经阴道彩色多谱勒血流显像对早期异位妊娠的诊断及鉴别诊断价值
|
摘要
目的：
通过经阴道黑白超声与经阴道彩色多普勒超声诊断早期异位妊娠的对比研究，探讨经阴道彩色多普勒超声诊断异位妊娠的价值及鉴别诊断价值。
方法：
1．以90例临床拟诊为异位妊娠的患者作为病例组，均同时进行经阴道黑白超声检查(TVS)和经阴道彩色多谱勒血流显像(TVS-CDFI)，以手术结果为诊断的金标准，将TVS及TVS-CDFI诊断结果分别与手术结果比较，评价TVS-CDFI诊断异位妊娠的价值。
2．纳入20例正常早孕者作为对照组，采用TVS-CDFI测量病例组及对照组的子宫动脉及滋养层动脉血流频谱参数(RI、VS、VD)，根据手术结果分组，将组间动脉血流参数采用单因素方差分析(One-Way ANOVA)，评价组间血流参数有无差异，探讨经阴道彩色超声检查鉴别诊断价值。
结果：
1．90例研究对象，手术确诊异位妊娠76例，黄体破裂3例，附件炎性包块11例，以手术结果为诊断异位妊娠的金标准，经阴道彩色超声(TVS-CDFI)诊断异位妊娠的敏感性100％，准确性97.7％，特异性85.7％，阳性预测值97.4％，阴性预测值100％；经阴道黑白超声(TVS)诊断异位妊娠的敏感性97.3％，准确性92.2％，特异性64.3％，阳性预测值93.6％，阴性预测值81.8％。经阴道彩色超声对早期异位妊娠的诊断具有更大的临床价值。2.20例对照组与90例病例组根据手术结果分为四组，四组间方差分析结果：子宫动脉血流阻力指数(RI)无显著差异性；病灶周围血流阻力指数(RI)有显著差异性。
结论：
经阴道彩色超声检查是诊断早期异位妊娠的重要方法之一，经阴道彩色超声检查在诊断异位妊娠时较黑白超声检查能为临床提供更准确的超声诊断，对异位妊娠与炎性包块及黄体破裂病人的鉴别诊断能提供更多的超声诊断信息，对于三种疾病的鉴别诊断具有临床价值。
Objective:
To evaluate the diagnosis and differentiate diagnosis valueof tansvaginal color sonography (TVS-CDFI) in ectopicpregnancy compared with transvaginal sonography(TVS).
Methods:
1.90 patients suspected of ectopic pregnancy wereprospectively enrolled in this study. TVS-CDFI、TVS andsurgical dignosis were carried out. The findings of surgicaldiagnosis were regarded as diagnosticgoldstandard. Comparedthe result of TVS-CDFI and TVS, analysis software of x~2Tec, evaluate the diognosis value of TVS-CDFI.2.20 patientsdisgnosed of early intrauterine pregnancy were enrolled in this study as control group .Measured their and case group'sCDFI-blood parameter, analysis with One-Way ANOVA,evaluate the differentiate diognosis value of TVS-CDFI.
Results 1.76 of 90 patients were ectopic pregnancy diagnosed bysurgery and 14 patients were non-ectopic pregnancy (including11 cases adnexal inflammation of ,3 cases of lutealrupture) .The sensitivety、specificity、accuracy、positivepredictive value and negative predictive value of TVS-CDFIwas 100%、85.7%、97.7%、97.4%、100%; .The sensitivety、specificity、accuracy、positive predictive value and negativepredictive value of TVS was 97.3%、64.3%、92.2%、3.6%、81.8%.TVS-CDFI have better accuracy in ectopic pregnancydiagnosis than TVS. 2.20 controll group and 90 case grouppatients were divided into 4 groups by the result of surgery.Their blood parameter analysed by One-Way ANOVA: theuterine arery resistant index (RI) between groups has nosignificant difference,the focus blood parameter RI betweengroups has significant difference.
Conclusion
TVS-CDFI is one of the important means in ectopicpregnancy diagnose. TVS-CDFI have better accuracy in ectopicpregnancy diagnosis than TVS,at the same time TVS-CDFI hasimportant value in differentiate adnexal inflammation and lutealrupture.
