三维超声在早期异位妊娠中的应用价值

The value of applying three-dimensional ultrasound to early ectopic pregnancy

目的探讨三维超声在早期异位妊娠诊断中的应用价值。方法应用二维及三维超声表面成像模式及断层成像模式(tomographic ultrasound,TUI)对160例停经4~7周,临床疑似异位妊娠的患者进行检查并诊断,诊断结果与临床随访或手术病理结果进行对照分析,比较常规二维超声及联合应用三维超声对早期异位妊娠诊断的敏感度、特异度、准确率。结果 160例患者经手术病理诊断证实异位妊娠136例,其中117例为输卵管妊娠,14例为剖宫产瘢痕妊娠,5例为宫角妊娠;经临床随访证实非异位妊娠24例,其中宫内妊娠12例,不全流产5例,附件区炎性包块5例,卵巢黄体囊肿2例,对照临床随访及手术病理诊断结果:(1)二维超声诊断早期异位妊娠的敏感度为83.8%(114/136),三维超声联合TUI技术诊断的敏感度为88.2%(120/136),二者比较差异无统计学意义(P> 0.05)。(2)二维超声诊断早期异位妊娠的特异度为62.5%(15/24),准确率为80.6%(129/160),三维超声联合TUI技术诊断的特异度为91.7%(22/24),准确率为88.8%(142/160),二者比较差异均有统计学意义(P <0.05)。结论建立在二维超声基础上的三维超声丰富了二维超声影像信息,具有良好的空间定位功能,能够在异位妊娠的早期提供更全面、更细致的诊断信息,二维及三维超声联合检查可提高早期异位妊娠诊断的特异度和准确率,减少误诊。

Objective To investigate the diagnostic value of three-dimensional ultrasound in the early stage of ectopic pregnancy. Methods Two-dimensional and three-dimensional ultrasound surface imaging and tomographic ultrasound imaging(TUI)were used to examine and diagnose 160 patients with clinical suspected ectopic pregnancy at 4 ~ 7 weeks after menopause. The diagnostic results were compared with those of clinical followup or surgical pathology. The sensitivity,specificity and accuracy of conventional two-dimensional ultrasound and combined three-dimensional ultrasound in the diagnosis of early ectopic pregnancy were compared and analyzed.Results 136 cases were confirmed ectopic pregnancy by surgical pathology or clinical follow-up results,among them 117 cases were tubal pregnancy,14 cases were cesarean scar pregnancy and 5 cases were corneal pregnancy.24 cases were confirmed non-ectopic pregnancy by clinical follow-up,among them 12 cases were intrauterine pregnancy,5 cases were incomplete abortion,5 cases were inflammatory mass and 2 cases were ovary corpus luteum cyst. Comparing what mentioned above with clinical investigations and the result of surgical pathology,the result shows:(1)The sensitivity rate of 3D-ultrasound was 88.2%(120/136)while 2D-ultrasound was 83.8%(114/136). No significant difference was found between the two methods(P > 0.05).(2)The specificity and accuracy rate of 3D-ultrasound were 91.7%(22/24)and 88.8%(142/160)while those of 2D-ultrasound were 62.5%(15/24)and 80.6%(129/160)respectively(all P < 0.05). Conclusions 3D-ultrasound based on 2D-ultrasound enriches the result of 2D-ultrasound by providing more comprehensive and detailed diagnostic information and good spatial positioning function. The combination of 2D-ultrasound and 3 D-ultrasound can improve the specificity and accuracy in the diagnosis of early ectopic pregnancy.