子宫角妊娠与输卵管间质部妊娠的超声诊断及鉴别诊断分析

Analysis of Ultrasonic Diagnosis and Differential Diagnosis of Interstitial Tubal Pregnancy with Uterine Horn Pregnancy

目的总结子宫角妊娠与输卵管间质部妊娠声像图特点及鉴别诊断意义。方法对手术及病理检查证实的48例子宫角妊娠和41例间质部妊娠的声像图进行回顾性分析。结果子宫角妊娠与间质部妊娠声像图均表现为妊娠囊或包块位于一侧子宫角部,或靠近子宫角部的附件区,二者在包块与子宫角之间是否有切迹、包块与子宫腔是否相邻及是否存在间质线征的表现上比较,差别无统计学意义(P>0.05);而子宫角妊娠包块周边具有完整肌层组织包绕的发生率要多于间质部妊娠(χ2=5.27,P<0.05)。超声引导或腹腔镜监视下清宫术获得成功的患者,其包块周边有略厚而完整的肌层组织包绕,较切开取胚、子宫角或间质部切除的患者多见(χ2=15.63,P<0.05)。结论子宫角妊娠与间质部妊娠超声主要鉴别点为妊娠包块周边是否有完整的肌层包绕,包块周围有略厚的肌层包绕是选择清宫术主要指标之一。

Objective To summarize the ultrasonographic characteristics of cornual and intramural pregnancy and evaluate its value on differential diagnosis. Methods In all 89 patients,the diagnosis was confirmed at surgery and histologic evaluation,including 48 cases of cornual pregnancy and 41 cases of intramural pregnancy. And the ultrasound findings of those patients were retrospectively analyzed.Results Both ectopic pregnancies presented a gestational sac or a pregnancy lump in the uterine horn,or in the adnexa area near the uterine horn on ultrasonography. No significant differences between cornual pregnancy and intramural pregnancy were found in the notch of pregnancy lump and uterine horn,the adjacent relation between lump and uterine cavity,and the sign of interstitial-line（P〉0.05）,whereas more intact muscularis around the pregnancy lump was found in cornual pregnancy than in intramural pregnancy（χ2=5.27,P〈0.05）. Patients who had uterine curettage under ultrasonographic guidance or laparoscopic surveillance showed a slightly thick and intact muscularis around the pregnancy lump in comparison to those who underwent embryo removal surgery,cornual or interstitial tubal resection（χ2=15.63,P〈0.05）. Conclusion A intact uterine muscularis around the pregnancy lump is the key point for differential diagnosis of cornual pregnancy and intramural pregnancy. And a slightly thick muscularis around the lump is one of the main indications for uterine curettage.