通过经阴道黑白超声与经阴道彩色多普勒超声诊断早期异位妊娠的对比研究，探讨经阴道彩色多普勒超声诊断异位妊娠的价值及鉴别诊断价值。
方法：
1．以90例临床拟诊为异位妊娠的患者作为病例组，均同时进行经阴道黑白超声检查(TVS)和经阴道彩色多谱勒血流显像(TVS-CDFI)，以手术结果为诊断的金标准，将TVS及TVS-CDFI诊断结果分别与手术结果比较，评价TVS-CDFI诊断异位妊娠的价值。
2．纳入20例正常早孕者作为对照组，采用TVS-CDFI测量病例组及对照组的子宫动脉及滋养层动脉血流频谱参数(RI、VS、VD)，根据手术结果分组，将组间动脉血流参数采用单因素方差分析(One-Way ANOVA)，评价组间血流参数有无差异，探讨经阴道彩色超声检查鉴别诊断价值。
结果：
1．90例研究对象，手术确诊异位妊娠76例，黄体破裂3例，附件炎性包块11例，以手术结果为诊断异位妊娠的金标准，经阴道彩色超声(TVS-CDFI)诊断异位妊娠的敏感性100％，准确性97.7％，特异性85.7％，阳性预测值97.4％，阴性预测值100％；经阴道黑白超声(TVS)诊断异位妊娠的敏感性97.3％，准确性92.2％，特异性64.3％，阳性预测值93.6％，阴性预测值81.8％。经阴道彩色超声对早期异位妊娠的诊断具有更大的临床价值。2.20例对照组与90例病例组根据手术结果分为四组，四组间方差分析结果：子宫动脉血流阻力指数(RI)无显著差异性；病灶周围血流阻力指数(RI)有显著差异性。
结论：
经阴道彩色超声检查是诊断早期异位妊娠的重要方法之一，经阴道彩色超声检查在诊断异位妊娠时较黑白超声检查能为临床提供更准确的超声诊断，对异位妊娠与炎性包块及黄体破裂病人的鉴别诊断能提供更多的超声诊断信息，对于三种疾病的鉴别诊断具有临床价值。
Objective:
To evaluate the diagnosis and differentiate diagnosis valueof tansvaginal color sonography (TVS-CDFI) in ectopicpregnancy compared with transvaginal sonography(TVS).
Methods:
1.90 patients suspected of ectopic pregnancy wereprospectively enrolled in this study. TVS-CDFI、TVS andsurgical dignosis were carried out. The findings of surgicaldiagnosis were regarded as diagnosticgoldstandard. Comparedthe result of TVS-CDFI and TVS, analysis software of x~2Tec, evaluate the diognosis value of TVS-CDFI.2.20 patientsdisgnosed of early intrauterine pregnancy were enrolled in this study as control group .Measured their and case group'sCDFI-blood parameter, analysis with One-Way ANOVA,evaluate the differentiate diognosis value of TVS-CDFI.
Results 1.76 of 90 patients were ectopic pregnancy diagnosed bysurgery and 14 patients were non-ectopic pregnancy (including11 cases adnexal inflammation of ,3 cases of lutealrupture) .The sensitivety、specificity、accuracy、positivepredictive value and negative predictive value of TVS-CDFIwas 100%、85.7%、97.7%、97.4%、100%; .The sensitivety、specificity、accuracy、positive predictive value and negativepredictive value of TVS was 97.3%、64.3%、92.2%、3.6%、81.8%.TVS-CDFI have better accuracy in ectopic pregnancydiagnosis than TVS. 2.20 controll group and 90 case grouppatients were divided into 4 groups by the result of surgery.Their blood parameter analysed by One-Way ANOVA: theuterine arery resistant index (RI) between groups has nosignificant difference,the focus blood parameter RI betweengroups has significant difference.
Conclusion
TVS-CDFI is one of the important means in ectopicpregnancy diagnose. TVS-CDFI have better accuracy in ectopicpregnancy diagnosis than TVS,at the same time TVS-CDFI hasimportant value in differentiate adnexal inflammation and lutealrupture.
