两种超声途径联合血清学指标诊治宫外孕的研究

Comparison of Two Ultrasonic Ways Combined with Serological Markers in the Diagnosis and Therapy on Ectopic Pregnancy

目的比较两种超声途径联合血清学指标动态监测在诊治宫外孕的临床价值。方法将广东医学院附属三水医院2008年1月-2011年9月的134例宫外孕患者随机分为两组,比较经腹部彩色多普勒超声(TAS)组和经阴道彩色多普勒超声(TVS)组两种途径影像学联合β-HCG、P指标动态监测的结果。结果 TVS组73例,诊断宫外孕69例,早期确诊率94.52%。TAS组61例,诊断宫外孕45例,早期确诊率为73.77%。TAS检出附件包块的敏感性与包块大小相关。134例患者保守治疗成功108例,失败26例。血清β-HCG<2000 mIU/ml组107例,成功99例,成功率为92.52%;血清β-HCG≥2000 mIU/mL组27例,成功20例,成功率为74.07%。早期宫外孕患者血清P值为0.39～21.56ng/m,平均(7.43±0.79)ng/L;治疗后2周P值为0.27～5.74 ng/ml,平均(3.86±1.04)ng/L,TVS+β-HCG+P治疗敏感度、特异度、准确度分别是97.76%、99.25%、98.51%。结论 TVS联合β-HCG、P指标的动态监测对宫外孕的诊断准确率优于TAS,对适时调整临床治疗方案有重要指导作用。

Objective To compare the clinical value of dynamic monitoring in the diagnosis and therapy on ectopic pregnancy with two ultrasonic ways combined with serological markers.Methods From 2008 January to 2011 September,134 cases of ectopic pregnancy patients in our hospital were randomly divided into two groups,the dynamic monitoring results of the tow ways imaging on transabdominal color Doppler ultrasound（TAS） group and transvaginal color Doppler ultrasound（TVS） group combined serological indicators of human chorionic gonadotropin（β-HCG）,progesterone（P） were compared.Results Among 73 cases TVS group,69 cases were diagnosed with ectopic pregnancy,the early diagnosis rate was 94.52%.Among 61 cases TAS group,45 cases were diagnosed with ectopic pregnancy,the early diagnosis rate was 73.77%.TAS detection sensitivity of the adnexal mass was associated with the size of mass.108 cases of conservative treatment in 134 cases were successful,with 26 cases failed.Serum β-HCG2000 mIU/ml group in 107 cases,99 cases were successful,the successful rate was 92.52%;serum β-HCG≥2000 mIU/ml group in 27 cases,with 20 cases successful,the successful rate was 74.07%.The early tubal pregnancy serum P value was 0.39-21.56 ng/ml,the mean was（7.43±0.79）ng/L;the serum P value was（0.27-5.74） ng/ml 2 weeks after treatment,and the mean was（3.86±1.04） ng/L,the TVS,β-HCG combined with P treatment sensitivity,specificity,and accuracy were 97.76%,99.25% and 98.51%,respectively.Conclusion Dynamic monitoring of TVS combined with β-HCG,P index in the early diagnostic accuracy of ectopic pregnancy was superior to that of TBS and it had an important role in guiding the timely adjustment of the clinical protocols.