体外受精-胚胎移植后经阴道超声对早期异位妊娠的诊断价值

Value of transvaginal ultrasonography in diagnosing early ectopic pregnancy after in vitro fertilization-embryo transfer

目的探讨体外受精-胚胎移植(IVF-ET)后经阴道超声(TVS)对早期异位妊娠的诊断价值。方法对2008年1月￣2010年7月,在该院生殖中心经IVF-ET助孕后,由TVS检查并经手术和病理证实的98例异位妊娠患者进行回顾性分析。结果 98例患者中TVS共诊断96例,经手术证实均未破裂,其中单纯异位妊娠占82.65%(81/98),宫内外复合妊娠(HP)占15.31%(15/98),漏诊和误诊各1例,共占2.04%(2/98)。TVS诊断早期异位妊娠的敏感性为97.96%(96/98)。96例患者的妊娠部位包括宫角妊娠3例,输卵管妊娠93例,其中单侧输卵管双胎妊娠5例,输卵管间质部妊娠13例。输卵管妊娠呈环状征、典型孕囊型及混合包块型3种类型,分别占11.83%(11/93)、56.99%(53/93)、31.18%(29/93)。3种类型异位妊娠患者移植后14 d血β-hCG的均值(除去HP)为(174.50±124.95)mIU/mL,其差异均无显著性(P=0.582),但以典型孕囊型14 d血β-hCG值最高。异位妊娠患者移植后14 d血β-hCG值显著低于宫内妊娠者(P=0.000)。TVS对异位妊娠的诊断时间最早为移植后18 d,最晚54 d,平均(25.83±6.05)d;89.58%的病例至移植后32 d均可由TVS诊断。HP的平均诊断时间为移植后(27.73±6.30)d。结论 IVF-ET后,89.58%的异位妊娠患者能在移植后32 d内由TVS诊断出,结合血β-hCG并动态追踪复查能进一步提高诊断率。因此,TVS对IVF-ET后早期异位妊娠具有重要的诊断价值。

【Objective】 To evaluate the clinical value of transvaginal ultrasonography（TVS） in the diagnosis of early ectopic pregnancy after in vitro fertilization-embryo transfer（IVF-ET）.【Methods】 98 patients of ectopic pregnancy were analyzed retrospectively,who were examined by TVS after IVF-ET and then confirmed by operation and pathological results from January 2008 to July 2010.【Results】 Among the 98 patients,96 cases were diagnosed as ectopic pregnancies by TVS which were confirmed unruptured by operation： simple ectopic pregnancies accounted for 82.65%（81/98）,heterotopic preganancies accounted for 15.31%（15/98）,2 cases of missed diagnosis and misdiagnosis together accounted for 2.04%（2/98）.The sensitivity of diagnosing ectopic pregnancy by TVS was 97.96%（96/98）.From the regional perspective,these 96 ectopic pregnancies were consisted of 3 cornual pregnancies and 93 tubal pregnancies： including 5 unilateral tubal twin pregnancies and 13 interstitial pregnancies.Three grey-scale appearances of tubal pregnancy were revealed： hyper-echoic ring,11.83%（11/93）;typical gestational sac,56.99%（53/93）;Inhomogeneous mass,31.18%（29/93）.The mean serum hCG（excluding HP） of these 3 types was（174.50±124.95） mIU/mL on the 14th day after IVF-ET.There were no significant differences among these three types（P =0.582）.However,the serum hCG level of the typical gestational sac type was much higher than that of other types.And intrauterine pregnancies was significantly higher than ectopic pregnancies of the serum hCG level on the 14th day after IVF-ET（P =0.000）.The earliest diagnostic time of ectopic pregnancies by TVS was Day 18 after transplantation,the latest time Day 54,and the average time was Day（25.83±6.05）,89.58% of which were directly diagnosed before Day 32.The mean diagnostic time of heterotopic pregnancies by TVS was Day（27.73±6.30） after transplantation.【Conclusion】 89.58% of ectopic pregnancies were diagnosed directly by TVS before the 32nd day after IVF-ET.Combining TVS with serum β-hCG can further improve the diagnostic efficiency.Therefore,TVS has great value for the diagnosis of early ectopic pregnancy after IVF-ET.