人工辅助生殖患者宫角妊娠的超声表现及其在临床转归的指导价值

Study on the diagnostic and prognostic values of ultrasound in patients with angular pregnancy through artificially assisted reproduction

目的探讨超声对人工辅助生殖患者早孕期宫角妊娠的诊断及指导临床转归的应用价值。方法回顾分析2015年4月至2019年5月在空军军医大学唐都医院生殖医学中心人工辅助生殖受孕(单胎)成功且于早孕期诊断为宫角妊娠的93例患者,超声测量孕囊大小、孕囊外缘肌层厚度、孕囊着床处宫角形态(是否有隆起)等指标,临床给予患者对侧卧位休息的期待疗法,超声随访。记录胚胎转入宫腔时间、胚胎是否存活。根据不同转归分为转入宫腔内组、宫角滞留并停育组、转归不良组。比较三组血清人绒毛膜促性腺激素(β-hCG)及孕囊内径、外缘肌层厚度、宫角隆起比例。结果宫角妊娠患者中,56例转为宫腔内妊娠,29例于宫角滞留并胚胎停育,4例转归不良(或破裂或转为间质部妊娠),4例放弃继续妊娠。转为宫内妊娠组、宫角滞留并停育组和转归不良组孕30 d血清β-hCG分别为794.75(387.93,1635.26)U/L、559.40(373.80,997.20)U/L、187.80(161.25,425.70)U/L,孕囊内径分别为17.25(12.13,23.50)mm、8.50(5.25,16.50)mm、8.25(4.13,13.13)mm,孕囊外缘肌层厚度分别为3.30(3.00,4.30)mm、3.60(3.10,4.60)mm、2.20(0.40,3.10)mm,宫角隆起占比分别为9%、0、100%,以上参数组间比较差异有统计学意义(均P<0.05)。结论二维结合三维经阴道超声可以明确宫角妊娠的诊断,并通过测量相关参数进行预后评价,从而有效地指导临床。

Objective To explore the diagnostic value of ultrasound in angular pregnancy for patients with artificially assisted reproduction in early pregnancy and its value in prognosing clinical outcome.Methods Retrospective study was made in 93 patients who conceived artificially assisted reproduction(singleton)successfully and were diagnosed with angular pregnancy in early pregnancy in the Reproductive Medicine Center of Tangdu Hospital,Air Force Military Medical University from April 2015 to May 2019.The evaluating parameters by ultrasound included the size of the gestational sac,the lateral myometrial thickness surrounding the gestational sac and the morphology of uterine cornua(enlargement or not)where the gestational sac implanted.The patients were treated with the expectant management by laying oppositely and followed-up by ultrasound.The time of gestational sac moving into the uterine cavity and pregnant outcome were recorded.According to the different outcomes,the patients were divided into three groups:group of moving into the cavity,group of retention in cornua and development arrest,poor outcome group.The serumβ-human chorionic gonadotropin(β-hCG),the mean diameter of gestational sac,the lateral myometrial thickness surrounding the gestational sac,and the proportion of cornua enlargement among the 3 groups were compared.Results Among the patients with angular pregnancy,the gestational sac moved into uterine cavity in 56 patients the gestational sac stayed in the cornua and the embryo stopped developing in 29 patients,4 patients had poor outcomes and 4 patients chose pregnancy termination.The serum level ofβ-hCG of the three groups on the 30th day of pregnancy were 794.75(387.93,1635.26)U/L,559.40(373.80,997.20)U/L and 187.80(161.25,425.70)U/L,respectively;the mean diameters of gestational sac for three groups were 17.25(12.13,23.50)mm,8.50(5.25,16.50)mm,8.25(4.13,13.13)mm,respectively;the lateral myometrial thicknesses surrounding the gestational sac were 3.30(3.00,4.30)mm,3.60(3.10,4.60)mm,2.20(0.40,3.10)mm,respectively;and the incidences of cornua enlargement were 9%,0,100%,respectively.There were statistical differences among these groups for the above parameters(P<0.05).Conclusions The diagnosis of angular pregnancy can be confirmed by both two-dimensional and three-dimensional ultrasound,and the prognosis can be evaluated by measuring the relevant ultrasonographic parameters,which would provide valuable clinical guidance.