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目的 探讨脾异位妊娠(SEP)临床特点，分析误诊原因，提出防范误诊措施，并分享多学科协作(MDT)救治经验。方法 回顾性分析2024年3月诊治的1例SEP误诊为异位妊娠合并外伤性脾破裂患者的临床资料。结果 患者因“腹痛2 h”入院。腹痛系上腹部受撞击后出现，初为左上腹痛，后波及全腹。急诊超声提示盆腹腔大量积液，宫内未见妊娠组织；尿妊娠试验阳性。初步诊断：异位妊娠合并外伤性脾破裂；失血性贫血。完善术前检查并行多学科会诊后行急诊腹腔镜探查术。术中见盆腹腔内大量积血及凝血块，子宫及双附件外观正常，表面无活动性出血及破裂口，向上探查，左上腹积聚大量凝血块，清除凝血块后见脾脏背面近下极有一包块伴活动性出血，与家属充分沟通后行脾肿物切除术。术后病理示：脾组织内见滋养细胞及绒毛，符合异位妊娠。误诊时间2 d。确诊后经多学科协作救治，患者术后第7天痊愈出院。结论 育龄期女性以腹痛就诊时，必须全面评估异位妊娠可能性，尤其需警惕罕见着床部位，以降低漏误诊风险。早期多学科协作对SEP的成功诊治至关重要。
Abstract：Objective To investigate the clinical characteristics of splenic ectopic pregnancy(SEP), to analyze the causes of misdiagnosis, to propose measures to prevent misdiagnosis, and to share the experience of multidisciplinary team(MDT) treatment. Methods A retrospective analysis was conducted on the clinical data of one patient with SEP misdiagnosed as ectopic pregnancy complicated by traumatic splenic rupture and treated in March 2024. Results The patient was admitted to the hospital due to abdominal pain for 2 h. The abdominal pain occurred after the impact of the upper abdomen, initially in the left upper quadrant, and later involved the whole abdomen. Emergency ultrasound showed massive pelvic and abdominal effusion, with no intrauterine gestational tissue, urine pregnancy test was positive. The initial diagnosis was ectopic pregnancy with traumatic splenic rupture, and hemorrhagic anemia. After comprehensive preoperative evaluation and MDT consultation, emergency laparoscopic exploration was performed. During the operation, a large amount of hemoperitoneum and blood clots were found in the pelvic and abdominal cavity, and the uterus and double adnexa appeared normal, with no active bleeding or rupture on the surface. Upon further exploration upward, a large amount of blood clots was found accumulated in the left upper quadrant of the abdomen, and after the blood clots were removed, a mass with active bleeding was found on the dorsal surface of the spleen near the lower pole. After full communication with the family, a splenic mass resection was performed. Postoperative pathology showed trophoblast cells and villi in the spleen tissue, which was consistent with ectopic pregnancy. The misdiagnosis lasted 2 d. After MDT treatment following diagnosis, the patient was cured and discharged on the 7 th day after surgery. Conclusion When women of reproductive age present with abdominal pain, a comprehensive assessment of the possibility of ectopic pregnancy is necessary, with particular attention to rare implantation sites to reduce the risk of missed or misdiagnosis. Early MDT treatment is crucial for the successful diagnosis and treatment of SEP.
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基本信息:
中图分类号:R714.22
引用信息:
[1]郝俊宽,孙莉,殷珊珊.罕见脾异位妊娠临床误诊分析及多学科救治经验[J].临床误诊误治,2026,39(10):20-25.
基金信息:
河北省医学科学研究课题计划项目（20261435）
2025-09-01
2025
2026-05-18
2026-05-20
2026
1
2026-05-28
2026-05-28