经阴道彩超诊断特殊部位异位妊娠38例分析

Analysis of 38 cases of ectopic pregnancy at special sites diagnosed by transvaginal ultrasound

目的探讨经阴道彩超在诊断特殊部位异位妊娠中的应用价值。方法回顾性分析38例特殊部位异位妊娠患者的超声声像图特征,将超声诊断与手术病理结果进行对照。结果 38例特殊部位异位妊娠患者经术前超声确诊30例,漏、误诊8例,总符合率为78.9%。剖宫产切口妊娠、输卵管间质部妊娠、宫角妊娠、卵巢妊娠的诊断率相对较高(分别为85.7%、87.5%、83.3%和66.7%),阔韧带妊娠、输卵管残端妊娠、腹腔妊娠的诊断率较低(本组全部漏诊或误诊),宫颈妊娠与残角子宫的诊断率最高(达100%)。结论不同类型的特殊部位异位妊娠有不同的声像图特点、诊断率、误诊率和漏诊率。经阴道彩色多普勒超声检查能及时提供有价值的声像图信息,为临床诊断与处理可提供重要参考,但存在一定的局限性,要同时结合患者病史、症状及体征、血或尿人绒毛膜促性腺素(HCG)等综合分析做出诊断。

Objective To discuss the value of transvaginal ultrasound in the diagnosis of ectopic pregnancies at special sites.Methods Ultrasound characteristics of 38 cases of ectopic pregnancy at special sites were analysed,and the results were compared with pathological findings.Results Among 38 cases of ectopic pregnancy at special sites,30 cases were diagnosed correctly and 8 cases were misdiagnosed by ultrasonography.The coincidence rate in total was 78.9%.The diagnostic accordance rates of caesarean-section scar pregnancy,interstitial tubal pregnancy,cornual pregnancy,and ovarian pregnancy were relatively high,which were 85.7%,87.5%,83.3% and 66.7%,respectively.Meanwhile,the diagnostic accordance rates of broad ligament pregnancy,tubal stump pregnancy,and abdominal pregnancy were low,all cases were misdiagnosed in our research.Furthermore,cervical pregnancies and rudimentary horn pregnancies were all diagnosed correctly in our research.Conclusion There are different ultrasound characters in different kinds of ectopic pregnancy at special sites with different diagnostic accordance and misdiagnostic rates.Transvaginal color Doppler ultrasound provides valuable informations.However,with the limitation of itself,accurate diagnosis should be made with the combination of patient＇s medical history,symptoms and signs,and human chorionic gonadotropin level of the blood or urine.