彩色多普勒超声在宫内合并宫外复合妊娠(HP)中的诊断价值

The value of color Doppler ultrasonography in the diagnosis of heterotopic pregnancy (HP)

目的探讨彩色多普勒超声在宫内合并宫外复合妊娠(heterotopic pregnancy,HP)中的诊断价值。方法回顾性分析2013年2月至2017年4月复旦大学附属妇产科医院超声诊断为HP后经系统治疗的病例59例,总结患者的临床特征及超声图像特点。结果 59例患者中经手术及病理确诊HP57例,误诊2例。确诊的57例患者中体外受精-胚胎移植术(in vitro fertilization and embryo transfer,IVF-ET)后51例(89.5%),促排卵后4例(7.0%),自然妊娠2例(3.5%)。44例(77.2%)异位妊娠病灶位于输卵管,10例(17.5%)位于宫角,2例(3.5%)位于卵巢,1例(1.8%)位于剖宫产切口瘢痕部位。根据超声图像,异位妊娠病灶分为两种类型:孕囊型(29例,50.9%)和混合包块型(28例,49.1%)。孕囊型病例中异位妊娠病灶内妊娠囊直径小于宫内妊娠囊。结论随着促排卵及辅助生殖技术(assisted reproductive technology,ART)的广泛应用,HP已不再是一种罕见疾病。结合临床病史及经阴道彩色多普勒超声检查有助于早期诊断HP,有利于及时准确地制定临床治疗方案。

ObjectiveTo explore the value of color Doppler ultrasonography in the diagnosis of heterotopic pregnancy (HP). MethodsFifty-nine cases diagnosed as HP by ultrasound and underwent systematic treatment in Obstetrics and Gynecology Hospital,Fudan University from Feb.,2013 to Apr.,2017 were retrospectively analyzed.The clinical features and characteristics of ultrasound images in HP patients were summarized. ResultsAmong 59 cases,57 cases were proved by operation and pathology as HP,2 cases were misdiagnosed.Of the confirmed 57 cases,51 cases (89.5%)were conceived with in vitro fertilization and embryo transfer (IVF-ET),4 cases (7.0%) resulted from ovulation induction and 2 cases (3.5%) were the result of natural conception.The majority of the ectopic pregnancies were located in the fallopian tubes (44 cases,77.2%),10 cases (17.5%) were sited in the cornual region,2 cases (3.5%) in the ovary and 1 case (1.8%) in the previous cesarean section scar.Two types of ultrasonographic presentation of ectopic pregnancy were seen in HP patients:gestational sac type (29 cases,50.9%) and complex mass type (28 cases,49.1%).In the case with a gestational sac, the diameter of the ectopic gestational sac was less than that of the intrauterine gestational sac. ConclusionsWith the widespread use of assisted reproductive technology (ART) and ovulation induction,the incidence of HP had significantly increased and was no longer a rare event.Combined with clinical features,the transvaginal color Doppler ultrasound could be helpful in early detection of HP and could contribute to making clinical decision timely and accurately.