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題 名 | Severe Ovarian Hyperstimulation Syndrome Coexisting with a Bilateral Ectopic Pregnancy=卵巢過度刺激症候群合併子宮外孕 |
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作 者 | 蕭啟信; 張明揚; 江其鑫; 謝景璋; 謝燦堂; | 書刊名 | 長庚醫學 |
卷 期 | 27:2 2004.02[民93.02] |
頁 次 | 頁143-147 |
分類號 | 417.125 |
關鍵詞 | 卵巢過度刺激症候群; 子宮外孕; 人工授精; Ovarian hyperstimulation syndrome; Ectopic pregnancy; Intrauterine insemination; |
語 文 | 英文(English) |
中文摘要 | 對於卵巢過度刺激的病患除了需要入院控制電解質及輸液的給予外,尚必須以超音波引導抽取腹腔內腹水做為治療。一旦病患妊娠試驗呈陽性反應合併卵巢過度刺激症候群時,常常因為卵巢過度刺激的臨床表徵,讓我們忽略了子宮外孕的可能性。本病例報告中,一位31歲婦女因多囊性卵巢,在門診接受人工授精(IUI)療程中,併發卵巢過度刺激症候群,住院期間除了給予輸液治療及抽取腹腔內腹水等保守性治療外,於入院後第14天因持續性下腹痛並抽出血樣性腹水,予以剖腹探查。術中呈現雙側輸卵管壺腹部膨大併雙側輸卵管繖部持續性鮮紅色血液滲出,經過雙側輸卵管線狀切開造口術後,取出內含子宮外孕妊娠組織並縫合所切開的造口,以保存病患雙側輸卵管。卵巢過度刺激症侯群合併子宮外孕的情形,相當不容易診斷,除了臨床表徵之外,持續的血中絨毛膜激素濃度及經陰道超音波的追蹤對於早期診斷應該有所助益。 |
英文摘要 | Management of severe ovarian hyperstimulation syndrome (OHSS) includes hospitalization for fluid and electrolyte management. Abdominal paracentesis is also used as minimally invasive form of management in selected cases of severe OHSS following ovulation induction. However, if pregnancy ensues, the syndrome persists for a longer period , and the clinical manifestations of severe OHSS could mask the picture of a bleeding gestational sac. It could be easily overlooked unless the possibility of an ectopic pregnancy is kept in mind in cases of severe OHSS exacerbated by early pregnancy with or without a previous ectopic pregnancy history. We report a case of severe OHSS with simultaneous bilateral tubal pregnancy following intrauterine insemination (IUI). A 31-year-old woman with polycystic ovarian disease developed severe OHSS during the therapeutic course of IUI. An emergent exploratory laparotomy was performed 14 days after admission, and the operative findings showed persistent profuse bleeding from the bilateral fimbrial ends with marked enlargement of the ampullary portions. A linear salpingotomy was performed by a longitudinal incision along the area of maximal distension of the dilated fallopian tubes to preserve her fertility. We recommend that in cases of severe OHSS exacerbated by early pregnancy, serial serum β-hCG and transvaginal ultrasound follow-up may be necessary due to the potential association of severe OHSS in pregnancy with an ectopic pregnancy. |
本系統中英文摘要資訊取自各篇刊載內容。