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題名 | Third Tubal Pregnancy after Bilateral Salpingectomy for Ectopic Pregnancies=因兩次輸卵管外孕切除雙側輸卵管後第三次輸卵管外孕病例報告 |
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作者 | 洪芳宜; 王國恭; 王國楨; 蘇聰賢; Hung, Fang-yi; Wang, Kuo-gon; Wang, Kuo-chen; Su, Tsung-hsien; |
期刊 | 中華民國婦產科醫學會會刊雜誌 |
出版日期 | 19980300 |
卷期 | 37:1 1998.03[民87.03] |
頁次 | 頁31-34 |
分類號 | 417.347 |
語文 | eng |
關鍵詞 | 輸卵管外孕; 重復性子宮外孕; Tubal pregnancy; Repeated ectopic pregnancy; |
中文摘要 | 背景:由於近來婦科顯微手術和保守藥物治療的進步,對於輸卵管外孕的處理方 式日趨保守,臨床醫師亦將面臨多次重複性子宮外孕的病人。 病例報告:一位29歲病人因下腹痛來急診求治,她曾因兩次輸卵管外孕破裂而接受 雙側輸卵管切除。檢查發現病人外觀蒼白、生命徵象不穩定且腹部有廣泛 性反彈壓痛,顯示有腹內出血的現象:右側子宮附屬器處有壓痛,直腸子 宮陷凹穿刺取得非凝固血液,懷孕測試陽性反應;超音波顯示空的子宮 腔、右子宮附件腫塊和直腸子宮陷凹有大量液體蓄積,懷疑是子宮外孕合 併內出血。剖腹探查證實了先前的診斷,著床位置在右輸卵管殘留斷端; 立即予切除手術,術後恢復良好。 結論:即使先前接受過雙側輸卵管切除,仍不能排除再次輸卵管外孕的可能性。 因此若不考慮保留生育能力,對於輸卵管外孕,儘可能施行輸卵管全切除 而非部份切除,以減少重複性子宮外孕的機會。 |
英文摘要 | Background:With the advent of microsurgery in gynecology and the advocacy of conservative surgical techniques for tubal pregnancies, clinicians may be confronted with patients having recurrent tubal pregnancies. Case report: A 29-year-old woman presented with low abdominal pain and abdominal distention of two days' duration. She had twice undergone unilateral salpingectomy following a urptured tubal pregnancy. Unstable vital signs, pallor, and diffuse abdominal rebound tenderness all indicated intraperitoneal bleeding. The right adniexal region was tender and nonclotting blood was obtained via culdocentesis. Ultrasound disclosed an empty uterus, a right adnexal mass measuring 2x2cm. and a large amount of fluid in the cul-de-sac. These findings, plus a positive pregnancy test, raised the suspicion of a recurrent ectopic pregnancy with internal bleeding. This was subsequently confirmed by exploratory laparotomy. The implantation site was found in the right redundant tubal stump, which was then excised. The postoperative course was uneventful. Conclusion: The possibility of pregnancy should always be considered despite previous bilateral tube "removal". When fertility is not a concern, performing a total salpingectomy instead of a partial tial salpingectomy for an ectpic tubal pregnancy can reduce the incidence of recurrent tubal pregnancy. |
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