引文
1．周永昌，郭万学主编．超声医学[第四版]．北京：科学技术文献出版社，2003．1：394
2. J.D.Seffah.Ultrasonography and ectopic pregnancy-a review. The international Journal of Gynecology & Obstetrics.2000,71. 263-264
3．陈坤赞，郭素贞．二维与彩色多谱勒超声对宫角妊娠的诊断与鉴别诊断．临床超声医学杂志．2002，4(6)：341-342
4．赵惠明，李晓艳．异位妊娠的彩色多谱勒超声诊断，中国超声诊断杂志，2003，4(7)：553—554
5．蔡晓玲，赵勇．经阴道CDFI超声诊断早期输卵管异位妊娠的临床观察．黑龙江医药科学．2004，27(4)：31—33
6. Michael Blaivas,RDMS,Matthew Lyon.Reliability of Adnexal Mass Mobility in distinguishing possible ectopic pregnancy from corpus luteum cysts.J Ultrasound Med.2005,24:599-603
7．周家琦，李岩，白冰．经阴道超声诊断早期异位妊娠69例及意义．齐齐哈尔医学院学报．2006．27(1)：55
8．冯芬．经阴道超声在诊断异位妊娠中的价值．中国超声诊断杂志．2005．6(4)：310-311
9. Barbara H,Braffman MD,Beverly G et al.Emergency department screening for ectopic pregnancy:Aprospective US study.Radiology. 1994,190:797-802
10. George Condous,Emeka Okaro,Asma Khalid et al,The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery, Human Reproduction,2005 20(5):1404-1409
11. A Kurjak,I Zalud,H Schlman,Ectopic pregnancy:transvaginal color Doppler of trophoblastic flow in questionable adnexa,J Ultrasound in Medicine 1991 10(12):685-689
12. Craven C M,Chedwich LR,Ward K et al,Placental basal plate formation is associated with fibrin deposition in decidual veins at sites of trophoblast cell invasion.Am J Obstet Gynecol,2002,186(2):291
13. Michael B.Color Doppler in the diagnosis of ectopic pregnancy in the emergency department:is there anything beyond a mass and fluid?J Emerg Med,2002,22(4):379
14．陈忠年，主编．妇产科病理学[M]．上海：上海科学技术出版社，1982，235-250
15．王淑云，杨博．脉冲及彩色多谱勒在诊断宫外孕中的应用[J]．中国超声医学杂志，1997，13(2)：58-59
16. Long MD.et al.Preliminary Doppler studies on the uterine artery and myometrium in trophoblastic tumors requiring chemorherapy.Br J Obetet Gynaecol,1989,97:686
17. Kirchler HC,Seebacher S,Alge AA, et al.Early diagnosis of tubal pregnancy:changes in tubal blood flow evaluate by endovaginal color Doppler sonography.Obstet Gynecol,1993,82:561-565
18. Brown DL.Diagnosis of ectopic pregnancy with endovaginal color Doppler US.Radiology,1993,187:20-22
1．周永昌，郭万学主编．超声医学[第四版]．北京：科学技术文献出版社，2003．1：394
2. J.D.Seffah.Ultrasonography and ectopic pregnancy -a review. The international Journal of Gynecology & Obstetrics. 2000,71.263-264
3．陈坤赞，郭素贞．二维与彩色多谱勒超声对宫角妊娠的诊断 与鉴别诊断．临床超声医学杂志．2002，4(6)：341-342
4．杨梅．张学兰．经腹与经阴道彩色多谱勒超声诊断异位妊娠的比较．中国乡村医药杂志．2006．4．158
5. Zinn HL, Cohen HL, Zinn DL, Uitrasound diagnosis of ectopic pregnancy:importantce of transvaginal imaging.J Ultrasound Med,1997,16:603
6. Cacciatore B,Ylostalo P, Stenman UH et al,Suspected ectopic preganancy, Br J Obstet Gynaecol,1998,95:497-502
7. Elaine F, Warrick,David A, The ectopic pregnancy:A Well-deserved review, Journal of diagnosric Medical Sonography,2002,18:289-297
8. Theodore J Dubinsky, MD,et al.Endometrial ColoFlow Image-Directed Doppler Imaging:Negative Predictive Value For Excluding Ectopic Pregnancy, Journal of Clinical Ultrasound. 1996.25(3). 103-108
9. H.Ch.Kirchler.D.Kolle.P.Schwegel. Changes in tubal blood flow in evaluating ectopic pregnancy.Ultrasound Obstet. Gynecol. 1992.2.283-288
10. M.R.Orden.S.Gudmundsson,et al,Intravascular Contrast agent in the ultrasonography of ectopic pregnancy, Ultrasound Obetet Gynecol,199914,348-352
11．朱晓平，陈富强，超声测定子宫内膜厚度对疑似异位妊娠患者的预测价值．中国实用妇科与产科杂志．2004，10(20)：627-628
12．赵惠明，李晓艳．异位妊娠的彩色多谱勒超声诊断，中国超声诊断杂志，2003，4(7)：553—554
13．蔡晓玲，赵勇．经阴道CDFI超声诊断早期输卵管异位妊娠的临床观察．黑龙江医药科学．2004，27(4)：31—33
14．王淑云，杨博．脉冲及彩色多谱勒在诊断宫外孕中的应用[J]．中国超声医学杂志，1997，13(2)：58-59
15. Brown DL.Diagnosis of ectopic pregnancy with endovaginal colorDoppler US.Radiology,1993,187:20-22
16．那志钢．彩色多谱勒血流显像在经阴道超声诊断异位妊娠中的价值．中国超声诊断杂志．2004，5(4)：269-270
17. Kirchler HC,Seebacher S,Alge AA,et al.Early diagnosis of tubal pregnancy:changes in tubal blood flow evaluate by endovaginal color Doppler sonography.Obstet Gynecol,1993,82:561-565.
