输卵管妊娠早期诊断的临床前瞻性研究  

Diagnosis of atypical early tubal pregnancies: a clinical prospective study

作　　者：施月春 王川 吴群 贺展望 谢敏慧 金玲丽 

机构地区：[1]浙江省宁海妇幼保健院,宁海315600 [2]缙云县人民医院妇产科,丽水323000

出　　处：《生殖与避孕》2015年第7期468-471,共4页Reproduction and Contraception

基　　金：浙江大学开放基金(2012RG/RH-0010);宁波市医学科技计划(2011B19)资助项目

摘　　要：目的:探讨输卵管妊娠的早期诊断方法。方法:停经45 d内的可疑早期异位妊娠患者83例,行阴道后穹隆穿刺取得腹腔液,同时进行腹腔液及静脉血清β-hCG、E2、P定量测定,以腹腔液β-hCG/血清β-hCG的比值分组,临床追踪妊娠预后,以腹腔镜手术病理诊断或诊刮病理诊断作为明确宫内、外妊娠的依据,并将腹腔液β-hCG/血清β-hCG的比值与妊娠结局进行关联分析。结果:腹腔液β-hCG/血β-hCG比值>1者均为输卵管妊娠;腹腔液β-hCG/血β-hCG比值<1者均为宫内妊娠,输卵管妊娠患者腹腔液及血清E2、P值明显低于宫内妊娠者,E2、P的腹腔液与外周血比值在两组间无统计学差异。行后穹隆穿刺无一例发生感染。结论:腹腔液β-hCG/血β-hCG的比值是早期输卵管妊娠的准确诊断依据,凡腹腔液β-hCG明显高于静脉血β-hCG者为输卵管妊娠,反之为宫内妊娠,符合率为100%。Objective： To investigate the diagnosis of atypical early tubal pregnancies. Methods： A total of 88 atypical suspicious early ectopic pregnancy patients were enrolled. All the patients were performed culdocentesis, with the serum and peritoneal fluid β-hCG, estradiol （E2）, progesterone （P） quantitatively determined, and were divided into two groups according to the lg value of peritoneal fluid β-hCG/serum β-hCG. Among the patients, 83 cases were pathologically diagnosed with tubal pregnancy or intrauterine pregnancy by laparoscopic operation or curettage, and the correlation between the value of peritoneal fluid β-hCG/serum β-hCG and the diagnosis was analyzed. Results： All the patients with peritoneal fluid β-hCG/serum β-hCG 〉1 were tubal pregnancies, and the others with the ratio 〈1 were intrauterine pregnancies confirmed by the follow up. The peritoneal fluid and serum E2, P of patients with tubal pregnancies were significantly lower than thoses of patients with intrauterine pregnancies, while there were no peritoneal fluid E2/serum E2 nor peritoneal fluid P/serum difference in the two groups. No infection occurred after culdocentesis. Conclusion： The value of peritoneal fluid β-hCG/ serum β-hCG is an accurate evidence of the diagnosis of atypical early tubal pregnancy. The peritoneal fluid β- hCG/serum β-hCG 〉1 indicates tubal pregnancy, peritoneal fluid β-hCG/serum β-hCG 〈1 indicates intrauterine pregnancy. Diagnostic results were totally coincident with pathological result.

关 键 词：输卵管妊娠 腹腔液 Β-HCG 后穹隆穿刺 

分 类 号：R714.221[医药卫生—妇产科学]