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目的:探讨子宫全切术后异位妊娠临床特点,为减少发病率和误诊率提供参考资料。方法:报道1例子宫全切除术后异位妊娠并搜集国内外有关资料的文献报道,汇总分析子宫切除术手术方式、术后异位妊娠发生的时间、临床表现和转归等临床资料。结果:共搜集到33篇相关文献,涉及34个病例,被纳入分析,其中33例是文献报道,1例为本文报道。发病时间从子宫全切术后22 d到12年不等,无特异临床表现,常见为腹痛、盆腔痛、恶心、呕吐,部分患者可有少量阴道流血、流液,术前确诊率低,大多为术中探查确诊,67.6%(23/34)就诊时已发生异位妊娠破裂,经阴道子宫全切术后异位妊娠发生率高于经腹子宫切除术。结论:育龄期妇女即使子宫切除术后也有异位妊娠可能,易误诊和延误治疗,可出现危及生命的异位妊娠破裂,患者出现腹痛、盆腔痛,阴道流血、流液,恶心、呕吐等症状时,应排除是否有异位妊娠可能,子宫切除术同时行双侧输卵管切除术可减少术后异位妊娠发生的可能。
Objective: To investigate the clinical features of ectopic pregnancy after hysterectomy and to provide references for reducing the incidence and misdiagnosis rate. Methods: A case report of one case of ectopic pregnancy after total hysterectomy and the collection of relevant data at home and abroad was reported. The clinical data of hysterectomy operation, time, clinical manifestation and prognosis of postoperative ectopic pregnancy were collected and analyzed. Results: A total of 33 related articles were collected and involved 34 cases, which were included in the analysis, of which 33 cases were reported in the literature and 1 case was reported in this paper. The onset time from hysterectomy 22 d to 12 years, no specific clinical manifestations, common abdominal pain, pelvic pain, nausea, vomiting, some patients may have a small amount of vaginal bleeding, fluid, low preoperative diagnosis, mostly Diagnosis of intraoperative exploration, 67.6% (23/34) have been diagnosed when the ectopic pregnancy rupture, vaginal hysterectomy after ectopic pregnancy than abdominal hysterectomy. Conclusions: Women of childbearing age may experience ectopic pregnancy even after hysterectomy, misdiagnosis and delayed treatment, which may lead to the rupture of life-threatening ectopic pregnancy. The patients have abdominal pain, pelvic pain, vaginal bleeding, fluid, nausea and vomiting , Should rule out the possibility of ectopic pregnancy, hysterectomy simultaneous bilateral tubal resection can reduce the possibility of postoperative ectopic pregnancy.