阴道超声对少见部位异位妊娠的诊断价值

异位妊娠是妇产科常见的急腹症之一,其中以输卵管妊娠最常见,约占异位妊娠的95%[1],其余发生在子宫切口处、子宫颈、子宫角、输卵管间质部、卵巢、腹腔及阔韧带等少见部位,约占0.5%[2]。这些少见部位妊娠的早期、准确诊断,对尽早终止妊娠,避免造成孕妇生命危险有非常重要的临床意义。     

应用阴道超声诊断异位妊娠

应用阴道超声诊断异位妊娠陆贤伟祝亚平酆豫增近年来，妇科领域有关应用阴道超声的研究日渐增多。因阴道超声扫描的探头能与盆腔器官密切接触，与腹部超声比较，图象清晰［１］。本研究报告我科自１９９３年１０月至１９９４年１１月，应用阴道超声诊断临床可疑为异位妊娠...     

经阴道彩色多普勒超声诊断异位妊娠的临床价值

目的通过对异位妊娠二维声像图及彩色多普勒血流特征的分析，提高对异位妊娠诊断和鉴别诊断的水平。方法对手术病理证实的72例异位妊娠患者附件包块的二维图像和血流频谱特征进行回顾性分析。结果异位妊娠包块中的血流显像有特征性表现：血流阻力指数〈0．4。72例中38例为非典型异位妊娠，二维超声诊断符合率为50．2％，结合彩色多普勒技术诊断符合率为98．8％。结论经阴道彩色多普勒超声检查，对异位妊娠诊断的准确性高，在诊断非典型异位妊娠方面有较高的使用价值。     

经阴道超声对异位妊娠的诊断价值

目的:探讨经阴道超声对异位妊娠的诊断价值。方法:回顾分析127例经手术、病理证实的异位妊娠的声像图特征。结果:经阴道超声检查漏诊2例,误诊2例,异位妊娠超声检出率及定位正确率为96．8%。结论:经阴道超声对异位妊娠的诊断有较大的临床应用价值。     

阴道超声对输卵管异位妊娠的诊断价值

异位妊娠是常见的妇产科疾病，近年来其发生率有明显上升的趋势。2001年12月～2005年5月我院利用经腹壁和经阴道途径联合对40例异位妊娠进行超声检查，现将结果报告如下。     

异位妊娠通过腹部超声诊断与阴道超声诊断的价值分析

目的 研究腹部超声与阴道超声诊断异位妊娠的临床价值。方法 选取30例异位妊娠患者,所有患者均开展腹部超声诊断和阴道超声诊断,比较两种诊断方法阳性检出率、诊断效能及不同征象声像图检出率。结果 阴道超声诊断阳性检出率96.7%高于腹部超声的80.0%,差异有统计学意义（P<0.05）。阴道超声诊断准确率、敏感度、特异度均高于腹部超声诊断,差异具有统计学意义（P<0.05）。阴道超声诊断在盆腔积液、附件包块、子宫假孕囊、胚芽形成及血管搏动方面检出率均高于腹部超声诊断,差异有统计学意义（P<0.05）。结论 相比腹部超声诊断,阴道超声应用于异位妊娠诊断中检出率明显较高,诊断效能更优,可为医师提供更可靠的判断依据,根据声像图特点明确患者病情,有助于后续治疗方案的选择,值得临床应用。     

经腹部超声与经阴道超声诊断异位妊娠的临床价值观察

目的：调查研究经腹部超声与经阴道超声诊断异位妊娠的临床价值。方法：采用随机数字表法将104例异位妊娠患者分成观察组和对照组各52例,给予观察组患者经阴道超声诊断方法,给予对照组患者经腹部超声诊断的方法,对比两组患者诊断异位妊娠的符合率以及不同超声声像图的阳性率。结果：观察组经阴道超声检查确诊45例,诊断符合率为86．5％,对照组经腹部超声检查确诊32例,诊断符合率为61．5％,两者相比具有显著的差异性（P〈0．01）。观察组患者检查的超声声像图所显示的附件包块、胚芽形成以及原始血管搏动等检测指标的阳性率均高于对照组,且差异具有统计学意义（P〈0．05）。结论：异位妊娠经过阴道超声诊断的阳性率高于经腹部超声检查,且操作简单,安全性较高,值得在临床上进一步推广运用。     

