妊娠子宫嵌顿的声像图特征分析

Ultrasonographic features of incarceration of the gravid uterus

目的总结妊娠子宫嵌顿的超声图像特征,提高超声对该病的检出率。方法回顾性分析2018年5月至2020年5月于北京大学第三医院确诊的3例妊娠子宫嵌顿患者及通过中国知网、万方数据库、维普期刊数据库及PubMed数据库检索的2000年1月至2020年7月中英文文献报道的53例经临床证实的妊娠子宫嵌顿患者的超声资料。总结56例患者的声像图特征及妊娠结局,统计各项超声特征显示率,复习相关文献并总结其诊断经验。结果56例患者中45例(80.4%)超声显示阳性征象,其中34例(60.7%)显示宫颈异常(宫颈拉长前移或显示不清),27例(48.2%)显示子宫后倾后屈,12例(21.4%)显示子宫底位于子宫直肠陷凹,4例(7.1%)显示膀胱拉长上移,宫颈异常与子宫后倾后屈的显示率差异有统计学意义(χ^(2)=5.452,P<0.05)。结论宫颈异常是妊娠子宫嵌顿超声显示率最高的征象,正确识别宫颈有助于提高对该病的检出率。

Objective To summarize the ultrasound characteristics of incarceration of gravid uterus(IGU)for improving the diagnostic accuracy of IGU.Methods Three cases of IGU patients were diagnosed in Peking University Third Hospital from May 2018 to May 2020.CNKI,Wanfang Data,China Science and Technology Journal Database and PubMed were searched using the search terms"incarcerate uterus"or"uterine incarceration"and"gravid"through January 2000 to July 2020,53 IGU cases were found.The ultrasound data and outcomes of the 56 IGU patients were retrospectively analyzed.The display rate of various ultrasonic features were counted.Relevant literatures were reviewed and the experience were summarized.Results Of the 56 cases with IGU,45 cases(80.4%)had positive results,of which 34 cases(60.7%)were found abnormal cervix(elongated anteriorly and superiorly displaced cervix or poorly visualized cervix),27 cases(48.2%)were found retroversion of the gravid uterus,12 cases(21.4%)were found that the fundus of the uterus lay deeply in the Douglas pouch,4 cases(7.1%)were found anteriorly and superiorly displaced bladder.There was statistically significant difference between the displaying rates of abnormal cervix and retroversion of the gravid uterus(χ^(2)=5.452,P<0.05).Conclusions Abnormal cervix was the most common feature of IGU by ultrasound.Correct identification of the cervix is helpful to improve the detection rate of IGU.