摘要
目的分析残角子宫妊娠的临床特征及诊治特点,降低误诊率。方法回顾性分析1993年7月1日～2016年12月31日我院收治的5013例异位妊娠患者的临床资料,并复习相关文献资料。结果 23年间残角子宫妊娠10例,占同期异位妊娠患者的0.20%,残角子宫宫腔与正常宫腔相通3例,非交通性残角子宫7例(70%)。4例外院B超提示宫内妊娠,其中2例行人工流产未见绒毛,1例孕3个月诊所保胎治疗后B超发现死胎,1例因腹痛诊所B超提示中孕,宫内活胎。另6例未行检查,首诊我院,其中1例为残角子宫妊娠破裂,1例未破裂前经超声确诊为残角子宫妊娠,占10%,3例以异位妊娠收入院,1例孕5月患者贫血、休克、腹胀明显,疑肠梗阻转上级医院。10例患者均行剖腹探查术,2例未破裂者择期手术,余8例行急诊手术,3例胎儿及胎盘排入腹腔或堵塞破口。残角子宫位于右侧6例,左侧4例,3例妊娠黄体在对侧,3例患侧输卵管伞端积水。手术方式为残角子宫加患侧输卵管切除术5例,单纯行残角子宫切除5例,同时圆韧带缝合固定3例。患者死亡1例(10%)。结论残角子宫妊娠非常罕见,常于孕中期发生残角子宫破裂,因无特异性临床表现,极易误诊。重视孕早期检查,慎密、准确地对患者的临床资料进行分析和超声检查有助于降低误诊率;确诊后应尽早手术,提倡最小侵入治疗。
Objective To analyze the clinical features,diagnosis and treatment of residual horn uterine pregnancy,and to reduce the misdiagnosis rate.Methods The clinical data of 5013 cases with ectopic pregnancy admitted to our hospital from July 1,1993 to December 31,2016 were retrospectively analyzed,and the related literature was reviewed.Results During 23 years,10 cases of residual horn uterine pregnancy accounted for 0.20%of ectopic pregnancy patients at the same period,3 cases of residual horn uterine cavity connected with normal uterine cavity,7 cases of non-communicating residual horn uterus(70%).Four cases of intrauterine pregnancy were indicated by B-mode ultrasonography.Among them,2 cases had no villus after induced abortion,1 case had stillbirth after 3-month pregnancy clinic treatment,and 1 case had mid-pregnancy and intrauterine live fetus because of abdominal pain clinic B-mode ultrasonography.The other 6 cases were not examined and were first visited in our hospital.Among them,1 case was ruptured uterine remnant horn pregnancy,1 case was diagnosed uterine remnant horn pregnancy by ultrasound before rupture,accounting for 10%.3 cases were admitted to hospital with ectopic pregnancy,1 case had obvious anemia,shock and abdominal distension in 5 months of pregnancy,and the suspected intestinal obstruction was transferred to superior hospital.All the 10 patients underwent laparotomy,2 cases without rupture underwent elective operation,the remaining 8 cases underwent emergency operation,and 3 cases of fetus and placenta were discharged into abdominal cavity or blocked the rupture.The residual horn uterus was located on the right in 6 cases,on the left in 4 cases,on the opposite side of the corpus luteum in 3 cases,and on the umbrella end of the fallopian tube in 3 cases.Surgical methods included residual horn hysterectomy plus salpingectomy on the affected side in 5 cases,simple residual horn hysterectomy in 5 cases,and circular ligament suture and fixation in 3 cases.One patient died(10%).Conclusions Residual horn uterine pregnancy is very rare,often occurs in the second trimester of pregnancy uterine rupture,because there is no specific clinical manifestations,it is very easy to misdiagnose.Attention to early pregnancy examination,careful and accurate analysis of clinical data and ultrasound examination can help to reduce the rate of misdiagnosis;early operation should be carried out after diagnosis,and minimal invasive treatment should be advocated.
作者
卢洁
王小敏
LU Jie;WANG Xiao-min(Department of Obstetrics and Gynecology,the Second People′s Hospital of Longgang District in Shenzhen City,Guangdong Province,Shenzhen 518112,China)
出处
《中国当代医药》
2019年第2期113-116,共4页
China Modern Medicine
关键词
残角子宫妊娠
误诊
诊断
治疗
Residual horn uterine pregnancy
Misdiagnosis
Diagnosis
Therapy