研究阴道超声与腹部超声联合检查对异位妊娠的诊断价值

目的研究异位妊娠用阴道超声联合腹部超声的诊断价值。方法研究对象是我院妇产科接收的60例异位妊娠患者,行腹部超声及阴道超声诊断,比较诊断结果。结果与腹部超声、阴道超声的单一检查比较,联合诊断的准确率高;漏诊率及误诊率低,显示差异存在统计学意义(P<0.05)。结论异位妊娠患者应用腹部超声联合阴道超声诊断能早期诊断病情。     

彩色多普勒超声对异位妊娠的诊断价值

目的:探讨彩色多普勒超声对异位妊娠的诊断价值.方法:对临床确诊的异位妊娠患者应用经腹部彩色多普勒超声和经阴道彩色多普勒超声检查,比较两种检查技术的诊断符合率。结果:经阴道彩色多普勒超声的诊断符合率(75.6%)明显高于应用经腹部彩色多普勒超声(24.4%)。结论:经阴道彩色多普勒超声具有高分辨率特征,使异位妊娠的诊断率得以提高,在临床中具有较高的应用价值。     

Laparoscopic management of ectopic pregnancies in unusual locations

ObjectiveThe aim of this study was to evaluate the feasibility and efficacy of laparoscopic surgery for patients with ectopic pregnancies in unusual locations.Materials and methodsThis is a retrospective case series of 31 patients from 6 weeks to 10 weeks postmenstrual who were referred for diagnosis and treatment and suspected of having an unruptured cesarean scar pregnancy (CSP) or cornual pregnancy (CP). The diagnosis was confirmed with transvaginal ultrasound, and all of the patients underwent laparoscopic management.ResultsA diagnosis of CSP or CP was confirmed in all of the patients during the laparoscopic procedure. None of the patients required conversion to laparotomy. The total operative time ranged from 40 minutes to 120 minutes. The total blood loss was limited, ranging from 30 mL to 200 mL. All of the women tolerated the operation well and had uneventful recoveries.ConclusionWhen performed by a well-trained gynecologist, laparoscopy appears to be a reasonable alternative for the treatment of unruptured CSP or CP.     

Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies

Interstitial ectopic pregnancy is a term loosely used in the literature to describe three different entities. The first is the true interstitial ectopic pregnancy, which occurs in the interstitial or intramural segment of the Fallopian tubes. The term cornual ectopic pregnancy should be reserved for pregnancy in women with a single uterine horn, a bicornuate uterus, or a septate uterus. Angular pregnancy is a term that is rarely used and should be limited to a pregnancy in one of the angles of the uterus, but not inside the Fallopian tube.Historically, interstitial pregnancy was considered safe to manage conservatively until over 12 weeks because of the delayed risk of rupture as a result of the protection offered by the muscle of the uterus. However, over the last decade evidence now suggests that early rupture is not uncommon. The management of an interstitial pregnancy should be ascertained by ultrasonography, particularly three-dimensional ultrasonography. Depending on the size and viability of the pregnancy, management should be planned accordingly. Laparoscopic management is ideal for surgeons comfortable with the principles of laparoscopic surgery and suturing. However, laparotomy is a suitable alternative that will always provide a safe outcome. Adequate suturing of uterine cornua could prevent the risk of rupture during subsequent pregnancies. Minimizing blood loss during and after surgery is a priority.     

Low-lying-implantation ectopic pregnancy: A cluster of cesarean scar,cervico-isthmus,and cervical ectopic pregnancies in the first trimester

