妇产科学：异位妊娠 (2).pptVIP

根治性手术：切除患侧输卵管 保守性手术：保留患侧输卵管 手术方式 输卵管伞部妊娠吸出术 输卵管切开取胚术 输卵管切除术 卵巢妊娠部分切除术 腹腔镜下局部注射药物 保守性手术 A E C B 伞部妊娠流产清除 输卵管切除术 优点：免除了手术创伤，保留患侧输卵管并恢复其功能 适应症： 　输卵管妊娠直径不超过4ＣＭ 　输卵管妊娠未破裂或流产 　无明显内出血 　血hＣＧ＜2０００Ｕ／Ｌ 化学药物治疗 抑制滋养细胞增生 破坏绒毛 使胚胎组织坏死、脱落、吸收 药物治疗：甲氨蝶呤（MTX） 经静脉全身给药 经Ｂ超介导阴道穿刺给药 经腹腔镜下穿刺给药 经宫腔镜输卵管插管给药 药物治疗：给药途径 卵巢妊娠（ovarian pregnancy） 临床表现：同输卵管妊娠 诊断标准： 双侧输卵管必须完整 囊胚必须位于卵巢组织内 卵巢副与囊胚必须以卵巢固有韧带与子宫相连 囊胚壁上有卵巢组织 治疗： 卵巢部分切除 患侧附件切除 腹腔妊娠（abdominal pregnancy） 　原发性 两侧卵巢及输卵管必须正常，无近期妊娠证据 无子宫腹膜瘘形成 妊娠只存在于腹腔内，无输卵管妊娠等的可能性 　继发性：为输卵管妊娠的继续 腹腔妊娠结局 足月妊娠 胎死腹内 石胎 腹腔妊娠的治疗 剖腹取出胎儿 胎盘留置原处 特殊部位妊娠 子宫残角妊娠 剖宫产瘢痕部位妊娠 小结 定义 好发部位 临床表现 辅助检查 治疗方法 思考 宫内宫外同时妊娠的处理？ 谢 谢 * It is a condition that significantly jeopardizes the mother because catastrophic bleeding may occur when the implanting pregnancy erodes blood vessels or ruptures of the tubal wall Ectopic pregnancy was first described in the 11th century, and, until the middle of the 18th century, it was usually fatal. John Bard reported the first successful surgical intervention to treat an ectopic pregnancy in New York City in 1759. The survival rate in the early 19th century was dismal. One report demonstrated only 5 patients of 30 surviving the abdominal operation. Interestingly, the survival rate in patients who were left untreated was 1 of 3. Any sexually active woman of childbearing age is at risk for ectopic pregnancy. In the past two or three decades, ectopic pregnancy has become more common. Today, about 1 in 50 pregnancies is ectopic. * Ectopic pregnancy was first described in the 11th century, and, until the middle of the 18th century, it was usually fatal. John Bard reported the first successful surgical intervention to treat an ectopic pregnancy in New York City in 1759. The survival rate in the early 19th century was dismal. One report demonstrated only 5 patients of 30 surviving the abdominal operation. Interestingly, the survival rate in patients who were left untreated was 1 of 3. * Most ectopic pregnancies are located in the fallopian