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1、婦科急腹癥GyneacologicAcuteAbdomen以腹部疼痛為主要癥狀的一組婦科急癥。腹痛是這三種疾病的主要癥狀急：發(fā)病突然，癥狀重，危及生命ectopicpregnancyextrauterinepregnancytorsionoftheovarianpedicletwistedovariancystsacutepelvicinflammatorydiseasearupturedovarianlutiaEndomitriosisstoryAcuteabdominalpainwantedtogivebow
2、elstheabdomenrigidityandtenderness、reboundtenderness.passwaterfaintedonthespotbloodpresurewaszeroDiagnosis?ectopicpregnancyEctopicPregnancyDefinition:EctopicpregnancyisdefinedaspregnancyoutsiedtheuterinecavityMostcommonsiteofoccurrenceisthefallopiantubetubalp
3、regnancy88.5%ovarianpregnancy4.5%cervicalpregnancy0.7%pregnancyinrudimentaryhorn1.5%pregnancyininterstitial4.8% abdominalpregnancy47863125theUK:0.25-1%gettingmorecommon.InFinland,tripledbetween1966and1985intheUS,afour-foldrisebetween1970and1983.InJamaica,anun
4、usuallyhighrateofectopicpregnancy(1in28deliveries).etiology:受精卵著床于子宮體腔以外?；蛞驗檩斅压芙Y(jié)構(gòu)異常，或受精卵行走異常。FACTORS輸卵管結(jié)構(gòu)異常受精卵行走異常PelvicinflammatorydiseaseAdvancingage TubalsurgeryDESexposure Previousectopic，repeatedIVFandovulationinduction Previoustermination經(jīng)宮腔或腹腔向?qū)?cè)ofpreg
5、nancy輸卵管移行輸卵管發(fā)育不良或功能異常smoke IUDIntrauterinedeviceusage肌瘤，卵巢腫物，EMSalpingitis→adhesionsofthetubalwall,→retardsthepassageofthefertilizedegg→Ectopicpregnancy。輸卵管的變化部位壺腹部峽部間質(zhì)部解剖管腔寬窄較窄肌層較厚薄很厚停經(jīng)8-12周6周4個月表現(xiàn)流產(chǎn)破裂破裂abdominalpainofectopicpregnancytubalrupture:sharpcolic
6、kypaintubalabortion:隱痛、脹痛伴隨癥狀Strainingatstoolfaintnessandshockamenorrheaormenstrualperioddelayedspottingtypebleeding掉出蛻膜管型子宮的變化：子宮稍大內(nèi)膜蛻膜反應(yīng)胚胎死亡：蛻膜剝離→出血Arias-Stell反應(yīng)sumerizetheSymptomsLowerabdominalpainandAbnormaluterinebleedingapproximately1-2weeksafterthemiss
7、edmenstrualperiod“異位妊娠最容易診斷，異位妊娠最不易診斷”體檢全身：貧血貌，面色蒼白，血壓下降，脈搏弱，快。四肢冰冷；腹部：拒按，腹膜刺激征，全腹壓痛、反跳痛重，肌緊張輕(tenderness,reboundtendernessandmuscularrigidity)，移動性濁音（＋）婦科：后穹隆飽滿，宮頸著色，舉痛，搖擺痛，子宮略大，軟，可有飄浮感，一側(cè)附件區(qū)觸及不規(guī)則包塊，壓痛明顯。內(nèi)科外科急性胃腸炎闌尾炎中毒性痢疾腸梗阻 輸尿管結(jié)石 膽囊炎脾破裂輔助檢查Urinepregnancytest
8、-maybenegative，(SerialserumB-hCGtesting)hCG(HumanChorionicgonadotropin),culdocentesis：抽出血，15分鐘不凝固。Ultrasound：宮腔空虛，輸卵管部位出現(xiàn)妊娠囊和異?；芈晥F，子宮前、后有液性暗區(qū)可助診。子宮內(nèi)膜：為排除宮內(nèi)妊娠流產(chǎn)，可刮宮。送病理。血常規(guī)，Hb進行性下降?？梢匝簼饪s。
