超声在输卵管间质部妊娠诊断和治疗中的应用价值

The application value of ultrasonography in diagnosis and treatment of tube interstitial pregnancy

目的探讨腔内超声诊断及超声引导下甲氨蝶呤(MTX)局部注射治疗在输卵管间质部妊娠(TIP)中的价值。方法对中国人民解放军总医院就诊的618例异位妊娠患者进行研究。研究分为2部分:诊断部分:610例患者有手术病理结果,并在术前曾接受腔内超声检查,评价腔内超声诊断TIP的灵敏度、特异度及总符合率;治疗部分:8例患者临床和超声表现符合TIP,接受了超声引导下MTX局部注射治疗,分析该治疗方法的适用人群。结果诊断部分:经手术病理证实的610例异位妊娠患者中28例为TIP,3例被超声误诊为TIP。腔内超声诊断TIP总符合率为98.52%,灵敏度79.57%,特异度99.48%。治疗部分:8例患者中,1例治疗失败转为手术治疗,7例顺利康复。结论腔内超声诊断TIP的符合率高,对临床治疗方案的选择有很大指导意义。妊娠包块显示清晰、未破裂且无明显内出血的TIP患者,若其病灶较小或血清β-hCG较低,可选择超声引导下介入治疗。此法损伤小,疗效好。

Objective To evaluate the application value of uhrasonography in diagnosis and treatment of tube interstitial pregnancy （ TIP）, and to observe the therapeutic effect of uhrasound-guided methotrexate local injection on TIP. Methods The data of 618 patients with eetopie pregnancy were analyzed, who were diagnosed by PLA General Hospital from January 2006 to December 2010. The study was divided into two parts, diagnosis part： 610 patients were pathologically diagnosed and received ultrasonography before operation, and the sensitivity, specificity and total eoineidenee rate of endo-luminal ultrasound diagnosis for TIP were evaluated. Treatment part： the 8 patients whose elinieal symptoms and the results of uhrasonography were correspondent with TIP reeeived ultrasound-guided methotrexate local injection,and the feasibility of the therapy was analyzed. Results Diagnosis part：among the 610 patients who were diagnosed as eetopie pregnancy by pathological examination after operation, there were 28 eases of TIP, however, there were 3 patients who were diagnosed as eetopie pregnancy because of diagnostic errors by ultrasonography. The total coincidence rate of endo-luminal ultrasound diagnosis for TIP was 98.52%, sensitivity 79.57%, specificity 99.48%. Treatment part ： among 8 patients, 1 patient underwent treatment failure,who had to be operated,but the other 7 patients recovered smoothly. Conclusion The coincidence rate of endo-luminal ultrasound diagnosis for TIP is higher,which has important instruction significance for the seleetion of clinical therapeutic schedule. The TIP patients with small lesion or low levels of HCG can choose ultrasound-guided methotrexate local injection treatment if their pregnancy lesion is showed clearly and unruptured. The therapy is effective,with little damage.