山西医科大学第二临床医学院妇产科课件第一章 异位妊娠.pptVIP

异 位 妊 娠 Ectopic Pregnancy 主讲人： 于 冰 单位：山西医科大学第二医院 妇产科教研室 Introduction Definition Etiology (the most common cause) Pathology (three pathological terminations) Clinical Manifestation (the classic triad) Diagnosis (four ancillary methods) Treatment (the primary treatment) Definition: Pregnancy in any location other than the body of the uterus is considered ectopic. Incidence: 0.5~1% （二） Signs Blood pressure and pulse hypotension 低血压 hypovolemia 血容量减少 Abdominal examination Abdominal tenderness with “rebound” 压痛、反跳痛 Shifting dullness 移动性浊音 Preliminary Summary the most common cause three pathological terminations the classic triad four basic ancillary methods primary treatment * * (宫 外 孕 extrauterine pregnancy) 图1 异位妊娠的发生部位 Tubal Pregnancy 壶腹部(Ampulla) 55~60% 峡部(Isthmus) 20~25% 伞部(Fimbria) 少见 间质部(Interstitial portion) 少见 Chronic salpingitis pelvic inflammatory disease (PID)盆腔炎 sexually transmitted disease(STD)性传播疾病 Prior tubal surgery 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 Etiology Pathology 一、Terminations of tubal pregnancy 2 1、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）Tubal abortion 图4 输卵管妊娠流产 （二）Rupture of tubal pregnancy 图5 输卵管妊娠破裂 ampullary pregnancy: 8-12W (abortion,rupture) isthmic pregnancy: 6W (rupture) interstitial portoion: 4M(rupture) 图6 间质部妊娠 (三)Secondary abdominal pregnancy 图7 腹腔妊娠 示意图 二、Uterine changes （一）Enlargement and soft: same as IUP(intrauterine pregnancy)