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目的探讨经阴道三维超声成像在输卵管间质部妊娠诊断与鉴别诊断中的应用价值。方法对经手术和病理证实的20例输卵管间质部妊娠的经阴道二维及三维超声图像进行回顾性分析,总结声像特征。结果 20例输卵管间质部妊娠的超声表现为孕囊型(8例)和包块型(12例)两类。三维超声成像在子宫冠状切面表现为子宫底部不对称,妊娠侧向外突起,孕囊(或包块)位于输卵管间质部,外侧子宫肌层不完整。20例中二维及三维超声检查均诊断间质部妊娠5例;二维超声诊断不确定,经三维超声诊断为间质部妊娠11例;二维超声诊断宫角妊娠2例,后经三维超声成像诊断为间质部妊娠;1例残角子宫输卵管间质部妊娠,二维及三维超声均诊断残角子宫妊娠;1例诊断输卵管峡部妊娠。结论经阴道三维超声成像能获得子宫冠状切面图像,较清晰显示子宫外形轮廓、孕囊与宫腔的关系,提高孕囊(或包块)在子宫内定位的准确性,对输卵管间质部妊娠的早期诊断和鉴别诊断具有重要的临床价值。
Objective To investigate the value of transvaginal three-dimensional ultrasonography in the diagnosis and differential diagnosis of tubal pregnancy. Methods The transvaginal 2D and 3D ultrasound images of 20 cases of tubal pregnancy confirmed by operation and pathology were retrospectively analyzed to summarize the characteristics of the sonographic features. Results The ultrasound findings of 20 cases of tubal pregnancy were gestational sac (8 cases) and mass (12 cases). Three-dimensional ultrasound imaging of the uterus in the coronal section showed asymmetric bottom of the uterus, pregnancy lateral protrusion, gestational sac (or mass) is located in the tubal interstitial, lateral myometrium is incomplete. 20 cases of two-dimensional and three-dimensional ultrasound were diagnosed interstitial pregnancy in 5 cases; two-dimensional ultrasound is not sure, three-dimensional ultrasound diagnosis of interstitial 11 cases of pregnancy; two-dimensional ultrasound diagnosis of uterine horn pregnancy, after three-dimensional Ultrasound imaging diagnosis of interstitial pregnancy; 1 case of residual horn uterine tubal pregnancy, two-dimensional and three-dimensional ultrasound were diagnosed rudimentary horn uterine pregnancy; 1 case of tubal isthmus pregnancy. Conclusions Transvaginal three-dimensional ultrasound imaging can obtain coronal section images of the uterus, clearly show the relationship between uterine contour and gestational sac and uterine cavity, and improve the accuracy of positioning the gestational sac (or mass) in the uterus. The early diagnosis and differential diagnosis have important clinical value.