包块型子宫角妊娠超声诊断分析

Ultrasonographic analysis of mass-type cornual pregnancy

目的总结包块型子宫角妊娠超声声像图特征及定位、定性诊断要点。方法对23例于2011年1月至2013年1月在北京协和医院超声检查并经手术及病理检查证实为包块型子宫角妊娠患者的超声声像图特征进行总结分析。结果 23例包块型子宫角妊娠患者（18例经阴道超声检查,5例经腹部超声检查）超声声像图均表现为位于一侧子宫角处向外突出的混合回声包块,其中20例包块边界清晰或较清晰,经腹部超声显示3例包块边界不清晰;15例可见间质线征,8例因包块与子宫内膜紧邻未显示间质线征;包块周边子宫肌层厚度为0.1-0.3 cm。23例中3例血清β-hCG检测值较高（〉20 000 IU/L）的患者超声可观察到子宫角包块中典型的中高回声绒毛结构;彩色多普勒血流成像示22例包块周边可见丰富环绕血流信号（其中9例伴内部较丰富血流信号）,1例包块周边示少许条状血流信号,动脉频谱均为低阻改变。23例包块型子宫角妊娠患者中,7例因包块呈蜂窝状混合回声、血流丰富及低阻动脉频谱误诊为滋养细胞肿瘤（5例经腹部超声检查,2例经阴道超声检查）,16例术前超声与手术病理诊断一致,声像图特征：包块均位于子宫角内膜延长线上;包块边界清晰、血流分布以周边环绕为主;血清β-hCG检测值较高的患者声像图中或可观察到典型的中高回声绒毛结构。结论超声诊断包块型子宫角妊娠应根据包块位置、边界、血流分布、有无绒毛结构并结合病史及血清β-hCG检测值与滋养细胞肿瘤相鉴别。经阴道超声检查在包块型子宫角妊娠定位、定性及鉴别诊断中有重要价值。

Objective To summarize the sonographic features and differential diagnosis points of masstype cornual pregnancy. Methods The sonographic findings of 23 pathological proven mass-type cornual pregnancy cases enrolled in PUMCH from 2011 January to 2013 January were retrospectively analyzed. Results All pathological proven mass-type cornual pregnancy were located at one corner of the uterus presenting as a heterogenous outward mass. Well-defined margins were found in 20 cases, and interstitial-line signs were found in 15 cases. The surrounding muscle thickness is 0.1-0.3 cm. Typical hyperechoic villi were found on sonography in cases with blood β-hCG 〉20 000 IU/L. On Doppler, the lesion showed abundant peripheral vascularity with low resistance in 22 cases, 9 lesions also showed abundant internal vascularity. Among 23 mass-type cornual pregnancy cases, 7 cases were misdiagnosed as gestational trophoblastic neoplasia（GTN） due to the similar sonographic characteristics including mixed-echo and abundant vascularity with low resistance. Sixteen cases were diagnosed by ultrasound preoperatively, with featured sonographic signs including mass located in the endometrial extension line; clear margin; peripheral vascularity; or detection of interstitial-line sign and typical villus. Conclusions Mass-type cornual pregnancy may be correctly diagnosed according to the location, boundary of the mass and the distribution of blood flow combining with clinical manifestation and blood β-hCG level. Transvaginal sonography could play an important role in diagnosis of cornual pregnancy.