverse colon mesentery,the right side of the abdominal aorta,and anterior to the inferior vena cava,and the posterior peritoneum was opened for complete excision of the mass.Postoperative histopathological examination showed chorionic villi and embryonic structures,consistent with ectopic pregnancy.The patient recovered well after the operation,and theβ-human chorionic gonadotropin had a decreasing trend.