妇产科 异位妊娠
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tubal sterilization or salpingectomy 绝育 输卵管切除术
Current IUD use:intrauterine device 宫内节育器
History of infertility
Pathology
一,Terminations
of tubal pregnancy
1,输卵管腔 2 2,输卵管内血肿 3,绒毛侵犯管壁 4,绒毛膜 5,羊膜
图2 输卵管妊娠剖面示意图
图3 输卵管妊娠时孕卵的着床部位
1,着床于粘膜皱襞内常向管腔破裂 2,着床于粘膜皱襞间常穿破管壁
(一)Tubal
abortion
图4 输卵管妊娠流产
(二)Rupture
of tubal pregnancy
Symptoms Vaginal bleeding (spotting)
external bleeding scanty,dark intermittent or continuous
Syncope and shock
acute hemoperitoneum severe abdominal pain hemorrhagic shock 急性内出血 剧烈腹痛 失血性休克
History
Diagnosis
Physical examination
β-HCG
Ultrasound Ancillary examination Culdocentesis Laparoscopy
Measurement of β-hCG (human chorionic gonadotropin) 绒毛膜促性腺激素测定
彩色多普勒超声 CDFI (Colour Doppler
图9 输卵管妊娠经腹超声影像
Culdocentesis
阴道后穹窿穿刺
腹腔积血
technique for identifying hemoperitoneum
图10 阴道后穹窿穿刺示意图
Laparoscopy 腹腔镜检查
图11 腹腔镜检查操作示意图
尿β-hCG: false-negative,false-positive false-negative,false血β-hCG(radioimmunoassays)
Ultrasonic Diagnosis 超声诊断 经腹超声 TAS (Transabdominal Sonography) Sonography) 经阴超声 TVS (Transvaginal Sonography) Flow Imaging)
(二) Signs
Blood pressure and pulse
hypotension hypovolemia 低血压 血容量减少
Abdominal examination
Abdominal tenderness with "rebound" 压痛, 压痛,反跳痛 Shifting dullness 移动性浊音
Definition:
Pregnancy in any location other than the body of the uterus is considered ectopic. Incidence: 0.5~1%
图1 异位妊娠的发生部位
Tubal Pregnancy
壶腹部(Ampulla) 峡部(Isthmus) 伞部(Fimbria) 55~60% 20~25% 少见
图8 输卵管妊娠子宫剖面示意图
(二)Endometrium Endometrium decidual reactiion
子宫内膜 蜕膜变
AriasAArias-Stella reaction A-S反应 proliferative phase 增生期 secretory phase/menstrual period 分泌期或月经期
图5 输卵管妊娠破裂
pregnancy: ampullary pregnancy: 8-12W 12W isthmic (abortion,rupture) 6W (rupture)
pregnancy: pregnancy:
portoion: interstitial portoion: 4M(rupture)
图6 间质部妊娠
(三)Secondary abdominal pregnancy Secondary
图7 腹腔妊娠 示意图
二,Uterine changes Uterine
(一)Enlargement and soft: nlargement soft: same as IUP(intrauterine pregnancy) 宫内孕
Treatment
Surgical treatment Non-operative approach
手术治疗(Surgical Treatment):
输卵管切除术(Salpingectomy)
图12 输 卵管妊娠 切除术
图13 输卵管妊娠术后所见
Preliminary Summary
the most common cause three pathological terminations the classic triad four basic ancillary methods primary treatment
Signs Pelvic examination (on bimanual examination 双合诊) 双合诊)
exquisite tenderness , especially on motion of the cervix 宫颈触痛 aadnexal mass 附件肿物 uterine enlargement 子宫增大
wenku.baidu.com
间质部(Interstitial portion) 少见
Etiology
Chronic salpingitis
pelvic inflammatory disease (PID)盆腔炎 sexually transmitted disease(STD)性传播疾病
Prior tubal surgery
Clinical Manifestation
一, Symptoms
Amenorrhea Abdominal pain Vaginal bleeding 停经 腹痛 阴道出血
Syncope and shock 晕厥与休克
Symptoms Amenorrhea
(3/4) mistake uterine bleeding for true menstruation(月经 月经) menstruation(月经) lack of amenorrhea do not exclude (90Abdominal pain(90-100%) due to tubal stretching "tearing pain with nausea and vomiting tearing"pain tearing pain in the shoulder tenesmus(里急后重 里急后重) tenesmus(里急后重)
�
异 位 妊 娠 Ectopic Pregnancy
(宫 外 孕 extrauterine pregnancy)
Introduction
Definition Etiology (the most common cause) Pathology (three pathological terminations) Clinical Manifestation (the classic triad) Diagnosis (four ancillary methods) Treatment (the primary treatment)
