超声诊断葡萄胎合并妊娠49例临床分析  

Clinical Analysis of 49 Cases of Hydatidiform Mole with Pregnancy Diagnosed by Ultrasound

作　　者：高倩倩 杨太珠 GAO Qianqian;YANG Taizhu(Department of Ultrasound,West China Second University Hospital,Key Laboratory of Obstetric&Gynecological and Pediatric Diseases and Birth Defects of Ministry of Education,Sichuan University,Chengdu Sichuan 610041,China)

机构地区：[1]四川大学华西第二医院超声科出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《实用妇产科杂志》2024年第4期281-285,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨葡萄胎合并妊娠的超声诊断价值及其预后。方法:回顾性分析2014年1月至2023年4月于四川大学华西第二医院超声诊断疑似葡萄胎合并妊娠的49例孕妇的临床资料,并根据病理检查结果分为葡萄胎组(20例)和良性病变组(25例),分析两组的超声检查和临床特征,并对不同医师超声图像的判读采用一致性检验。结果:①49例患者中31例孕妇选择终止妊娠,14例孕妇选择继续妊娠,4例失访。有明确病理诊断的45例患者,其中完全性葡萄胎4例,部分性葡萄胎16例;良性病变共25例,包括胎盘间叶发育不良5例、胎盘绒毛发育异常4例、胎盘粘连2例、胎盘梗死1例等。超声诊断葡萄胎合并妊娠的准确率44.4%(20/45)。②与良性病变组比较,葡萄胎组患者中占位的体积明显较大、占位中无回声的数量(一个切面>15个)明显较高、单个无回声的大小差异(≥80%)明显较低,差异均有统计学意义(P<0.05)。③2位超声医师对葡萄胎合并妊娠的超声图像进行判读,所有超声判读结果Kappa一致性系数均在0.75以上。结论:占位体积越大、占位中的无回声数量越多(一个切面>15个)、占位中无回声分布大小越一致越倾向诊断葡萄胎合并妊娠。胎盘间叶发育不良等良性疾病的超声表现易与葡萄胎混淆,应谨慎。虽然超声诊断的准确率不高,但及时发现异常便于临床管理。Objective:To study the value of ultrasound in the diagnosis and prognosis of hydatidiform mole complicated with pregnancy.Methods:49 female patients were suspected diagnosis of hydatidiform mole complicated with pregnancy by ultrasound in West China Second University Hospital from January 2014 to April 2023.According to the pathological results,the cases were divided into the hydatidiform mole group(20 cases)and the benign lesion group(25 cases).The ultrasound examination and clinical characteristics of the two groups were analyzed.The Cohen′s Kappa statistic was used for measuring agreement of ultrasound images by different doctors.Results:①Among the 49 cases,31 cases chose to terminate pregnancy,14 cases chose to continue pregnancy,and 4 cases were lost to follow-up.45 patients obtained definite pathological results,and 4 cases with complete hydatidiform mole,16 with partial hydatidiform mole.The other 25 cases were benign lesions,including 5 cases of placental mesenchymal dysplasia,4 cases of placental and chorionic villi abnormal,2 cases of placental adhesion,1 case of placental infarction,et al.The accuracy of ultrasound in the diagnosis of hydatidiform mole complicated with pregnancy was about 44.4%(20/45).②Compared with the benign lesion group,the mass volume in the hydatidiform mole group was significantly larger,the number of anechoic lesions in the mass(>15 anechoic in one section)was significantly higher,and the size difference of single anechoic lesion(≥80%)was significantly lower.All the differences were statistically significant(P<0.05).③In this study,two sonographers interpreted the ultrasound images of hydatidiform mole complicated with pregnancy,and all the ultrasound interpretation results of Kappa were above 0.75.Conclusions:The larger the volume of the mass,the more the number of anechoic lesions(>15 in one section)and the more consistent the size of anechoic distribution in the mass,the more likely diagnosed as hydatidiform mole complicated with pregnancy.Ultrasound findings of beni

关 键 词：超声诊断 葡萄胎 妊娠 胎盘 胎盘间叶发育不良 

分 类 号：R737.33[医药卫生—肿瘤]