经阴道及经腹超声结合血清指标检测对宫外孕的诊断价值

Clinical significance of transvaginal and transabdominal ultrasound combined with serum markers in the diagnosis of ectopic pregnancy

目的探讨经阴道及经腹超声结合血清指标检测对宫外孕的诊断价值义。方法选取2014年5月至2016年1月武汉市普仁医院收治的30例宫外孕患者作为宫外孕组,并选取同期于我院进行孕检的30例正常孕妇作为对照组;对照组及观察组均使用经阴道和经腹超声检查,并利用化学发光法检测血清中β-人绒毛膜促性腺激素(β-HCG)及孕酮水平。结果采用经阴道与经腹超声联合诊断的附件区包块、胚芽、卵黄囊及胎心搏动检出率(100.00%、50.00%、30.00%、33.33%、16.67%)显著高于单独使用经腹或经阴道超声(73.33%、96.67%、26.67%和46.67%、16.67%和26.67%、10.00%和30.00%、3.33%和13.33%),差异均有统计学意义(P<0.05);宫外孕组患者中21例使用腹部超声检查未见附件区包块但可见卵巢增大,使用阴道超声检查未见妊娠囊回声,附件区可见小包块;宫外孕组患者血清β-HCG及孕酮水平[(24.38±15.32)mIU/mL及(10.23±3.19)ng/mL]均明显低于正常妊娠的对照组[(89.51±21.43)mIU/mL及28.22±10.11)ng/mL],且差异均有统计学意义(P<0.05)。结论采用经阴道及经腹超声结合血清学指标可提高对宫外孕的诊断准确率,避免漏诊及误诊的发生。

Objective To explore the clinical significance of transvaginal and transabdominal ultrasound combined with serum markers in the diagnosis of ectopic pregnancy.Methods From May 2014 to Jan.2016,30 patients with ectopic pregnancy in Department of Gynaecology and Obstetrics in Puren Hospital of Wuhan City were selected as ectopic pregnancy group,and 30 normal pregnant women for pregnancy tests were selected as control group.All subjects underwent transvaginal and transabdominal ultrasonography,and the levels of β-h CG were detected by chemical luminescence method.Results The combined application of transvaginal and transabdominal ultrasound had significantly higher detection rate in adnexal masses,embryo,yolk sac and fetal heart beat（100.00%,50.00%,30.00%,33.33%,16.67%）than single use of transabdominal or transvaginal ultrasound（73.33% and 96.67%,26.67% and 46.67%,16.67% and 26.67%,10.00% and 30.00%,3.33% and 13.33%）（P0.05）.For 21 of the 30 ectopic pregnancy patients,transvaginal ultrasound showed no adnexal mass but visible ovarian enlargement,while transabdominal ultrasound showed no embryonic echoes but with visible adnexal small masses.Serum β-h CG and progesterone levels in ectopic pregnancy patients were（24.38±15.32）m IU/mL and（10.23±3.19） ng/mL,significantly lower than（89.51±21.43） m IU/mL and（28.22±10.11） ng/mL in the control group（P0.05）.Conclusion Using transabdominal and transvaginal ultrasound combined with serum markers to diagnose ectopic pregnancy can improve diagnostic accuracy and avoid missed diagnosis and misdiagnosis as far as possible,which has important clinical significance.