應(yīng)用陰道三維超聲診斷及鑒別診斷宮角妊娠與輸卵管間質(zhì)部妊娠的價值

練敏+何曉琴

【摘要】 目的：探討應(yīng)用經(jīng)陰道三維超聲對宮角妊娠與輸卵管間質(zhì)部妊娠的診斷與鑒別診斷。方法：回顧性分析2016年6月-2017年6月本院收治的經(jīng)手術(shù)及病理證實(shí)的宮角妊娠患者33例及輸卵管間質(zhì)部妊娠患者40例的臨床資料，比較兩種超聲的總診斷準(zhǔn)確率，觀察二維及三維陰道超聲的聲像圖特征。結(jié)果：73例患者中，經(jīng)陰道二維超聲檢查，正確診斷為宮角妊娠26例，輸卵管間質(zhì)部妊娠28例，總診斷準(zhǔn)確率為73.9%（54/73）；經(jīng)陰道三維超聲檢查，正確診斷為宮角妊娠30例，輸卵管間質(zhì)部妊娠37例，總診斷準(zhǔn)確率為91.7%（67/73），三維超聲總診斷準(zhǔn)確率明顯高于二維超聲（P<0.05）。在三維超聲檢查診斷中存在誤診6例，均為包塊型，宮角妊娠及輸卵管間質(zhì)部妊娠各誤診3例。其中有2例宮角妊娠與輸卵管間質(zhì)部妊娠相互誤診，1例輸卵管間質(zhì)部妊娠誤診為滋養(yǎng)細(xì)胞疾病，1例宮角妊娠誤為縱膈子宮一側(cè)妊娠。結(jié)論：經(jīng)陰道三維超聲成像對宮角妊娠與輸卵管間質(zhì)部妊娠的診斷與鑒別診斷具有較高準(zhǔn)確率，并明顯優(yōu)于二維超聲成像。

【關(guān)鍵詞】 宮角妊娠； 輸卵管間質(zhì)部妊娠； 三維； 超聲

Value of Three-dimensional Transvaginal Ultrasound in Diagnosis and Differential Diagnosis of Cornual Pregnancy and Interstitial Tubal Pregnancy/LIAN Min，HE Xiaoqin.//Medical Innovation of China，2017，14（32）：070-074

【Abstract】 Objective：To investigate the value of three-dimensional transvaginal ultrasound in diagnosis and differential diagnosis of cornual pregnancy and interstitial tubal pregnancy.Method：The clinical data of 33 cases of cornual pregnancy and 40 cases of interstitial tubal pregnancy were confirmed by surgery and pathology in our hospital from June 2016 to June 2017 were retrospectively analyzed，the total diagnostic accuracy of two kinds of ultrasound was compared，and the sonographic features of two-dimensional transvaginal ultrasound and three-dimensional transvaginal ultrasound were observed.Result：Among 73 patients，there were 26 cases of cornual pregnancy and 28 cases of interstitial tubal pregnancy were diagnosed by two-dimensional ultrasound，the overall accuracy rate was 73.9%（54/73）.At the same time，30 cases of cornual pregnancy and 37 cases of interstitial tubal pregnancy were diagnosed by three-dimensional ultrasound，the overall accuracy rate was 91.7%（67/73），the overall accuracy rate of three-dimensional ultrasound was significantly higher than that of two-dimensional ultrasound（P<0.05）.There were 6 cases of misdiagnosis in three dimensional ultrasonography，all of them were lump masses，3 cases were misdiagnosed as cornual pregnancy and interstitial tubal pregnancy.Among them，2 cases of cornual pregnancy and tubal interstitial pregnancy misdiagnosed each other，1 case of interstitial tubal pregnancy misdiagnosed as gestational trophoblastic disease，1 case of cornual pregnancy mistaken for unilateral pregnancy side of the mediastinum.Conclusion：Three-dimensional ultrasound have high accuracy rate in diagnosis and differential diagnosis of cornual pregnancy and interstitial tubal pregnancy，and obviously higher than that of two-dimensional ultrasound.endprint

【Key words】 Comual pregnancy； Interstitial tubal pregnancy； Three-dimensional； Ultrasound

First-authors address：Xiamen Maternity and Child Health Care Hospital，Xiamen 361000，China

doi：10.3969/j.issn.1674-4985.2017.32.017

宮角妊娠（Cornual pregnancy）和輸卵管間質(zhì)部妊娠（Interstitial tubal pregnancy）的發(fā)生率均低，僅占異位妊娠的4.2%[1]。但近年來隨著人工流產(chǎn)、清宮等宮腔手術(shù)、輔助生殖技術(shù)應(yīng)用增多，及盆腔炎、子宮內(nèi)膜炎、宮腔粘連、輸卵管炎癥發(fā)病率的提高，均致受精卵沒能在宮腔正常部位著床，使得宮角妊娠及輸卵管間質(zhì)部妊娠的發(fā)生率均逐漸升高[2]。宮角妊娠既有向?qū)m角外擴(kuò)展的可能，亦有向?qū)m內(nèi)延伸為正常妊娠的可能[3]。而輸卵管間質(zhì)部妊娠往往因間質(zhì)部管腔窄而短，且此處是子宮和卵巢動脈匯聚的地方，血管密集，如果妊娠囊著床于該處極易發(fā)生破裂，引起嚴(yán)重的出血，危及生命，一旦確診須手術(shù)切除或進(jìn)行全身或局部化療的保守治療[4-5]。而發(fā)病初期患者的臨床癥狀極為相似，術(shù)前容易誤診，因此能盡早準(zhǔn)確的診斷子宮角妊娠與間質(zhì)部妊娠對于臨床具有重要的意義。……