误诊为急性阑尾炎的不典型异位妊娠临床分析
Clinical Analysis of Atypical Ectopic Pregnancy Misdiagnosed as Acute Ap-pendicitis
邢丽颖 1王秋1
作者信息
- 1. 065000 河北 廊坊,廊坊市人民医院产科
- 折叠
摘要
目的 探讨不典型异位妊娠的临床特点、诊断和鉴别诊断方法及误诊原因、防范措施.方法 对 2021年4 月—2022 年7 月收治曾误诊的不典型异位妊娠9 例的临床资料进行回顾性分析.结果 本组出现突发性腹痛6例,持续性隐痛突然加剧3 例;麦氏点压痛 6 例,右下腹压痛 3 例,反跳痛 5 例,腹肌紧张 4 例;肠鸣音减弱 9 例,Rovsing's征阳性4 例;腹腔移动性浊音3 例.血白细胞升高6 例,轻度贫血3 例;腹部B超检查均提示右下腹低回声.就诊初期外院均初步诊断急性阑尾炎,拟行手术治疗,遂转我院.误诊时间(14.2±3.1)h.入我院后经进一步询问病史,5 例经腹腔穿刺、4 例经阴道后穹隆穿刺确诊异位妊娠.9 例确诊后皆急行腹腔镜右侧输卵管切除术,术后予抗感染治疗,术后2～3d痊愈出院.结论 不典型异位妊娠早期易误诊.基层医院接诊医师应加强对其认识,提高对育龄期急腹症女性警惕性,详细问诊,对怀疑异位妊娠者,要及时行相关检查,并需全面分析病情,以减少或避免该病误诊误治.
Abstract
Objective To investigate the clinical characteristics,diagnosis,differential diagnosis,causes of misdiag-nosis and preventive measures of atypical ectopic pregnancy.Methods The clinical data of 9 patients with atypical ectopic pregnancy who were misdiagnosed from April 2021 to July 2022 were retrospectively analyzed.Results There were 6 cases of sudden abdominal pain and 3 cases of persistent dull pain.There were 6 cases of McGlover point tenderness,3 cases of right lower abdomen tenderness,5 cases of rebound pain and 4 cases of abdominal muscle tension.Nine cases had reduced bowel sound and 4 cases had positive Rovsing's sign.Three cases had abdominal mobility dullness.There were 6 cases with elevated white blood cells and 3 cases with mild anemia.Abdominal ultrasound examination showed hypoecho in the right lower abdo-men.All patients were initially diagnosed with acute appendicitis in other hospitals at the early stage of treatment,and was transferred to our hospital for surgical treatment.The duration of misdiagnosis was(14.2±3.1)h.After admission to our hospital for further medical history inquiry,5 cases were diagnosed with ectopic pregnancy by peritoneal puncture and 4 cases by posterior vaginal fornix puncture.All the 9 patients underwent laparoscopic right salpingectomy after diagnosis,and were treated with anti-infection after surgery.They were cured and discharged from hospital at 2-3 d after surgery.Conclusion Early misdiagnosis of atypical ectopic pregnancy is more likely to occur.The receiving doctors in primary hospitals should strengthen their understanding of the disease,improve the vigilance of women of childbearing age with acute abdomen,make detailed inquiries,conduct relevant examinations in time for those suspected of ectopic pregnancy,and comprehensively ana-lyze the condition,so as to reduce or avoid misdiagnosis and mistreatment of the disease.
关键词
妊娠,异位/误诊/阑尾炎/病史/宫腔内节育器/阴道B超/后穹隆穿刺/腹腔穿刺Key words
Pregnancy,ectopic/Misdiagnosis/Appendicitis/Medical history/Intrauterine device/Vaginal ultra-sound/Posterior fornix puncture/Abdominal puncture引用本文复制引用
基金项目
廊坊市科学技术研究与发展计划项目(2019013148)
出版年
2023
国家科技期刊平台
NSTL
万方数据