输卵管妊娠血液动力学改变的彩色多普勒超声研究

Study on tubal artery flow during tubal pregnancy by transvaginal color Doppler sonography

目的对比分析输卵管妊娠(tubal pregnancy,TP)时双侧输卵管动脉血流,探讨彩色多普勒血流显像(color Doppler flow imaging,CDFI)诊断输卵管妊娠的价值。方法临床拟诊宫外孕患者40例,于术前行经阴道超声(transvaginal scanning,TVS)检查,CDFI显示双侧子宫动脉输卵管支血流,用脉冲多普勒检测收缩期最大流速(peak systolic velocity,PSV)、舒张末期流速(end diastolicvelocity,EDV)、平均流速(time averge matum,TAMAX)、搏动指数(pulsatility index,PI)及阻力指数(resistivity index,RI),并进行统计学处理。结果40例均确诊为TP,其中33例黄体位于患侧,输卵管动脉血流信号较健侧丰富,色泽明亮鲜艳,血流频谱呈单向高舒张期、低阻特征,EDV、TAMAX明显高于健侧,PI、RI则明显低于健侧(P<0.05),PSV双侧差异无统计学意义(P>0.05);5例黄体位于健侧者,所有参数差异无统计学意义(P>0.05)。2例TP破裂出血者,患侧EDV、TAMAX均低于健侧,且PI、RI高于健侧。结论经阴道CDFI监测输卵管动脉血流有助于TP的早期定性和定位诊断。

Objective To assess the value of transvaginal color Doppler sonography （TVCDS） in the diagnosis of tubal pregnancy（TP） by comparative study of tubal artery flow. Methods Forty cases of clinically suspected TP were examined by TVCDS prior to surgery. The bilateral tubal artery were displayed by color Doppler flow imaging （CDFI） and the hemodynamics parameters were measured by pulse Doppler （PD）, such as peak systolic velocity （PSV）, end diastolic velocity （EDV）, time average maxum （TAMAX）, pulsatility index （PI） and resistivity index （RI）. The hemodynamics parameters on bilateral tubal artery were compared and analized statistically. Results In 40 cases of TP conformed by surgery and pathology, the luteum were found in 38 cases and in which 33 were in the TP side and 5 in the other. In the former the tubal artery flow signal of TP side was abundant and bright compared to the other. The spectrum showed high-diastolic and low-resistance flow in TP side. EDV and TAMAX of the TP side were usually higher than another. PI and RI of the TP side were lower than the other（P 〈0. 05） , while no difference was shown in PSV（P〉0. 05）. In the later, no difference was shown in all the parameters. In two cases of TP with a great quantity of pelvic and abdominal liquid, EDV and TAMAX of the TP side were lower than the other and PI and RI of the TP side were higher. Conclusion TVCDS was very helpful to early diagnose in TP.