阴道三维超声对子宫角妊娠与输卵管间质部妊娠的鉴别诊断价值

Value of three-dimensional vaginal ultrasonography in the differential diagnosis of cornual pregnancy and interstitial tubal pregnancy

目的分析阴道三维超声对子宫角妊娠(CP)与输卵管间质部妊娠(ITP)的鉴别诊断价值。方法抽取2019年8月至2021年7月河南省第二人民医院收治的经手术及病理证实的异位妊娠患者98例,均行经阴道二维超声和阴道三维超声检查,其中CP患者55例(CP组),ITP患者43例(ITP组)。分析两组阴道二维、三维超声检出结果,比较两组阴道三维超声声像图特征和定量参数[滋养层动脉血流收缩期峰值流速(PSV)、滋养层动脉舒张末期血流速度(EDV)、滋养层动脉阻力指数(RI)、孕囊周边肌层包绕厚度]。结果CP组阴道三维超声检出率(92.73%,51/55)高于阴道二维超声(78.18%,43/55),ITP组阴道三维超声检出率(88.37%,38/43)高于阴道二维超声(69.77%,30/43),差异有统计学意义(P<0.05)。CP组完整周边肌层者占比、子宫内膜包绕或紧邻者占比(94.55%,52/55;81.82%,45/55)高于ITP组(25.58%,11/43;0,0/43),孕囊外凸者占比、宫腔完整者占比(21.82%,12/55;30.91%,17/55)低于ITP组(79.07%,34/43;95.35%,41/43),差异有统计学意义(P<0.05)。两组滋养层动脉PSV比较,差异未见统计学意义(P>0.05);CP组滋养层动脉EDV低于ITP组,滋养层动脉RI、孕囊周边肌层包绕厚度高于ITP组,差异有统计学意义(P<0.05)。结论阴道三维超声检查可提升CP、ITP检出率,并能通过周边肌层、宫角膨隆、宫腔完整等声像图特征,及滋养层动脉RI、滋养层动脉EDV、孕囊周边肌层包绕厚度等定量参数鉴别CP与ITP。

Objective To analyze the value of three-dimensional vaginal ultrasonography in the differential diagnosis of cornual pregnancy(CP)and interstitial tubal pregnancy(ITP).Methods A total of 98 patients with ectopic pregnancies confirmed by surgery and pathology admitted to Henan Second Provincial People’s Hospital from August 2019 to July 2021 were selected,and all of them underwent transvaginal two-dimensional ultrasound and three-dimensional vaginal ultrasound.Of the patients,55 patients were with CP(CP group),and 43 patients were with ITP(ITP group).The results of two-dimensional and three-dimensional vaginal ultrasound in the two groups were analyzed.The quantitative parameters of the three-dimensional vaginal ultrasound,including trophoblast arterial peak systolic blood flow velocity(PSV),trophoblast arterial end-diastolic velocity(EDV),trophoblast arterial resistance index(RI)and myometrium wrapping thickness around gestational sac,and the sonographic characteristics of the three-dimensional vaginal ultrasound in the two groups were compared.Results The detection rate of three-dimensional vaginal ultrasound(92.73%,51/55)was higher than that in two-dimensional vaginal ultrasound(78.18%,43/55)in the CP group(P<0.05);and the detection rate of three-dimensional vaginal ultrasound(88.37%,38/43)was higher than that in two-dimensional vaginal ultrasound(69.77%,30/43)in the ITP group(P<0.05).The proportion of intact peripheral myometrium,endometrial envelope or immediate adjacentry in the CP group(94.55%,52/55;81.82%,45/55)was higher than that in the ITP group(25.58%,11/43;0,0/43),and the proportion of patients with convex gestational sac and intact uterine cavity(21.82%,12/55;30.91%,17/55)were lower than those in the ITP group(79.07%,34/43;95.35%,41/43),and the differences were significant(P<0.05).There was no significant difference in PSV of trophoblast arteries between the two groups(P>0.05).The EDV of trophoblast arteries in the CP group was lower than that in the ITP group,and the RI of the trophoblast arteries and the thickness of myometrial wrapping around the gestational sac in the CP group were higher than those in the ITP group,and the differences were significant(P<0.05).Conclusions Three-dimensional vaginal ultrasonography can improve the detection rate of CP and ITP,and can distinguish CP and ITP by sonographic features,inclunding as peripheral muscle,uterine angle distention and uterine cavity integrity,as well as quantitative parameters,inclunding trophoblast arterial RI,trophoblast arterial EDV,and muscular wrapping thickness around the gestational sac.