18．尹晓云，齐韵，郭展雯等，经阴道彩色多谱勒方向性能量图在异位妊娠诊断中的价值．临床超声医学杂志．2005．7(6)：419-420
19．钱孝纲．CDFI检测异位妊娠子宫血循环阻力指数的临床价值．中国超声医学杂志．2002，18(3)：225-227
20．井茹芳，李春伶，周红莉等．彩色多谱勒超声诊断宫外孕的影像血特征研究．武警医学．2004．1：28-30
21．赵开银，周孝琳等．经阴道三维超声对输卵管妊娠的诊断价值．西部医学．2003，6(1)：61-62
22. B.Hinney, C.Bertagnoli.Diagnosis of early ectopic pregnancy by measurement of the materal serum to cul-de-sac fluid B-hcg ratio.Ultrasound Obstet.Gyneco.1995.5:260-266
23. G.Condous,E.Kipk.Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location.Ultrasound Obstet Gynecol.2005,26:770-775
24. Stovall TG.Ling FW.Cope BJ.et al.Preventing ruptured ectopic pregnancy with a single serum progesterone.Am J Obstet Gynecol 1989;160:1425-1428
2. J.D.Seffah.Ultrasonography and ectopic pregnancy-a review. The international Journal of Gynecology & Obstetrics.2000,71. 263-264
3．陈坤赞，郭素贞．二维与彩色多谱勒超声对宫角妊娠的诊断与鉴别诊断．临床超声医学杂志．2002，4(6)：341-342
4．赵惠明，李晓艳．异位妊娠的彩色多谱勒超声诊断，中国超声诊断杂志，2003，4(7)：553—554
5．蔡晓玲，赵勇．经阴道CDFI超声诊断早期输卵管异位妊娠的临床观察．黑龙江医药科学．2004，27(4)：31—33
6. Michael Blaivas,RDMS,Matthew Lyon.Reliability of Adnexal Mass Mobility in distinguishing possible ectopic pregnancy from corpus luteum cysts.J Ultrasound Med.2005,24:599-603
7．周家琦，李岩，白冰．经阴道超声诊断早期异位妊娠69例及意义．齐齐哈尔医学院学报．2006．27(1)：55
8．冯芬．经阴道超声在诊断异位妊娠中的价值．中国超声诊断杂志．2005．6(4)：310-311
9. Barbara H,Braffman MD,Beverly G et al.Emergency department screening for ectopic pregnancy:Aprospective US study.Radiology. 1994,190:797-802
10. George Condous,Emeka Okaro,Asma Khalid et al,The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery, Human Reproduction,2005 20(5):1404-1409
11. A Kurjak,I Zalud,H Schlman,Ectopic pregnancy:transvaginal color Doppler of trophoblastic flow in questionable adnexa,J Ultrasound in Medicine 1991 10(12):685-689
12. Craven C M,Chedwich LR,Ward K et al,Placental basal plate formation is associated with fibrin deposition in decidual veins at sites of trophoblast cell invasion.Am J Obstet Gynecol,2002,186(2):291
13. Michael B.Color Doppler in the diagnosis of ectopic pregnancy in the emergency department:is there anything beyond a mass and fluid?J Emerg Med,2002,22(4):379
14．陈忠年，主编．妇产科病理学[M]．上海：上海科学技术出版社，1982，235-250
15．王淑云，杨博．脉冲及彩色多谱勒在诊断宫外孕中的应用[J]．中国超声医学杂志，1997，13(2)：58-59
16. Long MD.et al.Preliminary Doppler studies on the uterine artery and myometrium in trophoblastic tumors requiring chemorherapy.Br J Obetet Gynaecol,1989,97:686
17. Kirchler HC,Seebacher S,Alge AA, et al.Early diagnosis of tubal pregnancy:changes in tubal blood flow evaluate by endovaginal color Doppler sonography.Obstet Gynecol,1993,82:561-565
