异位妊娠EctopicPregnancy课件

DefinitionandOverviewDefinitionIncidence:onein100pregnanciesTheincresingtendencyInducedfactors:infertilelowersocioeconomicgrouppreviousectopicpregnancy,10-20%salpingitisandtuboplastyUnruptruedtubalpregnancy(L)CASEONEElectrocoagulationandSectionLoopLigatureWhydiditimplantoutsideuterinecavity?UnclearExplanationofMechanismEtiologyTubalFactors(salpingitis

)ZygoteAbnormalities(chromosomalabnormalities)OvarianFactors(unextrudedovum)ExogenousHormones(progestin-onlyoralcontraceptives)OtherFactors(endometriosis,IUD)ClassificationandSpecificIncidenceTubalPregnancy:99%AbdominalPregnancyCompoundorhysterotrophicpregnancyCervicalPregnancyOtherabnormalpregnancies

LocationsofEctopicPregnancy55%25%Isthmic17%Interstitial2%<0.5%0.1%VeryrareAmpullaryFimbrial

AbdominalPregnancyomentumPlacentaTubalpregnancy

(99%)Ampullary(55%)Isthmic(25%)Fimbrial(17%)Interstitial(2%)BilateralDistalwithsegmentalabsenceofthetubeOvarianPregnancy

(<0.5%)OvarianTubo-ovarianAbdominal-ovarian(secondaryabdominalpregnancy)AbdominalPregnancy

(0.1%)PrimarySecondaryAbdomino-ovarianTubo-abdominalCompoundorHeterotrophicCombinedwithintrauterinepregnancy1in17,000～30,000pregnanciesCervicalPregnancyVeryrareIntraligamentousInthevesicovaginalspaceFollowinghysterectomy:inacervicalstump,inauterinetubeInaprolapseduterinetube(fimbrialorabdominal)OtherdisplacementofPregnancyinUterusCornual(角)(OneEx)Angular(畸形角)Withinauterinediverticulum(憩室)Inauterinesacculation(囊)Inarudimentaryhorn(始基角)Intramural(肌壁间)PathologyLackageofresistancetoinvasionbythetrophoblastMinimaldefenseagainstthepenetratingtrophoblastAbdominalpregnancy:1:15,000pregnanciesMortalityrate:90%Enlargeduterus:circulationandendometriumchangesEndometrialChanges&VaginalBleedingBleeding←endometrialinvolutionandsloughofdeciduaAtypicalendometrialchangesarenotdiagnosticofectopicpregnancyTheArias-Stellareaction(hormonaloverstimulation)Occasionally,endometrialtissuemaybepassedasaso-calleddecidualcast

NotrophoblasticcellsTerminationofthePregnancyTubal:abortionormissedabortionInterstitial,Angular,Cornual:ruptureintotheuterinecavity;thebroadligamentortheperitonealcavity.Cervical:ruptureintothecervicalcanalAbdominal:ruptureintotheperitonealcavity,intotheretroperitonealspace,orintoavitalorgan.Ovarian:ruptureintotheperitonealcavityCombined:Thetubalpregnancymayabortorrupture,andtheuterinepregnancymayabort,terminateprematurely,orcontinuetotermRuptureoftubepregnancyAbortionoftubepregnancyClinicalFindingsNospecificsymptomsorsignsarepathognomonicofectopicpregnancyCombinationoffindingsmaybesuggestiveSymptomsofearlypregnancy(amenorrhea,breasttenderness,andnausea)Bleeding(usuallyspotting)DiffuselowerabdominalpainOver16%ofectopicgestationspresentassurgicalemergencies.

SymptomsPelvicorlowerabdominalpain:99%Abnormaluterinebleeding:75%Secondaryamenorrhea:68%Generalizedpain:44%Unilaterallowerabdominalpain:33%Subdiaphragmaticpainorsharpshoulderpain:22%Syncope(晕厥):37%Uterinecast:7%SignsAbdominaltenderness－80%Adnexaltenderness－75%.ThepainmaybeexquisitelysevereonpalpationorslightmovementofthecervixanduterusAdnexalmass－Aunilateraladnexalmass:53%;boggyandpoorlydelineatedUterinechanges－normalsize:71%;6-8weeks'size:26%,9-12weeks'size:3%Fever－onlyabout2%ofpatientsLaboratoryFindingsSpecialExaminationsUtrasonicallyScanningCuldocentesis

Laparoscopy

Dilatationandcurettage

ExploratorylaparotomyCuldocentesis

LithotomypositionDifferentialDiagnosisWhatkindsofdiseasesshouldbedifferentiated:■appendicitis■salpingitis■rupturedcorpusluteumcyst■ovarianfollicle■uterineabortion■twistedovariancyst■urinarytractdisease■degeneratingleiomyomas■normalintrauterinepregnancywithotherabdominalorpelvicproblemsEssentialsofDiagnosisAmenorrheafollowedbyirregularvaginalbleedingAdnexaltendernessormassUltrasonographicevidenceofadnexalmassandnointrauterinegestationPositive-hCGComplicationsTreatmentEmergencyTreatment:

Immediatesurgery,anti-shockmeasures(warm,oxygen,applymoderatelysnugtourniquetsaroundtheupperlegs)Surgicaltreatment:

laparoscopictechniques.laparotomyMedicalTreatment:MTX.Itappear