早孕期超声在宫角妊娠诊断及临床决策中的应用  

Application of ultrasound in diagnosis and clinical decision-making of cornual pregnancy.

作　　者：胡永铭[1] 陈晶 唐蓉 李小清[1] 余琦 黄翠莹 陈红 HU Yong-ming;CHEN Jin;TANG Rong;LI Xiao-qing;YU Qi;HUANG Cui-ying;CHEN Hong(Department of Ultrasound,Haikou Women and Children Hospital,Haikou 570203,Hainan,CHINA.;Department of Radiology,Haikou Hospital,Xiangya School of Medicine,Central South University,Haikou 570100,Hainan,CHINA)

机构地区：[1]海口市妇幼保健院超声影像科,海南海口570203 [2]中南大学湘雅医学院海口市医院放射科,海南海口570100

出　　处：《海南医学》2020年第20期2658-2661,共4页Hainan Medical Journal

基　　金：海南省重点研发计划项目(编号:ZDYF2018176)。

摘　　要：目的探讨早孕期宫角妊娠的超声图像特征,评估超声对宫角妊娠的诊断和临床应用价值。方法回顾性分析2015年7月至2019年7月在海口市妇幼保健院就诊,且经手术(或产后)和病理证实的34例孕早期诊断为宫角妊娠孕妇的临床资料,依据妊娠物在宫角种植部位与宫腔内膜的关系、蜕膜包绕情况、突出浆膜程度等超声图像特征分为Ⅰ型和Ⅱ型,评估其妊娠转归,为临床决策提供依据。结果(1)Ⅰ型18例:其中8例孕囊内胚芽种植于宫腔侧,转归宫内妊娠可能性大,超声监测下继续妊娠,但1例胎盘植入,16周胎死宫内,其余7例足月顺产;7例胚芽种植于宫角外侧,药流+超声监测下人流;3例胚胎未发育,药流+宫腔镜下妊娠物清除术。(2)Ⅱ型16例:其中3例可见胚芽及心血管搏动;13例显示宫角混合型包块或胎盘样高强回声,为稽留流产。16例妊娠物均不同程度突向间质部,转归间质部妊娠风险大,选择药流+腹腔镜监测下宫腔镜妊娠物病灶清除术,过程顺利。结论宫角妊娠Ⅰ型胚芽种植于宫腔侧属“宫内偏位妊娠”范畴,可酌情选择超声监测下继续妊娠;对其它孕囊有突向间质部生长趋势者,需尽早根据超声影像特征选择不同手术治疗;早孕期超声对宫角妊娠诊断并评估、监测,能为临床决策提供可靠的依据,具有重要作用。Objective To explore the ultrasonographic features of uterine horn pregnancy in early pregnancy and evaluate the diagnostic and clinical value of ultrasound in uterine horn pregnancy. Methods The clinical data of 34 cases of uterine horn pregnancy in early pregnancy confirmed by surgery(or postpartum) and pathology in Haikou Women and Children Hospital from July 2015 to July 2019 were retrospectively analyzed. According to ultrasonic image characteristics such as the relationship between angle of planting area and uterine endometrium, decidua surrounding, degree of protrusion of serosa and blood supply, the patients were divided into Ⅰ type and Ⅱ type, which was used to evaluate the pregnancy outcome and provide the basis for clinical decision making. Results(1) Among the 18 cases of Ⅰ type:8 cases of pregnancy pouch embryo grown in uterine cavity side, likely outcome intrauterine pregnancy, under ultrasound monitoring continue to pregnancy, but 1 case of placenta implantation, fetal intrauterine death at 16 weeks, the rest of the 7 cases of full-term birth;7 cases of embryo were planted in the lateral corner of the uterine horn;3 cases of undeveloped embryos, and the pregnancy was removed by drug abortion and hysteroscopy.(2) 16 cases of Ⅱ type: 3 cases of germ and cardiovascular pulsation;13 cases showed mixed uterine horn mass or placental high echogenicity, which were missed abortions. All the 16 cases of gestation had different degrees of protrusion to the interstitium, and the risk of reversion to the interstitial pregnancy was high. Drug abortion and hysteroscopic pregnancy lesion removal under laparoscopic monitoring were selected, and the process was successful. Conclusion For cornual pregnancy Ⅰ type, germ of uterine cavity side grown in early pregnancy palace angle range of pregnancy is a "deviation" intrauterine pregnancy, and continue pregnancy can be chosen under ultrasound monitoring;Different surgical treatments should be selected as soon as possible according to the characteristics of u

关 键 词：早孕期 超声 宫角妊娠 诊断 临床决策 

分 类 号：R714.224[医药卫生—妇产科学]