宫角及输卵管妊娠的超声诊断分析

Ultrasound diagnosis of cornual pregnancy and tubal pregnancy

目的探讨宫角妊娠、输卵管间质部妊娠的超声声像特征及鉴别诊断价值。方法选取2012年12月至2015年6月济宁医学院附属医院收治的69例宫角或输卵管间质部妊娠患者的超声声像资料进行回顾性分析,以手术后结果作为金标准,对比宫角妊娠、输卵管间质部妊娠的声像特征差异,并计算超声检查鉴别诊断宫角妊娠、输卵管间质部妊娠的临床价值。结果宫角妊娠的孕囊与宫腔相通率为89.74%,显著高于输卵管间质部妊娠的13.33%,差异具有统计学意义(χ~2=4.286,P<0.05);孕囊周边肌层包绕厚度显著高于输卵管间质部妊娠者,差异具有统计学意义(t=11.064,P<0.05);宫角妊娠、输卵管间质部妊娠的收缩期峰值流速(PSV)值差异无统计学意义(t=0.957,P>0.05);宫角妊娠的舒张末期流速(EDV)显著低于输卵管间质部妊娠、宫角妊娠的阻力指数(RI)值显著高于输卵管间质部妊娠,差异均具有统计学意义(t值分别为3.774,3.602,均P<0.05);超声鉴别诊断宫角妊娠、输卵管间质部妊娠的灵敏度为87.18%、特异度为90.00%、漏诊率为12.82%、误诊率为10.00%。结论宫角妊娠、输卵管间质部妊娠的超声声像特征各有特点,对鉴别诊断具有较高的临床价值。

Objective To investigate the ultrasonographic features of cornual pregnancy and interstitial tubal pregnancy as well as differential diagnostic value.Methods Ultrasonographic data of 69 patients with cornual pregnancy or interstitial tubal pregnancy hospitalized in Affiliated Hospital of Jining Medical College from December 2012 to June 2015 were retrospectively analyzed.Comparison of differences in ultrasonographic features of cornual pregnancy and interstitial tubal pregnancy was made,taking postoperative results as gold standard.Clinical value of ultrasonic examination in differential diagnosis of cornual pregnancy and interstitial tubal pregnancy was assessed.Results Connection rate of gestation sac and uterine cavity in cornual pregnancy was89.74%,which was significantly higher than that of 13.33% in interstitial tubal pregnancy,and difference was statistically significant（χ~2=4.286,P〈0.05）.Thickness of muscle layer around gestation sac in cornual pregnancy was significantly higher than that in interstitial tubal pregnancy with significant difference（t=11.064,P〈0.05）.There was no significant difference in peak systolic velocity（PSV）between cornual pregnancy and interstitial tubal pregnancy（t=0.957,P〈0.05）.End diastolic velocity（EDV）in cornual pregnancy was significantly lower than that in interstitial tubal pregnancy,and resistance index（RI）in cornual pregnancy was significantly higher than that in interstitial tubal pregnancy with statistically significant differences（t value was 3.774 and 3.602,respectively,both P〈0.05）.The sensitivity,specificity,missed diagnosis rate and misdiagnosis rate of ultrasound in differential diagnosis of cornual pregnancy and interstitial tubal pregnancy was 87.18%,90.00%,12.82% and10.00%,respectively.Conclusion Ultrasonographic features of cornual pregnancy and interstitial tubal pregnancy are different,and they have high clinical value in differential diagnosis.