经阴道三维超声断层成像在早期宫角妊娠诊断和预测中的应用价值  

Application value of transvaginal three-dimensional tomographic ultrasound imaging in the diagnosis and prediction of early cornual pregnancy

作　　者：刘月媚[1] 罗海波[1] 陈桂武 李仲均[2] 张秀珍[1] 曾带娣 陈静[1] LIU Yuemei;LUO Haibo;CHEN Guiwu;LI Zhongjun;ZHANG Xiuzhen;ZENG Daidi;CHEN Jing(Department of Ultrasound,Affiliated Dongguan Hospital,Southern Medical University,Dongguan People’s Hospital,Guangdong Province,Dongguan 523000,China;Department of Gynecology and Obstetrics,Affiliated Dongguan Hospital,Southern Medical University,Dongguan People’s Hospital,Guangdong Province,Dongguan 523000,China)

机构地区：[1]南方医科大学附属东莞医院东莞市人民医院超声科,广东东莞523000 [2]南方医科大学附属东莞医院东莞市人民医院妇产科,广东东莞523000

出　　处：《妇儿健康导刊》2022年第9期33-35,39,F0004,共5页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

基　　金：广东省东莞市社会发展科技项目面上项目(20211800902752)。

摘　　要：目的探讨三维超声断层成像(3D-TUI)在早期宫角妊娠中的诊断和预测价值。方法收集2020年9月至2022年4月南方医科大学附属东莞医院(东莞市人民医院)经手术或病理证实的52例宫角妊娠患者,采用经阴道三维超声和3D-TUI成像技术,观察子宫和孕囊的位置,测量子宫大小、孕囊大小、宫腔容积、左右宫角间距(A线)、孕囊容积、孕囊周边最薄肌层厚度、孕囊中点到宫腔中线垂直距离(C线),分析其在不同类型宫角中的诊断价值。绘制C线、C/A比值和孕囊周边最薄肌层厚度预测不良事件发生的ROC曲线,获得其最佳截断值及敏感度和特异性。结果Ⅰ型宫角妊娠和Ⅱ型宫角妊娠的子宫大小和孕囊大小比较,差异无统计学意义(P>0.05);而两种类型宫角妊娠的C线、C/A比值、孕囊周边最薄肌层厚度比较,差异有统计学意义(P<0.05)。ROC曲线结果显示,C线、C/A比值、孕囊周边最薄肌层厚度预测不良事件发生的风险最佳截断值分别为11.0 mm、0.262和4.9 mm,敏感度和特异性为56.3%、87.5%、87.5%和75.0%、52.8%、52.8%。结论经阴道3D-TUI能多维度分析子宫与孕囊之间的空间位置关系,有助于宫角妊娠的分型及鉴别诊断,结合C线、C/A比值及孕囊周边最薄肌层厚度能预测其不良事件发生风险,具有一定的诊断和预测价值。Objective To explore the application value of transvaginal three-dimensional tomographic ultrasound imaging(3D-TUI)in the diagnosis and prediction of early cornual pregnancy.Methods A total of 52 cases of cornual pregnancy confirmed by surgery or pathology were collected in Affiliated Dongguan Hospital,Southern Medical University(Dongguan People’s Hospital)from September 2020 to April 2022.By using transvaginal threedimensional ultrasound and 3D-TUI,the position and size of the uterus and gestational sac,the volume of the uterine cavity and gestational sac,the distance between the left and right uterine horn(A-line),the thickness of the thinnest muscle layer around the gestational sac,the vertical distance from the midpoint of the gestational sac to the midline of the uterine cavity(C-line)were analyzed to their diagnostic value in different types of cornual pregnancy.The ROC curve of C-line,C-line/A-line ratio,and the thickness of the thinnest muscle layer around the gestational sac was drawn to predict the occurrence of adverse events,and best cut-off value,sensitivity,and specificity were obtained.Results There was no significant difference in the size of the uterus and gestational sac between typeⅠcornual pregnancy and typeⅡcornual pregnancy(P>0.05).There were significant differences in the C-line,C-line/A-line ratio,and the thickness of the thinnest muscle layer around the gestational sac between the two types of cornual pregnancy(P<0.05).The ROC curve results showed that the best cut-off values of C-line,C-line/A-line ratio,and the thickness of the thinnest muscle layer around the gestational sac were 11.0 mm,0.262,and 4.9 mm,respectively,and sensitivity and specificity were 56.3%,87.5%,87.5%and 75.0%,52.8%,52.8%for predicting the risk of adverse events.Conclusion Transvaginal 3D-TUI can analyze the spatial relationship between the uterus and gestational sac in multiple dimensions,which is helpful for the classification and differential diagnosis of cornual pregnancy.Combined with the C-line,C-line/A-

关 键 词：宫角妊娠 异位妊娠 经阴道超声检查 断层成像技术 

分 类 号：R445[医药卫生—影像医学与核医学]