18. Brown DL.Diagnosis of ectopic pregnancy with endovaginal color Doppler US.Radiology,1993,187:20-22
1．周永昌，郭万学主编．超声医学[第四版]．北京：科学技术文献出版社，2003．1：394
2. J.D.Seffah.Ultrasonography and ectopic pregnancy -a review. The international Journal of Gynecology & Obstetrics. 2000,71.263-264
3．陈坤赞，郭素贞．二维与彩色多谱勒超声对宫角妊娠的诊断 与鉴别诊断．临床超声医学杂志．2002，4(6)：341-342
4．杨梅．张学兰．经腹与经阴道彩色多谱勒超声诊断异位妊娠的比较．中国乡村医药杂志．2006．4．158
5. Zinn HL, Cohen HL, Zinn DL, Uitrasound diagnosis of ectopic pregnancy:importantce of transvaginal imaging.J Ultrasound Med,1997,16:603
6. Cacciatore B,Ylostalo P, Stenman UH et al,Suspected ectopic preganancy, Br J Obstet Gynaecol,1998,95:497-502
7. Elaine F, Warrick,David A, The ectopic pregnancy:A Well-deserved review, Journal of diagnosric Medical Sonography,2002,18:289-297
8. Theodore J Dubinsky, MD,et al.Endometrial ColoFlow Image-Directed Doppler Imaging:Negative Predictive Value For Excluding Ectopic Pregnancy, Journal of Clinical Ultrasound. 1996.25(3). 103-108
9. H.Ch.Kirchler.D.Kolle.P.Schwegel. Changes in tubal blood flow in evaluating ectopic pregnancy.Ultrasound Obstet. Gynecol. 1992.2.283-288
10. M.R.Orden.S.Gudmundsson,et al,Intravascular Contrast agent in the ultrasonography of ectopic pregnancy, Ultrasound Obetet Gynecol,199914,348-352
11．朱晓平，陈富强，超声测定子宫内膜厚度对疑似异位妊娠患者的预测价值．中国实用妇科与产科杂志．2004，10(20)：627-628
12．赵惠明，李晓艳．异位妊娠的彩色多谱勒超声诊断，中国超声诊断杂志，2003，4(7)：553—554
13．蔡晓玲，赵勇．经阴道CDFI超声诊断早期输卵管异位妊娠的临床观察．黑龙江医药科学．2004，27(4)：31—33
14．王淑云，杨博．脉冲及彩色多谱勒在诊断宫外孕中的应用[J]．中国超声医学杂志，1997，13(2)：58-59
15. Brown DL.Diagnosis of ectopic pregnancy with endovaginal colorDoppler US.Radiology,1993,187:20-22
16．那志钢．彩色多谱勒血流显像在经阴道超声诊断异位妊娠中的价值．中国超声诊断杂志．2004，5(4)：269-270
17. Kirchler HC,Seebacher S,Alge AA,et al.Early diagnosis of tubal pregnancy:changes in tubal blood flow evaluate by endovaginal color Doppler sonography.Obstet Gynecol,1993,82:561-565.
18．尹晓云，齐韵，郭展雯等，经阴道彩色多谱勒方向性能量图在异位妊娠诊断中的价值．临床超声医学杂志．2005．7(6)：419-420
19．钱孝纲．CDFI检测异位妊娠子宫血循环阻力指数的临床价值．中国超声医学杂志．2002，18(3)：225-227
20．井茹芳，李春伶，周红莉等．彩色多谱勒超声诊断宫外孕的影像血特征研究．武警医学．2004．1：28-30
21．赵开银，周孝琳等．经阴道三维超声对输卵管妊娠的诊断价值．西部医学．2003，6(1)：61-62
22. B.Hinney, C.Bertagnoli.Diagnosis of early ectopic pregnancy by measurement of the materal serum to cul-de-sac fluid B-hcg ratio.Ultrasound Obstet.Gyneco.1995.5:260-266
23. G.Condous,E.Kipk.Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location.Ultrasound Obstet Gynecol.2005,26:770-775
24. Stovall TG.Ling FW.Cope BJ.et al.Preventing ruptured ectopic pregnancy with a single serum progesterone.Am J Obstet Gynecol 1989;160:1425-1428