异位妊娠ectopic pregnancy 宫外孕extrauterine 课件

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1、异位妊娠EctopicPregnancy包医二附院妇产科教研室(宫外孕extrauterinepregnancy)IntroductionDefinitionEtiology(themostcommoncause)Pathology(threepathologicalterminations)ClinicalManifestation(theclassictriad)Diagnosis(fourancillarymethods)Treatment(theprimarytreatment)Definition:Pregnancyinanylocationot

2、herthanthebodyoftheuterusisconsideredectopic.Incidence:0.5~1%图1异位妊娠的发生部位TubalPregnancy壶腹部(Ampulla)55~60%峡部(Isthmus)20~25%伞部(Fimbria)少见间质部(Interstitialportion)少见Chronicsalpingitispelvicinflammatorydisease(PID)盆腔炎sexuallytransmitteddisease(STD)性传播疾病Priortubalsurgerytubalsterilizatio

3、norsalpingectomy绝育输卵管切除术CurrentIUDuse:intrauterinedevice宫内节育器HistoryofinfertilityEtiologyPathology一、Terminationsoftubalpregnancy21、输卵管腔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）Tubalabortion图4输卵管妊娠流产（二）Ruptureoftubalpregnancy图5输卵管妊娠破裂amp

4、ullarypregnancy:8-12W(abortion,rupture)isthmicpregnancy:6W(rupture)interstitialportoion:4M(rupture)图6间质部妊娠(三)Secondaryabdominalpregnancy图7腹腔妊娠示意图二、Uterinechanges（一）Enlargementandsoft:sameasIUP(intrauterinepregnancy)宫内孕图8输卵管妊娠子宫剖面示意图（二）Endometrium子宫内膜decidualreactiion蜕膜变Arias-Stell

5、areactionA-S反应proliferativephase增生期secretoryphase/menstrualperiod分泌期或月经期ClinicalManifestation一、SymptomsAmenorrhea停经Abdominalpain腹痛Vaginalbleeding阴道出血Syncopeandshock晕厥与休克SymptomsAmenorrhea(3/4)mistakeuterinebleedingfortruemenstruation(月经)lackofamenorrheadonotexcludeAbdominalpain(90

6、-100%)duetotubalstretching“tearing”painwithnauseaandvomitingpainintheshouldertenesmus(里急后重)SymptomsVaginalbleeding(spotting)externalbleedingscanty,darkintermittentorcontinuousSyncopeandshockacutehemoperitoneum急性内出血severeabdominalpain剧烈腹痛hemorrhagicshock失血性休克（二）SignsBloodpressurean

7、dpulsehypotension低血压hypovolemia血容量减少AbdominalexaminationAbdominaltendernesswith“rebound”压痛、反跳痛Shiftingdullness移动性浊音SignsPelvicexamination(onbimanualexamination双合诊)exquisitetenderness,especiallyonmotionofthecervix宫颈触痛aadnexalmass附件肿物uterineenlargement子宫增大Ancillaryexaminationβ-HCGUl

8、trasoundCuldocentesisLaparoscopyD