经阴道及腹部超声诊断异位妊娠在急诊中的应用

The use of trans-vaginal and trans-abdominal ultrasound in diagnosing emergency ectopic pregnancy

目的探讨急症中联合应用经阴道超声(TVS)与经腹部超声(TAS)早期快速诊断异位妊娠的诊断方法及图像特征,提高诊断符合率。方法我院对3年来收治的104例经住院治疗的异位妊娠患者进行回顾分析,孕妇入院前24 h至少行1次TVS、TAS超声检查,入院前超声诊断为异位妊娠的104例患者,45例经腹腔镜手术病理证实,59例经药物治疗前后行2次以上TVS、尿人绒毛膜促性腺激素(HCG)定性、重复血HCG定量测定及后穹窿穿刺等得到证实。结果104例患者,经TAS诊断88例,漏诊16例,超声诊断符合率84.6%(88/104);经TVS诊断102例,漏诊2例,超声诊断符合率98.1%(102/104),2种方法差异有显著性(P<0.05)。结论经TVS诊断有较高符合率,并具有无创、可重复性。TVS与TAS联合应用,互为补充,在急诊中可为临床提供更有价值的早期、快速诊断。

Objective To review the diagnostic accuracy rate and the image characters of emergency ectopic pregnancy in trans- vaginal and trans- abdominal ultrasound examinations （TVS and TAS）. Methods Retrospective study was carried out on 104 inpatients with ectopic pregnancy, 2003 -2006. They had passed at least one TAS or TVS before admission. The ultrasound diagnosis was affirmed by surgical pathology following laparoscopic operation in 45 surgical ca- ses, and by repeated PVS, urine and blood HCG and posterior fornix puncture in 59 conservatively treated cases. Resultsh was found that in the 104 cases, 88 were diagnosed by TAS, with 16 cases missed; 102 by TVS, with 6 cases missed. The rate of sensitivity was 84.6% and 98.1% respectively （ P 〈 0.05 ）. Conclusion TVS is more sensitive than TAS, though both of them are non - traumatic and repeatable. Their combined use will help establish earlier and rapid ultrasound diagnosis of emergency ectopic pregnancy.