摘要
目的探讨经阴道三维超声(3D-TVS)检查在宫角妊娠(CP)患者诊断中的应用价值。方法回顾性分析新乡市中心医院2018年1月至2020年8月收治的CP患者46例作为CP组,另选取同期输卵管间质部妊娠(ITP)患者54例作为ITP组,观察经阴道常规超声和3D-TVS检查结果、CP及ITP血流动力学指标[舒张末期流速(EDV)、收缩期峰值流速(PSV)、阻力指数(RI)]、阴道常规超声和3D-TVS下ITP、CP图像征象。结果经阴道常规超声诊断准确率77.00%(77/100)低于3D-TVS检查的92.00%(92/100)(P<0.05)。CP血流动力学指标EDV、PSV为(0.16±0.06)m/s、(0.35±0.11)m/s,低于ITP的(0.23±0.08)m/s、(0.41±0.10)m/s,RI为(0.55±0.11)高于ITP的(0.44±0.10)(P<0.05)。CP的经阴道常规超声图像特征:①孕囊型:子宫底部一侧探及孕囊回声,且边界清晰,内见胚芽或卵黄囊回声,偶见原始心管搏动;②不均质包块型:一侧膨隆,探及不规则团块回声,内部回声不均匀,存在不规则液性暗区,包块边界模糊,菲薄肌层围绕,此处血流较为丰富,无心管搏动。ITP的经阴道常规超声图像特征:①孕囊型:宫角膨隆部位或子宫一侧探及孕囊回声,不与宫腔相通,不与内膜相连,包裹肌层菲薄,偶见肌层包裹不完整;②不均质包块型:宫角双侧不对称性增大,一侧膨隆明显,探及不均匀混合回声团块或包块回声,不与宫腔相通,肌层菲薄或缺失,能探及血流信号。CP的3D-TVS图像特征:可见子宫增大,且宫角一侧均匀膨隆,内见不均质包块回声或囊状,病灶较大时凸出子宫,呈现喇叭状;同时冠状切面可见病灶与宫腔侧内膜线连续,病灶输卵管侧无内膜回声,其周围被完整肌层包绕。ITP的3D-TVS图像特征:可见子宫不对称增大,且宫底一侧凸起,外周轮廓极像“海狮头部”,内见不均质包块回声或囊状;冠状切面观察宫腔形态较为完整,病灶与宫腔不连通,病灶、宫角区域内膜边缘分界明确,探及宽约1~9 mm间质线回声,病灶包绕菲薄肌层,不完整或缺失。结论在宫角妊娠诊断中,3D-TVS检查能监测病灶血流动力学变化,诊断准确率较高,在与ITP鉴别诊断中具有较大应用价值。
【Objective】To explore the value of three-dimensional transvaginal ultrasound(3D-TVS)in the diagnosis of angular pregnancy(CP).【Methods】Forty-six patients with CP admitted to our hospital from January 2018 to August 2020 were retrospectively analyzed as CP group,and 54 patients with tubal interstitial pregnancy(ITP)during the same period were selected as ITP group.The results of transvaginal conventional ultrasound and 3D-TVS examination,CP and ITP hemodynamic indexes[end diastolic velocity(EDV),peak systolic velocity(PSV),resistance index(RI)],ITP and CP image signs under transvaginal conventional ultrasound and 3D-TVS were observed.【Results】The diagnostic accuracy of transvaginal conventional ultrasound(77.00%,77/100)was lower than that of 3D-TVS(92.00%,92/100)(P<0.05).CP hemodynamic indexes EDV and PSV were 0.16±0.06 m/s and 0.35±0.11 m/s,which were lower than those of ITP(0.23±0.08 m/s and 0.41±0.10 m/s).RI was 0.55±0.11,higher than ITP(0.44±0.10)(P<0.05).The characteristics of CP conventional transvaginal ultrasound images were as follows:①Pregnancy sac type:the echo of pregnancy sac was detected on one side of the bottom of uterus,and the boundary was clear.The echo of embryo or yolk sac was found inside,and the primitive cardiac tube pulsated occasionally;②Heterogeneous inclusion type:one side swelling,irregular mass echo detection,internal echo was not uniform,there was irregular liquid dark area,the inclusion of vague boundary,thin muscle layer around,blood flow was rich here,centreless tube pulsation.The characteristics of conventional transvaginal ultrasound images of ITP were as follows:①Pregnancy sac type:the echo of the pregnancy sac was detected in the dilated part of the uterine horn or one side of the uterus,which was not connected with the uterine cavity or the endometrium,and the muscle layer was thin,and the muscle layer was occasionally incomplete;②Heterogeneous mass type:the bilateral asymmetry of the uterine angle increased,one side of the swelling was obvious,and the uneven mixed echo mass or the echo of the lump was not connected with the uterine cavity,and the muscle layer was thin or missing,and the blood flow signal could be detected.The 3 D-TVS image features of CP showed that the uterus was enlarged,and one side of the uterine angle was evenly distensed;the uneven mass echo or cystic shape was found inside;when the lesion was large,it protruded out of the uterus and presented trumpet shape;at the same time,the coronal section showed that the lesion was continuous with the endometrial line of the uterine cavity,there was no endometrial echo on the fallopian tube side of the lesion,and the surrounding area was surrounded by a complete muscle layer.The 3 D-TVS image features of ITP:the uterus was asymmetrically enlarged,and one side of the fundus was raised;the outer contour was very like the"head of a sea lion",and the echo or sac shape of heterogeneous mass was found inside;coronal section observation of the uterine cavity was relatively complete,the lesion was not connected with the uterine cavity,the endometrial edge of the lesion and the uterine angle area was clearly demarcated,the echo of the stromal line about 1-9 mm wide was detected,and the lesion was surrounded by thin muscle layer,incomplete or missing.【Conclusion】In the diagnosis of angular pregnancy,3 D-TVS can monitor the hemodynamic changes of lesions with high diagnostic accuracy,and has great application value in differential diagnosis with ITP.
作者
尚缜邈
李建玲
石太英
SHANG Zhenmiao;LI Jianling;SHI Taiying(Department of Ultrasound,Xinxiang Central Hospital,Xinxiang,Henan 453000,China)
出处
《中国医学工程》
2023年第1期90-95,共6页
China Medical Engineering
