经阴道彩色多普勒超声对宫外孕破裂与卵巢黄体破裂的鉴别诊断价值

Value of transvaginal ultrasonography in differential diagnosis of ruptured ectopic pregnancy and rupture of corpus luteum

目的比较经阴道彩色多普勒超声对宫外孕破裂与卵巢黄体破裂的鉴别诊断价值。方法选取2014年6月至2017年6月间蓝田县中医医院诊治的宫外孕破裂患者50例为观察组,卵巢黄体破裂50例为对照组,比较宫外孕破裂与卵巢黄体破裂的二维超声表现、多普勒血流特征及血流动力学指标。结果宫外孕破裂表现为附件区不均质性混合回声包块,27例见胎芽及原始心管搏动,13例见假性妊娠囊。卵巢黄体破裂表现为附件区不均质低回声,边界不清,无胎芽及原始心管搏动,病变周围及子宫直肠陷凹内显示液性暗区。宫外孕破裂以点状及条状血流为主(82.0%),而卵巢黄体破裂以环状或半环状血流为主(68.0%),两者多普勒血流表现间比较差异有统计学意义(P<0.05);宫外孕破裂血流频谱中,高阻力型比例为18.0%,无张力期血流比例为22.0%,舒张期血流为18.0%,低阻力型血流为42.0%,卵巢黄体破裂血流频谱中,高阻力型比例为6.0%,无张力期血流比例为8.0%,舒张期血流为6.0%,低阻力型血流为80.0%,两者比较差异均有统计学意义(P<0.05);宫外孕破裂搏动指数(PI)为(0.91±0.29)、阻力指数(RI)为(0.58±0.16)、收缩期峰值流速(PSV)为(12.3±3.6)cm/s,卵巢黄体破裂PI为(0.78±0.21)、RI为(0.46±0.12)、PSV为(15.6±4.5)cm/s,两者比较差异均有统计学意义(P<0.05)。结论宫外孕破裂与卵巢黄体破裂具有不同的超声声像图及血流频谱特征,经阴道彩色多普勒超声具有很高的鉴别诊断价值。

Objective To compare the value of transvaginal ultrasonography in the differential diagnosis of ruptured ectopic pregnancy and ovarian corpus luteum rupture. Methods From June 2014 to June 2017, 50 patients with ruptured ectopic pregnancy were chosen as the observation group, and 50 patients with corpus luteum rupture were chosen as control group. The two-dimensional ultrasonography, Doppler flow characteristics and hemodynamic indexes were compared between the two groups. Results The ruptured ectopic pregnancy was characterized by heterogeneous mixed echo mass in the adnexal region, with fetal bud and primitive cardiac tube pulsation in 27 cases and pseudocyst in13 cases. The rupture of ovarian corpus luteum showed inhomogeneous low echo in the adnexal region, with unclear boundary, no fetal bud and primitive heart tube pulsation, and fluid dark area around the lesion and in Douglas cul-de-sac. Ruptured ectopic pregnancy showed mainly spot and strip blood flow（82.0%）, while ovarian corpus luteum rupture mainly showed ring or semi-ring blood flow（68.0%）, with statistically significant difference in the Doppler flow performance（P〈0.05）. The proportion of high resistance blood flow, tension-free blood flow, diastolic blood flow, low resistance blood flow was 18.0%, 22.0%, 18.0%, 42.0% for ruptured ectopic pregnancy, versus 6.0%, 8.0%, 6.0%, and80.0% for corpus luteum rupture（P〈0.05）. The pulsation index（PI）, resistance index（RI）, peak systolic velocity（PSV）were（0.91±0.29）,（0.58±0.16）,（12.3±3.6） cm/s for ruptured ectopic pregnancy, versus（0.78±0.21）,（0.46±0.12）,（15.6±4.5） cm/s for corpus luteum rupture（P〈0.05）. Conclusion Ruptured ectopic pregnancy and rupture of corpus luteum have different sonographic and blood flow spectrum characteristics, and transvaginal ultrasound has high value in the differential diagnosis of the two diseases.