经腹部联合经阴道彩色多普勒超声在鉴别诊断宫角妊娠和输卵管间质部妊娠中的应用

Application of transabdominal combined with transvaginal color Doppler ultrasound in differential diagnosis of cornual pregnancy and tubal interstitial pregnancy

目的:研究经腹部联合经阴道彩色多普勒超声在鉴别诊断宫角妊娠和输卵管间质部妊娠中的应用价值。方法:选取2021年1月至2022年5月在佛山市南海区桂城医院妇科门诊接受手术治疗且经病理证实的宫角妊娠和输卵管间质部妊娠患者共20例,所有患者均接受经腹部彩超和经阴道彩超检查,对两种异位妊娠类型患者的超声检查结果进行统计,并对比宫角妊娠和输卵管间质部妊娠患者的超声特征。结果:1)宫角妊娠的检出率和超声图像特征:宫角妊娠患者采用经腹部联合经阴道彩超检查的检出率是87.50%。经腹部超声可见横切子宫偏向宫角部,内膜末端无回声。经阴道超声可见子宫略增大,子宫内膜增厚,单侧宫角稍微膨隆,有完整孕囊或活胎,纵切面紧靠宫底,横切面孕囊和宫腔相同。2)输卵管间质部妊娠的检出率和超声图像特征:输卵管间质部妊娠经腹部联合经阴道彩超检查的检出率是91.67%。经腹部超声检查可见子宫角侧膨出或偏大。经阴道彩超可见子宫略增大,横切面孕囊和宫腔不连通,纵切面显示孕囊与子宫底外缘紧贴。3)宫角妊娠与输卵管间质部妊娠患者的超声特征比较:宫角妊娠患者的肌层完整性、包块距宫腔<10mm占比、孕囊周围血流频谱阻力指数<0.5占比均显著高于输卵管间质部妊娠患者,经对比差异显著,P<0.05;而宫角妊娠患者的肌层厚度和输卵管间质部妊娠患者对比无显著性差异,P>0.05。结论:在宫角妊娠和输卵管间质部妊娠的鉴别诊断中,运用经腹部联合经阴道彩色多普勒超声可提高检出率,同时可根据超声图像特征对这两种少见异位妊娠类型进行鉴别。

Objective:To study the application value of transabdominal combined with transvaginal color Doppler ultrasound in the differential diagnosis of cornual pregnancy and tubal interstitial pregnancy.Methods:Choose between January 2021 and May 2022 in nanhai district,foshan city,keijo hospital outpatient service of department of gynaecology surgery and confirmed by pathology palace Angle and)portion of fallopian tube pregnancy patients with a total of 20 patients,all patients were accepted by abdominal colour to exceed and transvaginal colour to exceed,of two types of ectopic pregnancy patients with ultrasound examination for statistical results,The ultrasound characteristics of uterine horn pregnancy and tubal interstitial pregnancy were compared.Results:1)The detection rate and ultrasound image characteristics of cornual pregnancy:the detection rate of patients with cornual pregnancy by transabdominal combined with transvaginal color ultrasound was 87.50%.Transabdominal ultrasound showed that the transection of the uterus was biased toward the corner of the uterus,and the end of the endometrium was not echoic.Transvaginal ultrasound showed slightly enlarged uterus,thickened endometrium,slightly distended unilateral uterine horn,intact gestational sac or live fetus,close to the uterine floor in longitudinal view,and the gestational sac and uterine cavity in transverse view.2)The detection rate and ultrasound image characteristics of tubal interstitial pregnancy:the detection rate of tubal interstitial pregnancy by abdominal combined with transvaginal color ultrasound was 91.67%.T ransabdominal ultrasonography showed lateral enlargement or enlargement of the uterine horn.Transvaginal color ultrasound showed that the uterus was slightly enlarged,and the gestational sac was disconnected from the uterine cavity in the transverse section,while the gestational sac was close to the outer edge of the uterine floor in the longitudinal section.3)Comparison of ultrasonic characteristics between patients with cornual pregnancy and tubal interstitial pregnancy:the myometrium integrity,the proportion of mass less than 10mm from the uterine cavity,and the proportion of blood flow spectrum resistance index around the gestational sac<0.5 in patients with cornual pregnancy were significantly higher than those in patients with tubal interstitial pregnancy,and the differences were significant(P<0.05).However,there was no significant difference in myometrium thickness between patients with cornual pregnancy and patients with tubal interstitial pregnancy(P>0.05).Conclusion:Transabdominal combined with transvaginal color Doppler ULTRASOUND can improve the detection rate in the differential diagnosis of uterine horn pregnancy and tubal interstitial pregnancy,and can distinguish these two rare ectopic pregnancy types according to the characteristics of ultrasound images.