ObjectiveTo describe the treatment outcomes of aberrant ectopic implantations in the lower segment of the uterus in a cohort population and to evaluate whether or not low-lying-implantation ectopic pregnancy (LLIEP), a new term, is appropriate to include in the traditional diagnoses of cervical pregnancy (CP), cesarean scar pregnancy (CSP), and other unusual aberrant implantations in the lower segment of the uterus in the first trimester, in terms of clinical characteristics, treatment, and prognosis.Materials and methodsForty-two women with ectopic pregnancies of <12 weeks' gestational age from July 2003 to December 2008 were prospectively studied. Each patient underwent an ultrasound evaluation by an experienced consultation team and was grouped into the CP, CSP, or cervico-isthmic pregnancy (CIP) group. Patients underwent either suction dilatation and curettage (D and C) alone, or laparoscopic uterine artery blockage followed by suction D and C, to remove the aberrant trophoblasts without other adjuvant treatments. Clinical characteristics and biochemical factors, including obstetric history, patient age, body mass index (BMI), gestational age, serum hematocrit and β-hCG level, operation method, operation time, and intraoperative blood loss were evaluated.ResultsThere were no significant differences in patient age (mean = 34.1 ± 6.4 years), previous number of cesarean deliveries (mean = 1.5 ± 0.8), gestational age (mean = 6.9 ± 1.2 weeks), serum β-hCG (mean = 35,384.3 ± 41,726.9 mIU/mL), operation time (mean = 60.3 ± 46.6 minutes), and surgical blood loss (mean = 124.7 ± 191.5 mL) among the three patient groups. The uterus was successfully preserved in all patients after treatment.ConclusionThe prognosis of surgical management for ectopic implantations in the lower segment of the uterus is good. The new term LLIEP seems appropriate to cover all forms of aberrant ectopic implantations in the lower segment of the uterus in the first trimester, in terms of treatment efficacy. The use of LLIEP for preoperative ultrasound diagnosis would enable the clinician to diagnose unusual cases more easily, without the need to change the current treatment policy.     

The efficacy and safety of managing ectopic pregnancies with transvaginal ultrasound-guided local injections of absolute ethanol

Purpose: To describe the efficacy and safety of managing ectopic pregnancies (EP) with ultrasound-guided local injections of absolute ethanol (AE). Methods: 69 cases of EP following IVF performed in our clinic were treated with a local injection of 0.3 ml AE with a 23-gauge needle under transvaginal ultrasonic guidance. The efficacy was evaluated comparing serum beta-human chorionic gonadotropin (β-hCG) levels before and after the injection. Results: In the 60 successful cases (87%), the serum β-hCG level decreased by 10–30% in two hours postinjection. Of these, 46 were effective with a single injection and the half-life of β-hCG was achieved within 4 days in 45 cases. In 56 cases (including repetitive administration) serum β-hCG levels decreased to 20 mIU/mL within 20 days. The treatment showed no side effects and could be given on an outpatient basis without anesthesia. Conclusions: This method was shown to be a safe, effective new approach to treating EP.Transvaginal ultrasound-guided local injections of absolute ethanol are a safe and effective approach to treating ectopic pregnancies.     

阴道超声引导胚胎减灭术在少见部位异位妊娠中的应用

目的 探讨阴道超声引导胚胎减灭术在少见部位异位妊娠治疗中的应用价值。方法 2005年1月～2006年10月在北京大学第三医院生殖医学中心10例少见部位异位妊娠行阴道超声引导胚胎减灭术，并对治疗结局进行追踪和分析。结果 患者年龄25～37岁，妊娠周数7～8周。宫颈妊娠4例（宫颈合并宫腔内妊娠1例），输卵管间质部妊娠4例，宫角妊娠2例。6例超声显示异位妊娠囊内胎心搏动。hCG水平范围为4826～122300IU／L。术后1周血清hcG升高3例，其余术后血清hCG逐渐下降。1例间质部妊娠术后1周hCG水平升高，行第2次穿刺术时出现腹腔内出血症状和体征，急行腹腔镜探查和一侧输卵管切除术。其余患者血hCG4～8周降至正常，异位病灶3～5个月恢复正常。结论 阴道超声引导胚胎减灭术合并局部注射MTX作为一种微创技术，可安全有效地应用于非常见部位异位妊娠的保守治疗。     

Definition and diagnosis of cesarean scar ectopic pregnancies

Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy, where the pregnancy implants into a myometrial defect caused by a cesarean scar. Its incidence is predicted to increase, given the global increase in cesarean deliveries. As most cesarean scar ectopic pregnancies present as failing pregnancies or patients choose termination of pregnancy, there are limited data on their natural history. However, early first trimester diagnosis is essential, given the associated significant maternal morbidity. Transvaginal sonography is generally considered to be the optimal method for diagnosing cesarean scar ectopic pregnancy. There is no evidence that MRI adds to the diagnostic accuracy, and it is therefore not recommended for routine evaluation of cesarean scar ectopic pregnancy. There is no agreed reference standard for the diagnosis of cesarean scar ectopic pregnancy; therefore, the validity of several proposed sonographic diagnostic criteria reported by different authors remains unknown. There are also various suggested classification systems for cesarean scar ectopic pregnancy, which divide them in differet types. However, the proposals are very heterogeneous, and superiority of one classification system over another is yet to be established.