经阴道彩色多普勒超声在异位妊娠诊断中的应用价值

The application value of transvaginal ginal Color Doppler Ultrasound in diagnosis of ectopic pregnancy

目的探讨经阴道彩色多普勒超声(Transvaginal color Doppler ultrasound,TCDU)对异位妊娠(Ectopic pregnancy,EP)患者诊断的准确性及应用价值,为临床早期诊断EP提供参考依据。方法对临床诊断的89例EP患者行TCDU及经腹部超声(Transabdomonal scanning,TAS)检查,检查前患者充盈膀胱,先行TAS检查,然后行TCDU检查,明确宫内有无妊娠囊(Gestational sac,GS),同时观察双附件区,盆腹腔情况,确定附件区有无GS及包快,应用彩色多普勒血流显像(Colordoppler flow imaging,CDFI)观察异位GS血流情况;脉冲多普勒(Doppler Pulse Wave Doppler,PW)检测血流频谱情况,将TCDU检测结果与TAS、手术病理行对比对照分析。结果本组89例患者中,TCDU诊断EP 78例,宫内早早孕5例,正常6例;TAS诊断EP58例,宫内早早孕5例;正常26例;手术病理诊断为EP 79例,宫内早早孕7例,正常3例;TCDU诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为98.7%、80.0%、96.6%、97.5%、88.9%;TAS诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为67.1%、50.0%、65.2%、91.4%、16.1%,TCDU对EP诊断的敏感性、准确性及阴性预测值均显著高于TAS(P<0.05),对EP周围滋养动脉血流明显高于TAS。结论 TCDU能更清晰的显示EP的位置、大小,胚胎是否存活;TCDU较TAS更早发现EP,CDFI对EP周围滋养动脉的血流信号敏感性、准确性及阴性预测值高于TAS,所以TCDU是诊断EP的一种更有效的首选检查方法。

[ Objective ] To discuss the accuracy and application value of transvaginal color doppler ultrasound （transvaginal color doppler ultrasound, TCDU） in diagnostic eetopic pregnancy （ectopic pregnancy ,EP）and provide a referencen for clinical in early diagnosis. [ Methods ] 89 patients who with EP in clinical diagnosis under TCDU and transabdominal sonography （transabdominal sonography ,TAS ） examination, before examination patients must with bladder filling, first TAS, then TCDU, to make clear is there intrauterine gestational sac （ Gestational sac, GS ）, while observing the dual attachment area and intraperitoneal basin, to determine is there GS or pack fast, testing blood flow by color Doppler flow imaging （color Doppler flow imaging ,CDFI ） observation of ectopic GS flow; detecting the blood flow frequency spectrum by pulse Doppler （ Doppler Pulse Wave Doppler, PW ）, then make contrast analysis in TCDU test results with TAS and operation pathology . [ Resluts ] This group of 89 patients, TCDU in the diagnosis of EP in 78 cases, intrauterine early pregnancy in 5 cases, normal in 6 cases; TAS diagnosis of EP 58 cases, intrauterine early pregnancy in 5 cases; 26 cases of normal operation; pathological diagnosis for79 cases of EP, intrauterine early pregnancy in 7 cases,3 cases of normal;The TCDU diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 98.7%,80%,96.6%,97.5%,88.9%; TAS diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 67.1%,50%,65.2%,91.4%,16.1%, TCDU to EP diagnostic sensitivity, accuracy and negative predictive value were significantly higher than that of TAS （ P 〈 0.05）, the EP peripheral nutrient artery blood flow was significantly higher in TAS. [ Conclusion ] TCDU can clearly show the location, size and the embryo is survival or not; TCDU make earlier testing than TAS, and TCDU is higher than TAS in sensitivity, accuracy and negative predictive value in testing blood flow signal of around the EP nutrient artery, so TCDU is a more effective preferred inspection method in the diagnosis of EP.