经阴道三维超声在输卵管间质部妊娠临床治疗中的应用研究

目的探讨适合经阴道吸引术治疗输卵管间质部妊娠的患者经阴超三维图像特点。方法三维超声疑为输卵管间质部妊娠的患者共96例,检查过程中测量包块与子宫腔距离、包块大小和表面的肌层厚度,根据图像特征,分为(Ⅰ型)和非近宫腔型(Ⅱ型),所有患者均行腹腔镜及宫腹腔镜联合检查术,并根据情况选择合适的手术方式,并随访治疗结局。结果 96例患者中Ⅰ型24例,Ⅱ型72例,24例Ⅰ型输卵管间质部妊娠中2例误诊,72例Ⅱ型中3例误诊,总准确率达94.8%。22例确诊Ⅰ型输卵管间质部妊娠患者中10例尝试宫腹腔镜联合监视下吸引术,8例获得成功,2例穿孔。其余12例Ⅰ型和所有Ⅱ型行腹腔镜下输卵管切除及宫角切开去除病灶缝合术。结论经阴道三维超声诊断输卵管间质部妊娠的准确率高,同时可以准确获得病灶与宫腔距离以及病灶大小和表面肌层厚度,为间质部妊娠选择不同的术式提供影像学依据。

Application of 3D-transvaginal ultrasound in interstitial tubal pregnancy

Objective To explore the characteristics of three-dimensional vaginal images of patients of interstitial tubal pregnancy who is suitable to have transcervical suction of interstitial pregnancy under laparoseopic and hysteroscopie guid- ance. Methods Measuring the length from uterus cavity to lump, the size and the muscle layer thickness of lump who is suspectly diagnosed as interstitial pregnancy from three-dimensional vaginal images. According to image fetures, the pa- tients were divided into type I （type of near the uterine cavity） and type Ⅱ （type of non-near the uterine cavity）. All patients had examination with laparoseopy combined with laparoscopy and suitable modus operandi was selected according the ex- amination. All patients were followed up. Results 24 cases of type I and 72 cases of type Ⅱwere diagnosed in 96 pa- tients. 2 cases of type Ⅰ and 3 cases of type Ⅱ were misdiagnosed. The accuracy rate was 94.8%. 8 cases were succeeded to perform transcervieal suction in laparoscopic and hysteroscopic guidance in 10 cases of type I . Conclusion 3D transvaginal uhrasoumt can get the relationship of the lump and uterus cavity, the size and the thickness of the myometrial surface. Of the lump, so 3D transvaginal uhrasound can provide the guidance for clinical treatment.