输卵管妊娠破裂超声危急值的应用评估

Application and evaluation of ultrasound critical value in ruptured tubal pregnancy

目的评估超声对输卵管妊娠破裂的诊断和危急值上报情况。方法回顾性分析2017年8月至2021年5月北京协和医院手术确诊的70例输卵管妊娠破裂患者的临床、超声资料, 评估输卵管妊娠破裂的超声诊断准确性及危急值上报概况。结果 68例患者行术前盆腔超声检查, 超声准确提示附件区异位妊娠包块、腹盆腔积液/血凝块者63例(92.6%, 63/68), 漏诊附件区异位妊娠包块5例(7.4%, 5/68)。漏诊病例中4例(80.0%, 4/5)为宫内外复合妊娠[2例体外受精-胚胎移植(IVF-ET) 2枚, 1例为患者服用促排卵药, 1例孕妇有双胎家族史], 1例(20%, 1/5)为单独输卵管妊娠。2例未行超声检查。术前超声诊断的63例输卵管妊娠破裂均上报了超声危急值。结论超声能较准确诊断输卵管妊娠及判断是否破裂, 并及时上报危急值, 可有效保障医疗安全。应用辅助生殖的早孕期超声诊断的特殊性和复杂性值得引起重视。

Objective To evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Methods The clinical and ultrasound data of 70 patients with ruptured tubal pregnancy diagnosed by surgery in Peking Union Medical College Hospital from August 2017 to May 2021 were retrospectively analyzed to evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Results Among the 70 patients,68 patients underwent gynecological ultrasonography and two patients did not.Sixty-three cases(92.6%,63/68)were accurately diagnosed as adnexal ectopic pregnancy mass,abdominal and pelvic effusion/blood clot,and 5 adnexal ectopic pregnancy masses(7.4%,5/68)were missed.Among the 5 missed cases,4 cases(80%,4/5)were heterotopic pregnancy(2 cases of IVF-ET 2 embryos,1 case of patient taking ovulation induction drugs,1 case of gravida with twin family history)and 1 case(20%,1/5)of single tubal pregnancy.Critical values were reported in the all 63 cases of ruptured tubal pregnancy diagnosed by preoperative ultrasound.Conclusions Ultrasound could accurately diagnose tubal pregnancy and assess its rupture,and timely report the critical value,effectively guarantee the medical safety.The particularity and complexity of ultrasound diagnosis in early pregnancy with assisted reproductive technique deserve more attention.