三种不同超声方法对异位妊娠的诊断价值
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摘要
目的比较经阴道超声、腹部超声及阴-腹联合超声检查,三种超声方法检测异位妊娠的特征性表现。方法将2016年3月至2018年3月衢州市中医医院85例少见部位异位妊娠患者作为研究对象,分别行经阴道超声、腹部超声与阴-腹联合超声。比较三种超声检查方法对不同部位异位妊娠的检出率,异位妊娠特征性表现,以及诊断漏诊率和确诊率的差异。结果阴-腹联合超声检查对早期异位妊娠特征性表现,如胎心搏动(21.18%)、可见胚芽(37.65%)、附件包块(98.82%)、宫内假孕囊(30.59%)、盆腔积液(92.94%)的检出率较单一经阴道超声检查者(8.24%、22.35%、88.24%、16.47%、78.82%)明显升高(χ~2值分别为8.38、4.73、6.22、4.71、6.99,均P<0.05),较腹部超声者(1.18%、9.41%、76.47%、7.06%、68.24%)亦明显升高(χ~2值分别为18.85、18.83、17.60、15.40、16.58,均P<0.05)。阴-腹联合超声对宫颈妊娠、腹腔妊娠、残角子宫妊娠、卵巢妊娠、剖宫产瘢痕妊娠的检出率较单一采用腹部超声检查者均明显升高(χ~2值分别为5.03、5.73、4.26、6.94、8.03,P<0.05),而与单用经阴道超声检查比较,均无明显差异(χ~2值分别为1.74、1.54、0.96、2.88、1.77,均P>0.05)。阴-腹联合超声对异位妊娠的诊断漏诊率(4.71%)较单一经阴道超声(27.06%)、腹部超声(47.06%)检查者明显降低(χ~2值分别为14.27、37.56,均P<0.01)。结论经阴-腹联合超声检查既能清晰地观察腹腔状况,亦能全面显示宫腔和包块的细微结构等情况,可为临床诊断提供可靠、全面的图像信息,提高异位妊娠的诊断准确率,减少漏诊的发生。
Objective To compare the characteristics of transvaginal ultrasound, abdominal ultrasound and transvaginal-abdominal combined ultrasound in detecting ectopic pregnancy. Methods From March 2016 to March 2018, 85 patients with rare ectopic pregnancy in Quzhou Municipal Hospital of TCM accepted transvaginal ultrasound, abdominal ultrasound and transvaginal-abdominal combined ultrasound. The detection rate of ectopic pregnancy, the characteristic manifestations of ectopic pregnancy, the missed diagnosis rate and the correct diagnosis rate were compared among three methods. Results The detection rates of fetal heart beat(21.18%), visible embryo(37.65%), adnexal mass(98.82%), intrauterine pseudopregnant sac(30.59%) and pelvic effusion(92.94%) by transvaginal-abdominal combined ultrasound were significantly higher than those by single transvaginal ultrasound(8.24%, 22.35%, 88.24%, 16.47% and 78.82%)(χ~2 value was 8.38, 4.73, 6.22, 4.71 and 6.99, respectively, all P<0.05), and were significantly higher than those by single abdominal ultrasound(1.18%, 9.41%, 76.47%, 7.06% and 68.24%)(χ~2 value was 18.85, 18.83, 17.60, 15.40 and 16.58, respectively, all P<0.05). The detection rates of cervical pregnancy, abdominal pregnancy, residual horn uterine pregnancy, ovarian pregnancy and cesarean scar pregnancy by transvaginal-abdominal combined ultrasound were significantly higher than those by single abdominal ultrasound(χ~2 value was 5.03, 5.73, 4.26, 6.94 and 8.03, respectively, all P<0.05), but showed no differences in comparison of those by single transvaginal ultrasound(χ~2 value was 1.74, 1.54, 0.96, 2.88 and 1.77, respectively, all P>0.05). The missed diagnosis rate of ectopic pregnancy by transvaginal-abdominal combined ultrasound(4.71%) was significantly lower than that by single transvaginal ultrasound(27.06%) and abdominal ultrasound(47.06%)(χ~2 value was 14.27 and 37.56, both P<0.01). Conclusion Transvaginal-abdominal combined ultrasonography can not only clearly reveal the abdominal cavity, but fully display the fine structure of uterine cavity and mass. It can provide reliable and comprehensive image information for clinical diagnosis, improve the diagnostic accuracy of ectopic pregnancy and reduce the occurrence of missed diagnosis.
