2025 年第 4 期 第 20 卷

卵巢妊娠临床误诊漏诊讨论分析

Discussion and analysis of clinical misdiagnosis and missed diagnosis of ovarian pregnancy

作者：朱夏琴郝敏刘芸王志启

英文作者：Zhu Xiaqin Hao Min Liu Yun Wang Zhiqi

单位：首都医科大学附属北京友谊医院妇产科，北京100050

英文单位：Department of Obstetrics and Gynecology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：异位妊娠；卵巢；休克；外科手术

英文关键词：Ectopicpregnancy;Ovary;Shock;Surgicaloperation

• 摘要：

• 目的 探讨卵巢妊娠的临床特征、有效诊治方法及可能的高危因素，减少误诊漏诊。方法 收集并分析首都医科大学附属北京友谊医院2013年1月至2023年12月手术确诊的32例卵巢妊娠患者的病历资料，分析病例相关高危因素、手术及病理特点，总结卵巢妊娠诊治经验。结果 卵巢妊娠可发生于育龄期各年龄段，主要临床表现为停经、腹痛及阴道出血。术前临床准确诊断率低，存在部分误诊情况，8例曾外院或内科就诊，诊断为异位妊娠以外的疾病：宫内节育器移位，盆腔炎，胃肠炎。术前仅1例临床诊断卵巢妊娠，余均诊断输卵管妊娠。32例中31例（96.9%）术前行妇科超声检查。仅2例描述病变位于卵巢内，3例提示病变与卵巢关系密切。术中诊断也存在困难：23例（71.9%）行腹腔镜探查手术，9例（28.1%）行开腹探查手术。21例（65.6%）术中术后临床、病理均符合卵巢妊娠。4例（12.5%）术中未见明显绒毛，可见黄体，考虑卵巢黄体破裂合并妊娠，术后病理提示卵巢妊娠，术后修正诊断卵巢妊娠。3例（9.4%）术中可见卵巢破裂口，破口周围可见黄体组织，未见明显绒毛组织，术后病理提示腹腔积血中可见绒毛，术中术后诊断均考虑卵巢妊娠。4例（12.5%）术中探查双侧输卵管均完好，均可见卵巢破口，术中未见明显黄体破裂征象，术中诊断考虑卵巢妊娠破裂，术后全部病理均未见胎盘绒毛或滋养细胞，手术后人绒毛膜促性腺激素（hCG）下降满意。术后诊断仍考虑卵巢妊娠。所有患者均行病变侧卵巢楔形切除，手术后患者血hCG下降满意。无患者接受二次手术。结论 卵巢妊娠为妇产科急症少见类型，但腹腔内出血可危及孕产妇生命，提高认识并结合病史、超声检查及血hCG等可提高术前诊断率，以便更为快速地制定有效的诊治方案，腹腔镜下卵巢楔形切除术是安全有效的，术后需随访血hCG。

• Objective To investigate the clinical characteristics, effective diagnosis and treatment methods and possible high risk factors of ovarian pregnancy, and to reduce misdiagnosis and missed diagnosis. Methods The clinical data of 32 patients with ovarian pregnancy diagnosed by surgery in Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2023 were collected and analyzed. The related risk factors, surgical and pathological characteristics of the cases were analyzed, and the experience of diagnosis and treatment of ovarian pregnancy was summarized. Results Ovarian pregnancy could occur in all ages of childbearing age. The main clinical manifestations were amenorrhea, abdominal pain and vaginal bleeding. The preoperative clinical accurate diagnosis rate was low, and there were some cases of misdiagnosis. Eight cases were diagnosed with diseases other than ectopic pregnancy, such as intrauterine device displacement, pelvic inflammatory disease, and gastroenteritis, after visiting external hospitals or internal medicine departments. Before operation, only one case was clinically diagnosed as ovarian pregnancy, and the rest were diagnosed as tubal pregnancy. Thirty-one cases (96.9%) underwent gynecological ultrasound examination before operation. Only 2 cases described that the lesion was located in the ovary, and 3 cases suggested that the lesion was closely related to the ovary. There were also difficulties in intraoperative diagnosis: 23 cases (71.9%) underwent laparoscopic exploration surgery, and 9 cases (28.1%) underwent laparotomy surgery. Twenty-one cases (65.6%) were clinically and pathologically consistent with ovarian pregnancy during and after surgery. Four cases (12.5%) showed no obvious villi during surgery, but corpus luteum was visible, suggesting ovarian corpus luteum rupture with pregnancy. Postoperative pathology suggested ovarian pregnancy, and the diagnosis of ovarian pregnancy was revised after surgery. Three cases (9.4%) showed ovarian rupture during surgery, with corpus luteum tissue visible around the rupture and no obvious chorionic tissue. Postoperative pathology suggested the presence of chorionic villi in abdominal hematoma, and both intraoperative and postoperative diagnoses considered ovarian pregnancy. Four cases (12.5%) underwent intraoperative exploration of both fallopian tubes, all of which were intact and showed ovarian rupture. No obvious corpus luteum rupture was observed during the operation, and the intraoperative diagnosis considered ovarian pregnancy rupture. All postoperative pathology showed no placental villi or trophoblast cells, and the postoperative chorionic gonadotropin (hCG) decreased satisfactorily. Ovarian pregnancy was still considered in the postoperative diagnosis. All patients underwent wedge resection of the affected ovary, and the patient′s blood hCG decreased satisfactorily after surgery. No patients underwent secondary surgery. Conclusion Ovarian pregnancy is a rare type of emergency in obstetrics and gynecology, but intra-abdominal bleeding can endanger the life of pregnant women. Improving awareness and combining medical history, ultrasound examination, and blood hCG can improve preoperative diagnosis and treatment rates, so as to develop effective diagnosis and treatment plans more quickly. Laparoscopic ovarian wedge resection is safe and effective, and postoperative follow-up of blood hCG is necessary.