Current IUD use:intrauterine device 宫内节育器
History of infertility
Pathology
一,Terminations
of tubal pregnancy
1,输卵管腔 2 2,输卵管内血肿 3,绒毛侵犯管壁 4,绒毛膜 5,羊膜
图2 输卵管妊娠剖面示意图
图3 输卵管妊娠时孕卵的着床部位
1,着床于粘膜皱襞内常向管腔破裂 2,着床于粘膜皱襞间常穿破管壁
(一)Tubal
abortion
图4 输卵管妊娠流产
(二)Rupture
of tubal pregnancy
Symptoms Vaginal bleeding (spotting)
external bleeding scanty,dark intermittent or continuous
Syncope and shock
acute hemoperitoneum severe abdominal pain hemorrhagic shock 急性内出血 剧烈腹痛 失血性休克
History
Diagnosis
Physical examination
β-HCG
Ultrasound Ancillary examination Culdocentesis Laparoscopy
Measurement of β-hCG (human chorionic gonadotropin) 绒毛膜促性腺激素测定
彩色多普勒超声 CDFI (Colour Doppler
图9 输卵管妊娠经腹超声影像
Culdocentesis
阴道后穹窿穿刺
腹腔积血
technique for identifying hemoperitoneum
图10 阴道后穹窿穿刺示意图
Laparoscopy 腹腔镜检查
图11 腹腔镜检查操作示意图
尿β-hCG: false-negative,false-positive false-negative,false血β-hCG(radioimmunoassays)
Ultrasonic Diagnosis 超声诊断 经腹超声 TAS (Transabdominal Sonography) Sonography) 经阴超声 TVS (Transvaginal Sonography) Flow Imaging)
(二) Signs
Blood pressure and pulse
hypotension hypovolemia 低血压 血容量减少
Abdominal examination
Abdominal tenderness with "rebound" 压痛, 压痛,反跳痛 Shifting dullness 移动性浊音
Definition:
Pregnancy in any location other than the body of the uterus is considered ectopic. Incidence: 0.5~1%
图1 异位妊娠的发生部位
Tubal Pregnancy
壶腹部(Ampulla) 峡部(Isthmus) 伞部(Fimbria) 55~60% 20~25% 少见
图8 输卵管妊娠子宫剖面示意图
(二)Endometrium Endometrium decidual reactiion
子宫内膜 蜕膜变
AriasAArias-Stella reaction A-S反应 proliferative phase 增生期 secretory phase/menstrual period 分泌期或月经期
图5 输卵管妊娠破裂
pregnancy: ampullary pregnancy: 8-12W 12W isthmic (abortion,rupture) 6W (rupture)
pregnancy: pregnancy:
portoion: interstitial portoion: 4M(rupture)
图6 间质部妊娠
(三)Secondary abdominal pregnancy Secondary
图7 腹腔妊娠 示意图
二,Uterine changes Uterine
(一)Enlargement and soft: nlargement soft: same as IUP(intrauterine pregnancy) 宫内孕
Treatment
Surgical treatment Non-operative approach
手术治疗(Surgical Treatment):
输卵管切除术(Salpingectomy)
图12 输 卵管妊娠 切除术
图13 输卵管妊娠术后所见
Preliminary Summary
the most common cause three pathological terminations the classic triad four basic ancillary methods primary treatment
Signs Pelvic examination (on bimanual examination 双合诊) 双合诊)
exquisite tenderness , especially on motion of the cervix 宫颈触痛 aadnexal mass 附件肿物 uterine enlargement 子宫增大
wenku.baidu.com
间质部(Interstitial portion) 少见
Etiology
Chronic salpingitis
pelvic inflammatory disease (PID)盆腔炎 sexually transmitted disease(STD)性传播疾病
Prior tubal surgery
Clinical Manifestation
一, Symptoms
Amenorrhea Abdominal pain Vaginal bleeding 停经 腹痛 阴道出血
Syncope and shock 晕厥与休克
Symptoms Amenorrhea
(3/4) mistake uterine bleeding for true menstruation(月经 月经) menstruation(月经) lack of amenorrhea do not exclude (90Abdominal pain(90-100%) due to tubal stretching "tearing pain with nausea and vomiting tearing"pain tearing pain in the shoulder tenesmus(里急后重 里急后重) tenesmus(里急后重)
�
异 位 妊 娠 Ectopic Pregnancy
(宫 外 孕 extrauterine pregnancy)
Introduction
Definition Etiology (the most common cause) Pathology (three pathological terminations) Clinical Manifestation (the classic triad) Diagnosis (four ancillary methods) Treatment (the primary treatment)