Objective To compare the characteristics of transvaginal ultrasound, abdominal ultrasound and transvaginal-abdominal combined ultrasound in detecting ectopic pregnancy. Methods From March 2016 to March 2018, 85 patients with rare ectopic pregnancy in Quzhou Municipal Hospital of TCM accepted transvaginal ultrasound, abdominal ultrasound and transvaginal-abdominal combined ultrasound. The detection rate of ectopic pregnancy, the characteristic manifestations of ectopic pregnancy, the missed diagnosis rate and the correct diagnosis rate were compared among three methods. Results The detection rates of fetal heart beat(21.18%), visible embryo(37.65%), adnexal mass(98.82%), intrauterine pseudopregnant sac(30.59%) and pelvic effusion(92.94%) by transvaginal-abdominal combined ultrasound were significantly higher than those by single transvaginal ultrasound(8.24%, 22.35%, 88.24%, 16.47% and 78.82%)(χ~2 value was 8.38, 4.73, 6.22, 4.71 and 6.99, respectively, all P<0.05), and were significantly higher than those by single abdominal ultrasound(1.18%, 9.41%, 76.47%, 7.06% and 68.24%)(χ~2 value was 18.85, 18.83, 17.60, 15.40 and 16.58, respectively, all P<0.05). The detection rates of cervical pregnancy, abdominal pregnancy, residual horn uterine pregnancy, ovarian pregnancy and cesarean scar pregnancy by transvaginal-abdominal combined ultrasound were significantly higher than those by single abdominal ultrasound(χ~2 value was 5.03, 5.73, 4.26, 6.94 and 8.03, respectively, all P<0.05), but showed no differences in comparison of those by single transvaginal ultrasound(χ~2 value was 1.74, 1.54, 0.96, 2.88 and 1.77, respectively, all P>0.05). The missed diagnosis rate of ectopic pregnancy by transvaginal-abdominal combined ultrasound(4.71%) was significantly lower than that by single transvaginal ultrasound(27.06%) and abdominal ultrasound(47.06%)(χ~2 value was 14.27 and 37.56, both P<0.01). Conclusion Transvaginal-abdominal combined ultrasonography can not only clearly reveal the abdominal cavity, but fully display the fine structure of uterine cavity and mass. It can provide reliable and comprehensive image information for clinical diagnosis, improve the diagnostic accuracy of ectopic pregnancy and reduce the occurrence of missed diagnosis.
引文
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[7]Richardson A,Gallos I,Dobson S,et al.Accuracy of first-trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extrauterine embryo:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2016,47(1):28-37.
[8]Yamaguchi M,Honda R,Erdenebaatar C,et al.Treatment of cervical pregnancy with ultrasound-guided local methotrexate injection[J].Ultrasound Obstet Gynecol,2017,50(6):781-787.
[9]马红霞,张敏青,瞿庆红,等.TVCDS与TACDS对异位妊娠早期诊断的特异性及灵敏性分析[J].中国妇幼健康研究,2017,28(3):314-316.
[10]Alammari R,Thibodeau R,Harmanli O.Vaginal hysterectomy for treatment of cervical ectopic pregnancy[J].Obstet Gynecol,2017,129(1):63-65.
[2]胡璇,周静,洪云,等.超声RI和ET联合血β-hCG在宫外孕诊断中的价值研究[J].中国妇幼健康研究,2016,27(11):1332-1335.
[3]张志峰,范立新,刘伟玺,等.异位妊娠患者子宫内膜的超声形态特点分析[J].中国基层医药,2018,25(9):1204-1205.
[4]López C L,Lopes V G S,Resende F R,et al.Gestational trophoblastic neoplasia after ectopic molar pregnancy:Clinical,diagnostic,and therapeutic aspects[J].Revi Bras Ginecol Obstet,2018,40(5):294-299.
[5]Murji A,Garbedian K,Thomas J,et al.Conservative management of cervical ectopic pregnancy[J].J Obstet Gynaecol Can,2015,37(11):1016-1020.
[6]宣兰萍.超声在50例特殊部位异位妊娠诊断中的价值[J].中国计划生育学杂志,2017,25(5):340-342.
[7]Richardson A,Gallos I,Dobson S,et al.Accuracy of first-trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extrauterine embryo:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2016,47(1):28-37.
[8]Yamaguchi M,Honda R,Erdenebaatar C,et al.Treatment of cervical pregnancy with ultrasound-guided local methotrexate injection[J].Ultrasound Obstet Gynecol,2017,50(6):781-787.
[9]马红霞,张敏青,瞿庆红,等.TVCDS与TACDS对异位妊娠早期诊断的特异性及灵敏性分析[J].中国妇幼健康研究,2017,28(3):314-316.
[10]Alammari R,Thibodeau R,Harmanli O.Vaginal hysterectomy for treatment of cervical ectopic pregnancy[J].Obstet Gynecol,2017,129(1):63-65.