经阴道或经直肠彩色多普勒超声检测滋养层血流对异位妊娠早期鉴别诊断的价值  

Value of trophoblast blood flow detection by transvaginal or transrectal color Doppler ultrasound in early differential diagnosis of ectopic pregnancy

作　　者：何以敉[1] 高上达[1] 林礼务[1] 叶琴[1] 吴丽足[1] 王艳[1] 林学英[1] 

机构地区：[1]福建医科大学附属协和医院超声科福建省超声医学研究所,福州350001

出　　处：《中华医学超声杂志（电子版）》2011年第1期44-47,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：福建省科技三项费资助高校专项计划项目(K04057)

摘　　要：目的探讨经阴道或经直肠彩色多普勒超声检测滋养层血流对异位妊娠早期诊断的应用价值。方法对320例早期妊娠(宫内妊娠组50例,流产组92例,异位妊娠组178例)伴或不伴下腹痛及阴道出血的患者行经阴道或经直肠彩色多普勒超声检查,将超声检查结果与手术病理和临床随访结果进行对照分析。结果 (1)异位妊娠组178例患者经阴道或经直肠彩色多普勒超声检查均未检出宫内多彩镶嵌滋养层血流信号(0/178);宫内妊娠组及流产组患者宫内多彩镶嵌滋养层血流信号显示率分别为47例(47/50,94.0%)及88例(88/92,95.7%)。(2)3组患者附件区探及有彩色血流信号的囊状结构(CSCF)195例(195/320,60.9%),其中宫内妊娠组50例、流产组19例、异位妊娠组126例;异位妊娠组患者附件区探及1个CSCF62例(62/126,49.2%),检出率低于宫内妊娠组(50/50,100%),两组比较差异有统计学意义(P<0.001)。(3)异位妊娠组64例患者附件区探及2个CSCF(64/126,50.8%),且多数患者(109/126,86.5%)附件区病灶囊壁探及非环状血流信号,2项检测数据均高于宫内妊娠组(0/50)和流产组(0/19)。(4)异位妊娠组患者附件区囊壁动脉血流RI<0.4或>0.6检出率为34.1%(43/126),高于宫内妊娠组(6/50,12.0%)及流产组(2/19,10.5%),两组检出率比较差异有统计学意义(P<0.05)。(5)4项超声特征(附件区探及2个CSCF、CSCF内见胎心搏动、CSCF囊壁非环状血流信号、动脉血流RI<0.4或>0.6)提示异位妊娠的敏感度分别为36.0%、8.4%、61.2%、24.2%;特异度为100%、100%、100%、94.4%;准确度为64.4%、49.1%、78.4%、55.3%。(6)多项超声指标联合应用(探及附件区2个CSCF、CSCF内见胎心搏动、囊壁非环状血流信号及其动脉血流RI值<0.4或RI>0.64)诊断异位妊娠的敏感度、特异度、准确度分别达92.1%、95.1%、93.4%。结论经阴道或经直肠彩色多普勒超声多项指标联合应用可显著提高超声对异位妊娠早期诊断的准确性,有重�Objective To evaluate the application value of trophoblast blood flow detection by transvaginal or transrectal （TVTR） color Doppler ultrasound in early diagnosis of ectopic pregnancy. Methods Three hundred and twenty cases of early pregnancy（ 50 intrauterinepregnancy group, 92 in abor- tion group and 178 in ectopic-pregnancy group）with or .without abdominal pain and vaginal bleeding took TVTR examination. Ultrasound （US） findings were analyzed and compared with results of surgery pathology and clinical follow-up. Results （ 1 ） One hundred and seventy-eight cases of eetopic-pregnancy group had TVTR examination, and the detection rate of intrauterine colorful mosaic trophoblast flow was 0 （0/178） low- er than intrauterine-pregnancy group （47/50,94.0%） and abortion group （ 88/92,95.7% ）. （2） In 320 patients, adnexal cystic structure with color flow （CSCF） was detected in 195 cases （ including 50 cases in intrauterine-pregnancy group, 19 cases in abortion group, and 126 cases in ectopic-pregnancy group）. The detection rate of adnexal single CSCF in ectopic-pregnancy group （62/126,49. 2% ） was lower than intranterine-pregnancy group （ 50/50,100% ） and abortion group （ 19/19,100% ） , and the difference had statistical significance （ P 〈 0. 001 ）. （ 3 ） In ectopie-pregnaney group, half of the patients （ 64/126,50.8% ）showed adnexal double CSCF, and most of the patients（ 109/126,86.5% ）showed non-circular flow in the cystic wall. The detection rate of the two indices was higher than in the intrauterine-pregnancy group（0/50） and abortion group（O/19）. （4）The detection rate of adnexal arterial flow resistive index （RI） 〈 0.4 or 〉 0.6 in the cystic wall of ectopic-pregnancy group was 34. 1% （43/126）, which was higher than that of intrauterine-pregnancy group （6/50,12.0%） and abortion group （2/19,10.5%）with statistical significance （P 〈 0.05）. （5）Four ultrasound characteristics （adnextal double CSCF, CSCF with a h

关 键 词：彩色多普勒超声检查 腔内超声检查 异位妊娠 

分 类 号：R445.1[医药卫生—影像医学与核医学]