经阴道彩色多普勒超声多参数诊断输卵管妊娠的准确性评价

Accuracy of transvaginal color Doppler ultrasonography in the diagnosis of tubal pregnancy using multiple parameters

目的评价经阴道彩色多普勒超声(TVCD)多参数诊断输卵管妊娠的准确性。方法采用TVCD对50例输卵管妊娠患者(输卵管妊娠组)的子宫动脉、肌层螺旋动脉、输卵管滋养动脉、子宫内膜区螺旋动脉阻力指数(RI)及子宫内膜厚度分别进行检测,并与30例正常宫内早早孕(对照组)的多项检测参数进行对照分析。结果输卵管组患者的子宫动脉、肌层螺旋动脉及子宫内膜区螺旋动脉平均RI值均高于对照组,两组比较差异有非常显著性(P<0.01);彩色多普勒血流成像(CDFI)对输卵管组螺旋动脉的显示率为44%,低于对照组的显示率100%(P<0.01);输卵管组检出子宫内膜区螺旋动脉4例(4/50),对照组检出30例(30/30),两组比较差异有非常显著性(P<0.01);输卵管组检出滋养动脉45例(45/50),其平均RI值为0.45±0.04;输卵管妊娠组46例(46/50)子宫内膜厚度<15mm,对照组28例(28/30)子宫内膜厚度≥15mm,两组子宫内膜厚度测值比较差异有非常显著性(P<0.01)。TVCD多项参数诊断输卵管妊娠的敏感性为96.00%,特异性100%,准确性97.50%,阳性预期值100%,阴性预期值93.75%。结论采用多项参数检测可提高输卵管妊娠与宫内早早孕的鉴别诊断准确性。

Objective To explore the accuracy of transvaginal color Doppler ultrasonography(TVCD)imaging for the multiple parameters in the diagnosis of tubal pregnancy.Methods The blood flow RI values of uterine artery,helicine artery,tubal trophoblast artery,uterine endometrial artery and the multiple parameters in the uterine endometrial thickness in 50 cases of tubal pregnancy(TP group)were tested and compared with corresponding values in 30 cases of very early normal pregnancy stage(C group).Results The average RI value for uterine artery,helicine artery,uterine endometrial artery in the TP group was higher than that of the C group(P<0.01)and the CDFI positive rate for uterine helicine artery in the TP group was significantly lower than that of the C group(P<0.01).The blood flow detection rate for uterine endometrial artery in the TP group was 8%,but in the control group was 100%(P<0.01).The blood flow detection rate for trophoblast artery in the TP group was 90% and the average RI value was 0.45±0.04.The uterine endometrial thichness was <15 mm of 92.00% in the TP group,but was ≥15 mm of 93.33% in the control group(P<0.01).Conclusions In our study the diagnostic sensitivity,specificity,accuracy,the positive predictive value and the negative predictive value were 96.00%,100%,97.50%,100% and 93.75%,respectively in the TP group.It is suggested that multiple parameters on transvaginal color Doppler ultrasonography may improve the accuracy of differential diagnosis between tubal pregnancy and normal pregnancy in very early trimester.