彩色多普勒超声对少见部位异位妊娠的诊断价值及鉴别诊断

The valve of color Doppler ultrasonography in diagnosis and differential diagnosis of rare ectopic pregnancy

目的探讨彩色多普勒超声对少见型异位妊娠的临床诊断价值及鉴别诊断。方法回顾性分析104例经手术证实的少见型异位妊娠患者的临床资料及超声图像,将术前超声诊断与术后病理结果进行对照分析,探讨少见型异位妊娠的临床特征、超声图像特点及鉴别诊断。结果 104例少见型异位妊娠此次自然受孕、辅助生殖技术受孕及促排卵受孕的比例分别为68%、30%及2%,有妇科手术史、异位妊娠史、人工流产史、剖宫产史及生育史的比例分别为25.9%、19.2%、47.1%、31.7%及45.2%。术前超声诊断80例,误诊16例,漏诊8例,总符合率77%,漏误诊率23%,其中宫颈妊娠及剖宫产术后子宫瘢痕妊娠诊断率最高(均100%),输卵管间质部妊娠、宫角妊娠、卵巢妊娠、残角子宫妊娠、输卵管残端妊娠及宫内合并宫外复合妊娠诊断率分别为75%、66.6%、60%、50%、50%及76%,腹腔妊娠诊断率最低(本组全部漏诊),与术后病理结果的一致性较好(Kappa值=0.769,P<0.001)。结论少见型异位妊娠声像图特征既有共性又有个性。超声医生应重视临床病史,动态观察,注意鉴别诊断,提高早期诊断率,减少漏误诊,如此有助于临床治疗方案和手术时机的合理选择。

Objective To explore the valve of color Doppler ultrasonography in the diagnosis and differential diagnosis of rare ectopic pregnancy.Methods The clinical data and ultrasound findings of 104 patients with rare ectopic pregnancy confirmed by surgery were analyzed respectively.Results Among 104 cases of rare ectopic pregnancy,the proportion of patients with natural conception,assisted reproductive technology(ART)and ovulation induction was 68%,30%and 2%;and 25.9%,19.2%,47.1%,31.7%and 45.2%of the patients had history of gynecological operation,ectopic pregnancy,abortion,cesarean section and childbearing,respectively.Compared with surgical results,80 cases were correctly diagnosed,16 cases were misdiagnosed and 8 cases missed diagnosis by ultrasography with a coincidence rate of 77%.Cervical pregnancy and cesarean scar pregnancy were all diagnosed correctly.The diagnostic accordance rates of tubal interstitial pregnancy,cornual pregnancy,ovarian pregnancy,residual horn uterine pregnancy,fallopian tube residual pregnancy and heterotopic pregnancy(HP)were 75%,66.6%,60%,50%,50%and 76%,respectively;while all cases of abdominal pregnancy were misdiagnosed in this series.The diagnosis of ultrasound had high consistency with the result of pathology(Kappa=0.769,P<0.001).Conclusion The ultrasonic findings of rare ectopic pregnancy have common features and also some unique characteristics for different types of ectopic pregnancy.The clinical history,differential diagnosis and dynamic observation are important for improvement of the early diagnosis and reducing misdiagnosis of rare ectopic pregnancy.