双语病例报告罕见双侧输卵管自发性同时
Ararecaseofspontaneoussimultaneousbilateraltubalectopicpregnancy
罕见双侧输卵管自发性同时异位妊娠一例
ABSTRACT
摘要
Ectopicpregnancyisstillanimportantcauseofmaternalmortality.Theincidenceofectopicpregnanciesisreportedtoberising.Spontaneousbilateraltubalectopicpregnancyintheabsenceofprecedinginductionofovulationisextremelyunusualoccurrenceandistherarestformofectopicpregnancy.Theestimatedincidenceis1intoofallectopiccorrespondingtooneperlivebirths.Thepreoperativediagnosisofbilateralectopicpregnancyremainsachallenge.Serumβ-hCG,TVS,colorDopplerhelpmakingdiagnosisofectopicpregnancybutlaparoscopyisgoldstandarddiagnosticmodality.Thediagnosisofbilateraltubalpregnancyisusuallymadeintra-operatively.Thisunderscorestheimportanceofidentifyingandcloselyexaminingbothtubesatthetimeofsurgery,eveninthepresenceofsignificantadhesivedisease.Salpingostomy,salpingotomy,salpingectomy,segmentalresection,fimbrialexpressionaretheoperativemodalitiesdescribedformanagementofectopicpregnancy.
异位妊娠仍然是孕产妇致死的重要原因。据报道，异位妊娠发病率一直在上升。在没有排卵前诱导的情况下，自发性双侧输卵管异位妊娠是一种极不寻常的现象，也是异位妊娠最罕见的一种形式。据估计，相对于1/的活产率而言，异位妊娠发病率为1/~1/。双侧异位妊娠的术前诊断仍然面临着挑战。血清β-hCG，TVS，彩色多普勒能够辅助诊断异位妊娠，但是腹腔镜检查才是黄金标准诊断方式。双侧输卵管妊娠诊断通常在手术内进行，这强调了即使在明显存在粘合性疾病的情况下，手术时识别和密切检查的重要性。输卵管造口术、输卵管切开术、输卵管切除术、节段性切除以及菌毛表达均是异位妊娠的手术管控方式。
CASEREPORT
病例报告
A36yearsfemalewithhistoryofprimaryinfertilitywithirregularmensescamewith6weeksofamenorrhea.Shehadundergonelaparoscopicovariancystectomywithfulgurationofendometrioticspotsandadhesiolysis3yearsback.Shehadhistoryof2previousfailedIVFcycleswhichweredone2yearsand1yearback.Shehadundergonediagnostichysteroscopyandlaparoscopicpolycysticovariesdrilling.Since6monthsshewasnottakinganyinfertilitytreatment.Urinepregnancytestwasdonewhichshowedpositivepregnancytest.Transvaginalsonographyshowedthickenedendometrium(endometrialthickness=10mm)withintrauterine2mmsaclikestructureandbilateralhaemorrhagiccystsofovaries.Soshewasadvisedtofollowupwithrepeatultrasonographyafter2weeks.
患者，36岁，女性。病史：原发性不孕，月经不调，闭经6周。3年前，行腹腔镜卵巢囊肿切除术，子宫内膜异位点电灼以及黏连松解术。患者于两年前和一年前分别做了体外受精周期，均未成功。曾做诊断性子宫镜检查和腹腔镜多囊卵巢打孔术。最近6个月，患者未接受任何不孕不育治疗。尿妊娠检查结果显示阳性妊娠。经阴道超声检查显示子宫内膜增厚（子宫内膜厚度=10mm），子宫内存在2mm囊样结构，以及双侧卵巢出血性囊肿。因此，主治医生建议2周后再次进行超声检查。
Butafter10days,shepresentedwithacutepaininbothflanks.Shewashaemodynamicallystable.Onperabdominalexaminationtherewasminimaltendernessinleftiliacregion.Onpervaginalexamination,bulkyuteruscorrespondingto6-8weekssizewithbilateralfornicealfullnessandminimaltendernessinbothforniceswaselicited.
但是10天后，患者双腹侧出现急性疼痛症状，血液动力学稳定。经腹部检查显示左髂区出现轻微压痛。经阴道检查显示，子宫扩大，相当于妊娠6-8周大小，双侧穹隆丰满，有轻微压痛感。
Nocervicalmotiontendernesswasobserved.Serumβ-hCGwas(correspondingto5-6weeksofgestation.Urgentultrasonographydonewhichwassuggestiveofrightsidedunrupturedectopicpregnancywithlefthaemorrhagicovariancyst(Trilaminarendometrialpatternwith15mmthicknesswithnointrauterinegestationalsac,Rightadnexalmassof1.78cmx1.29cmshowingcharacteristic‘gestationalsacwithsurroundingtubalring’withnofetalcardiacactivitydemonstrableandcolourdopplershowingcharacteristicincreasedvascularitywith‘ringoffirepattern’,Leftovarywasbulkywith?haemorrhagicovariancyst)[Figure1(a)and(b)].
无颈椎运动压痛。血清β-hCG（相当于胎龄5-6周），紧急超声检查显示右侧异位妊娠，输卵管未破裂，伴左侧出血性囊肿（三层子宫内膜形态，厚度为15mm，无宫内孕囊，右附件包块1.78cmx1.29cm显示特征性“妊娠囊伴周围输卵管环”，无胎心，彩色多普勒检查显示特征性血管增多，呈“火环”状，左卵巢扩大？出血性卵巢囊肿）[图1（a）和（b）]。
Figure1(a):Obviousgestationalsaccorrespondingto4w1dwithinanechoicsacsurroundedbytubalring,nofetalcardiacactivitydemonstrable.
图1（a）：明显孕囊，对应于消声囊内4w1d，周围包围输卵管环，无胎心
Figure1(b):Ringoffirepattern.
图1（b）：火环形态
Allroutineinvestigationsweredone.Adequatebloodwascrossmatchedandreserved.Patientandrelativeswerecounselledandexplainedregardingdiagnosis,treatmentrequiredandoptionsoftreatmentavailable.Patientandrelativesweredesirousoffuturefertility.Butpatient全国白癜风银川最好的白癜风医院
