Ectopic Pregnancy: Clinical Review and Diagnostic Strategies

異位妊娠：臨床審查與診斷策略

蔡宏志(Horng-Jyh Tsai) ； 劉崇賢(Chung-Hsien Liu) ； 李茂盛(Maw-Sheng Lee)

《中山醫學雜誌》 14卷3期 (2003/09) Pp. 429-435

https://doi.org/10.30096/CSMJ.200309.0006

摘要

目的：本文以臨床審查子宮外孕病例來分析研究診斷子宮外孕的策略。方法：以一個大學醫院214個証實子宮外孕病例回溯性審查臨床資料，症狀與徵候，可能的危險因素。子宮外孕的診斷策略分析借以超音波攝影，尤其經由陰道執行者，一系列血清定量人類絨毛膜促性腺激素（hCG）相關的，已建立公認的鑑別區值（以上或以下），以及只用超音波即可診斷者。結果：卵管懷孕並無左右邊好發之不同，但6例子宮角（間質部）懷孕有5例發生在右側。子宮外孕最常見的症狀與徵候除月經延遲之外為腹痛（74.3%），陰道出血或點狀出血（59.3%）。協助生殖技術相關的子宮外孕19例中17例（89.5%）為非急症診斷者。子宮外孕之危險因素有病史曾有先前的子宮外孕，不孕症，以前的手術，現在有子宮內避孕器。確立的子宮外孕診斷策略上應用超音波與hCG鑑別區值在2000mIU/ml或以上者有91例（42.5%）可以正確地診斷。結論：以目前診斷子宮外孕的試驗而言，解決方案中，以超音波合併hCG成為最常使用且最可靠的方式。如有任何疑問，經陰道操作的超音波檢查與一系列之定量hCG值應該常規地且自由地應用，尤其是不典型式的子宮外孕。

關鍵字

異位妊娠 ； 診斷 ； 超音波檢查 ； hCG

並列摘要

Objective: To review ectopic pregnancy clinically and analyse strategies in the diagnosis of ectopic pregnancy. Methods: Clinical data, symptoms and signs, possible risk factors of 214 documented
ectopic pregnancies were retrospectively reviewed in a university based hospital setting. Strategies in the diagnosis of ectopic pregnancy were analysed using ultrasonography, especially transvaginal ultrasonography, serial serum quantitative hCGs with established discriminatory zones, above or below, and using ultrasound only. Results: There was no laterality for tubal pregnancy, but 5 out of 6 cases of cornual pregnancy were on the right side. The most common symptoms and signs of ectopic pregnancy
except missed periods were abdominal pain (74.3%) and vaginal bleeding or spotting (59.3%). Seventeen of nineteen cases related patients undergoing assisted reproduction therapy (89.5%) were diagnosed with ectopic pregnacy on a non-emergency basis. Risk factors for ectopic pregnancy were history of ectopic pregnancy, infertility, previous surgery, and presence of intrauterine device. Using ultrasound and discriminatory zone of hCG level 2000 mIU/ml and above, 91(42.5%) cases of the confirmed cases of ectopic pregnacy could be diagnosed correctly. Conclusion: Algorithms combined with ultrasound and hCG are the most commonly used
methods for accurately diagnosing ectopic pregnancy. Transvaginal ultrasound and serial quantitative hCGs should be routinely and freely used, especially in atypical ectopic pregnancy.

並列關鍵字

words: Ectopic pregnancy ； Diagnosis ； Ultrasound ； hCG