经阴道三维超声自由解剖成像技术在特殊部位异位妊娠诊断中的应用

Application of intracavity three-dimensional ultrasonic OmniView technology in diagnosis of special-site ectopic pregnancy

目的探讨经阴道三维超声自由解剖成像技术(OmniView)在部分少见的特殊部位异位妊娠诊断中的应用价值。方法回顾性选取2016年4月至2018年4月就诊于重庆市妇幼保健院,经宫腔镜、腹腔镜或宫腹腔镜联合手术证实为输卵管间质部妊娠、宫角妊娠、子宫角部合并输卵管间质部妊娠、残角子宫妊娠、子宫肌壁间妊娠的患者81例。所有患者均于术前行经阴道三维超声OmniView模式检查,分析各种特殊部位异位妊娠的超声特征表现以及超声诊断结果与宫腔镜、腹腔镜或宫腹腔镜联合手术结果的一致性。结果手术证实输卵管间质部妊娠57例(57/81,70.3%),术前超声诊断57例;子宫角部合并输卵管间质部妊娠2例(2/81,2.5%),术前超声均诊断为宫角妊娠;宫角妊娠18例(18/81,22.2%),术前超声诊断20例,误诊2例;子宫肌壁间妊娠2例(2/81,2.5%),残角子宫妊娠2例(2/81,2.5%),术前超声均明确诊断。经阴道三维超声OmniView技术对5种特殊部位异位妊娠的诊断正确率为97.5%(79/81),误诊率为2.5%(2/81),与宫腔镜、腹腔镜或宫腹腔镜联合手术结果具有较好的一致性(Kappa值=0.945,P<0.001)。结论经阴道三维超声OmniView技术操作简单,可直观显示妊娠包块的位置、与宫腔的关系及周围肌层的情况,在特殊部位异位妊娠的诊断中可为临床提供可靠信息,有助于治疗方案及手术时机的合理选择,具有较高的临床应用价值。

Objective To explore the value of intracavity three-dimensional ultrasound OmniView technology in the diagnosis of special-site ectopic pregnancy.Methods Eighty-one patients with tubal interstitial pregnancy,cornual pregnancy,cornual pregnancy with tubal interstitial pregnancy,residual horn pregnancy,or intramural pregnancy confirmed by hysteroscopy,laparoscopy,or hysteroscopy combined with laparoscopy at Chongqing Maternal and Child Health Hospital from April 2016 to April 2018 were selected retrospectively.All patients were examined by transvaginal three-dimensional ultrasound Omniview technology before operation.The ultrasonographic features of ectopic pregnancy in various special sites and the consistency of ultrasound diagnosis with the results of hysteroscopy,laparoscopy,or hysteroscopy combined with laparoscopy were analyzed.Results Fifty-seven(57/81,70.3%)cases of interstitial tubal pregnancy were confirmed by operation,all of which were diagnosed by preoperative ultrasound.Two(2/81,2.5%)cases of uterine horn pregnancy combined with tubal interstitial pregnancy confirmed by pathology were diagnosed as cornual pregnancy by preoperative ultrasonography.Eighteen(18/81,22.2%)cases of cornual pregnancy were confirmed among 20 cases diagnosed by preoperative ultrasound,of which two were misdiagnosed.Two(2/81,2.5%)cases of intramural pregnancy and two(2/81,2.5%)cases of residual horn uterine pregnancy were correctly diagnosed by preoperative ultrasonography.The coincidence rate and misdiagnosis rate of three-dimensional ultrasound Omniview technology in the diagnosis of ectopic pregnancy at these five special sites were 97.5%(79/81)and 2.5%(2/81),respectively,which had high consistency with the results of hysteroscopy,laparoscopy,or hysteroscopy combined with laparoscopy(Kappa=0.945,P<0.001).Conclusion Intracavity three-dimensional ultrasound OmniView technology is simple to operate and can visually display the position of pregnancy mass,the relationship with uterine cavity,and the circumferential muscular layer.It can provide reliable information for clinical diagnosis of ectopic pregnancy at special sites,and is helpful to the rational choice of treatment plan and operation time.