经阴道彩色多普勒超声对输卵管妊娠中妊娠黄体的临床研究

Value of the corpus luteum in diagnosis of tubal pregnancy by transvaginal color Doppler ultrasound

目的探讨妊娠黄体在超声诊断输卵管妊娠(TP)中的临床意义。方法临床拟诊宫外孕患者50例,于术前行经阴道超声(TVS)检查。在确定TP包块的同时,对妊娠黄体进行观察,CDFI显示双侧子宫动脉输卵管支血流,检测收缩期最大流速(PSV)、舒张末期流速(EDV)、平均流速(TAmax)、搏动指数(PI)及阻力指数(RI),并进行统计学处理。结果在确诊为TP的40例中,超声诊断符合38例。妊娠黄体的声像图表现可分为:薄壁囊肿型、薄壁囊肿内部光点型、厚壁囊肿型、实质低回声型四种类型。超声显示妊娠黄体38例(95.0%),黄体与TP同侧33例(86.8%);与TP非同侧5例(13.2%)。黄体与TP同侧时,患侧输卵管动脉血流EDV、TAmax明显高于健侧,PI、RI则明显低于健侧(P<0.05),PSV双侧无统计学差异(P>0.05);黄体与TP非同侧时,双侧血流参数均无统计学意义(P>0.05)。结论妊娠黄体在超声诊断早期TP时具有重要的定位作用。

Objective To investigate the value of corpus luteum in diagnosis of tubal pregnancy （TP） by transvaginal sonography （TVS）. Methods Fifty cases of clinically suspected TP were examined by TVS pre-operation. Transvaginal sonography included observation of TP mass, corpus luteum and hemodynamic parameters of the both left and right tubal arteries, by means of measuring peak systolic velocity （PSV）, end diastolic velocity （EDV）, time average maximum （TAmax）, pulsatility index （PI） and resistance index （RI）. The parameters on bilateral tubal arteries were compared statistically. Results The luteum were found in 38 of 40 cases with TP conformed by surgery and pathology. The corpus luteum can be divided into four types according to sonographic appearance, the cyst with thin wall, the cyst with thin wall and internal echoes, the small cyst with thickened wall, and hypoechoic solid. Thirty-three were located on the same side as TP and 5 on the other side. When the luteum and TP on the same side, EDV and TAmax of the TP side tubal artery were higher than the other side, but PI and RI were lower （P〈0.05）, there was no difference of PSV between two sides （P〉0.05） when the luteum and TP on different side, there was no differences in all the parameters. Conclusion Corpus luteum was very helpful to early diagnose the location of TP.