阴道超声对输卵管妊娠的诊断价值及甲氨蝶呤与腹腔镜治疗效果比较

The diagnostic value of vaginal ultrasound for tubal pregnancy and the comparison between methotrexate and laparoscopy

目的探究阴道超声在输卵管妊娠的诊断价值及观察甲氨蝶呤保守治疗与腹腔镜治疗效果。方法回顾性选取我院收治的输卵管妊娠患者94例,均接受阴道超声(阴道超声组)和腹部超声(腹部超声组)检查,并将94例患者根据治疗方式分为甲氨蝶呤组45例,腹腔镜组49例。比较阴道超声对输卵管妊娠的诊断价值,并分析甲氨蝶呤保守治疗与腹腔镜治疗效果对输卵管妊娠的疗效。结果阴道超声检查显示宫内假孕囊、附件区包块、胚芽、卵黄囊、心芽搏动等超声影像学表现的阳性率则分别为37.23%、94.68%、42.55%、47.87%、12.77%,高于腹部超声检查显示的15.96%、76.60%、18.09%、26.60%、10.64%,差异均有统计学意义(P<0.05);并且阴道超声诊断准确率为92.55%,高于腹部超声的76.60%,差异有统计学意义(P<0.05)。腹腔镜组住院时间、人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)恢复时间明显短于甲氨蝶呤组,腹痛发生率高于甲氨蝶呤组,差异均有统计学意义(P<0.05)。腹腔镜组治疗1年后宫内妊娠率低于甲氨蝶呤组,差异有统计学意义(P<0.05),但两组再次输卵管妊娠比较,差异无统计学意义(P>0.05)。结论阴道超声对输卵管妊娠的诊断价值较高,而甲氨蝶呤非手术治疗与腹腔镜治疗均对输卵管妊娠有一定治疗效果,且各有优势,临床可根据治疗需求进行选择。

Objective To investigate the diagnostic value of vaginal ultrasound in tubal pregnancy and to observe the effect of conservative treatment with methotrexate versus laparoscopic treatment.Methods Ninety-four patients with tubal pregnancy admitted to our hospital were retrospectively selected to undergo vaginal ultrasound(vaginal ultrasound group)and abdominal ultrasound(abdominal ultrasound group),and the 94 patients were divided into two subgroups according to the treatment modality,including 45 cases in the methotrexate group and 49 cases in the laparoscopic group.The diagnostic value of vaginal ultrasound for tubal pregnancy was compared,and the efficacy of conservative treatment with methotrexate versus laparoscopic treatment on tubal pregnancy was analyzed.Results The positive rates of ultrasound imaging findings such as intrauterine pseudopregnancy sac,adnexal mass,pregnancy germ,yolk sac,and heart bud pulsation were 37.23%,94.68%,42.55%,47.87%and 12.77%respectively,which were higher than 15.96%,76.60%,18.09%,26.60%and 10.64%by abdominal ultrasound,suggesting significant differences(P<0.05).The diagnostic accuracy of transvaginal ultrasound was 92.55%,which was higher than that(76.60%)of abdominal ultrasound(P<0.05).The length of hospitalization and the recovery time of human chorionic gonadotropin(hCG)in the laparoscopic group were significantly shorter than those in the methotrexate group,and the incidence of abdominal pain was higher than that in the methotrexate group,suggesting significant differences(P<0.05).At 1 year after treatment,the intrauterine pregnancy rate in laparoscopic group was lower than that in methotrexate group,suggesting significant differences(P<0.05),but there was no significant difference in tubal pregnancy again between two groups(P>0.05).Conclusion Vaginal ultrasound has a high diagnostic value for tubal pregnancy,while conservative treatment with methotrexate and laparoscopic treatment have certain therapeutic effects on tubal pregnancy,and each has its own advantages.The clinical choice can be made based on treatment needs.