目的明确各种不同原因妇科急性腹腔内出血的临床特征以减少误诊及指导治疗。方法对收治的233例妇科急性腹腔内出血手术进行回顾性分析。结果通过了解病史、症状、体征、B超检查和腹腔穿刺,异位妊娠的术前和病理诊断符合率94.1%,36例卵巢破裂中有10例术前误诊为异位妊娠,1例误诊为卵巢囊肿蒂扭转,误诊率30.6%,11例出血性输卵管炎,误诊为异位妊娠5例,卵巢破裂3例,误诊率72.7%。结论异位妊娠依然是妇科急性腹腔内出血的首要原因,准确的早期诊断和有效的抢救措施是减少死亡率的关键;卵巢破裂是妇科急性腹腔内出血的第2位原因,其临床诊断率有待提高;出血性输卵管炎在近年来有增多的趋势,如何提高对其诊断及治疗的认识应引起我们的重视。 Objective To clarify the clinical features of acute intraperitoneal hemorrhage of various causes to reduce misdiagnosis and guide treatment. Methods A retrospective analysis of 233 cases of gynecological acute intraperitoneal hemorrhage was performed. Results The preoperative and pathological diagnosis coincidence rate was 94.1% by understanding the history, symptoms and signs, B-ultrasound and paracentesis, and 10 of 36 cases of ovarian rupture were misdiagnosed as ectopic pregnancy preoperatively and 1 case misdiagnosed as Ovarian cyst torsion, misdiagnosis rate of 30.6%, 11 cases of hemorrhagic salpingitis, misdiagnosed as ectopic pregnancy in 5 cases, 3 cases of ovarian rupture, misdiagnosis rate was 72.7%. Conclusions Ectopic pregnancy is still the primary cause of acute intraperitoneal hemorrhage in gynecology. Precise early diagnosis and effective rescue measures are the key to reduce mortality. Ovarian rupture is the second cause of acute intraperitoneal hemorrhage in gynecology. The clinical diagnosis rate needs to be improved. Hemorrhagic salpingitis in recent years, there is an increasing trend, how to improve their diagnosis and treatment should be our attention.