经阴道超声检查诊断无症状输卵管妊娠的价值

The Value of Transvaginal Ultrasonography in Diagnosing Asymptomatic Ectopic Pregnancy

目的:评价经阴道超声检查(TVUS)对无症状输卵管妊娠(TP)的临床诊断价值。方法:选择68例临床怀疑输卵管妊娠患者,其中β-血清人绒毛膜促性腺激素(β-HCG)水平超过1500U/L或妊娠超过37天者52例,排除了有急腹症的患者16例,均施行腹腔镜检查与TVUS,并经手术病理证实为TP诊断。结果:52例患者中,TVUS怀疑输卵管妊娠50例,包块位于右侧输卵管28例,其中间质部4例;左侧输卵管22例,其中间质部5例。50例患者中,48例与腹腔镜检查结果一致。另2例中,1例被误诊,1例TVUS所见的TP包块位置与腹腔镜检查不一致。超声所见为正常的2例,经腹腔镜检查也未能确定TP病灶。TVUS对TP诊断的敏感性、特异性、阳性预期值,阴性预期值分别为100%、50%、98%、100%。结论:TVUS对早期诊断无症状输卵管妊娠具有重要的临床价值和可信度,而且对希望保守治疗的患者能够代替诊断性腹腔镜检查。

Objective：To evaluate diagnostic value of the transvaginal ultrasonography （TVUS） in the asyrnptomatic tubal pregnancy （TP）.Methods：We selected 68 women whom were clinically suspected of TP. 52 cases without sonographic evidence of the intrauterine gestational sac with serum 15-hCG level beyond 1500 mlU/ml or gestation period beyond 37 days were performed the laparoscopy and be compared with the TVUS findings, all surgical specimens were confirmed by the pathological examination. Another 16 cases with acute abdomen were excluded. P, esults： of 52 subjects, TP were suspected by TVUS in 50 patients,suspected TP site on right and left fal- lopian tuba in 24 and 17 cases, right and left interstitial portion in 4 and 5 cases, normal in 2 cases, respectively. Of 52 cases, 49 TP cases were finally confirmed by iaparoscopic and pathological examination. There were two cases of misdiagnosis, lesion site be discordance in one and TP mass not be identified by laparoscopy in another one. In 2 cases with normal TVUS findings,no suspicious of TP were identified by laparoscopy and be diagnosed as sponateous abortion. By 2 x 2 contingency table analysis, sensitivity, specificity, positive predictive value, and negative predictive value of the TVUS for diagnosis of the TP were 100%, 50%, 98%, and 100%, respectively. Conclusions： The TVUS is very powerful and reliable in diagnosis of TP, and may replace the diagnostic laparoscopy if conservative management is intended.