宫角妊娠的三维超声声像图特点及早期诊断价值

Three-dimensional ultrasonographic features of uterine horn pregnancy and its early diagnostic value

目的分析宫角妊娠(uterine horn pregnancy,UHP)的三维超声声像图特点及其早期诊断价值。方法选择2015年6月至2016年8月来凤县人民医院收治的UHP患者38例,进行二维超声、三维超声检查,并与病理检查或宫腔镜检查结果对比,分析UHP的三维超声声像图特点及早期诊断价值。结果 38例患者经三维超声诊断出符合UHP 35例(92.11%),高于二维超声的29例(76.32%),差异有统计学意义(P<0.05);三维超声与病理检查或宫腔镜检查结果比较,差异无统计学意义(P>0.05)。38例患者中,根据病灶结构诊断主要有:子宫增大,形态不规则,两侧不对称或凸出,孕囊光环偏心圆状,内膜向宫角延伸,孕囊与内膜相连,孕囊可见卵黄囊或心管搏动的完整孕囊型23例;子宫增大,形态不规则,两侧不对称,可见凸起包块,回声增厚,可见不均质包块,上方可见肌壁层,内有无回声区的团块型12例。此外,彩色多普勒血流成像也显示局灶性丰富血流信号。经宫腔镜或病理诊断确认超声漏诊1例,误诊2例(息肉回声减弱,并伴有炎症水肿)。结论三维超声检查准确率高,具有简单、经济、可重复且较方便等特点,减轻患者负担,提高了临床诊断率,可作为UHP的首选检查。

Objective To analyze the three-dimensional ultrasonographic features of uterine horn pregnancy(UHP) and its early diagnostic value. Methods 38 cases of UHP patients admitted to Laifeng County People’s Hospital from June 2015 to August 2016 were selected, their two-dimensional ultrasound and three-dimensional ultrasonography images were analyzed by comparison with pathological examination or hysteroscopy. To analyze the three-dimensional ultrasonographic features of uterine horn pregnancy(UHP) and its early diagnostic value. Results In 38 patients, 35 cases with UHP were diagnosed by three-dimensional ultrasound(92.11 %), which was higher than two-dimensional ultrasound(76.32 %),the difference was statistically significant(P<0.05). There was no significant difference between the three-dimensional ultrasound and pathological examination or hysteroscopy(P>0.05). Among the 38 patients, the diagnosis based on the lesion structure mainly included:the uterus enlarged, the shape irregular, the sides asymmetrical or convex, the sac of the gestational sac eccentric, the endometrium extended toward the uterine horn, the gestational sac connected with the endometrium, and the gestational sac showed the intact gestational sac of the yolk sac or the heart tube in 23 cases;the uterus enlarged, the shape irregular, the sides asymmetrical, the convex mass visible, the echo thickened, the heterogeneous mass visible, the muscle wall layer visible above, and agglomerates with or without echogenic area in 12 cases. In addition, color Doppler flow imaging also showed focally abundant blood flow signals. One case of missed diagnosis of ultrasound was confirmed by hysteroscopy or pathological diagnosis, and 2 cases were misdiagnosed(the polyp echo was weakened with inflammation and edema). Conclusion Three-dimensional ultrasound examination has high accuracy, simple, economical, reproducible and convenient, which reduces the burden on patients and improves the clinical diagnosis rate. It can be used as the first choice for UHP.