宫角妊娠的超声诊断及鉴别诊断

目的探讨宫角妊娠的超声诊断及鉴别诊断要点。方法回顾性分析浙江省温岭市中医院2005年10月至2013年4月的56例门诊拟诊为宫角妊娠的病历资料。结果其中10例妊娠44天内的早期宫角妊娠2周内转为宫内妊娠；其余46例均经手术治疗和病理检查，其中38例为宫角妊娠（右侧20例，左侧18例），6例为间质部妊娠，1例为滋养细胞性疾病，1例为纵膈子宫一侧妊娠。宫角妊娠总的诊断准确率为67．86％，其中经腹部和经阴道超声诊断准确率分别为44．44％和63．16％，两种方法联合诊断准确率94．74％，联合组诊断准确率明显高于经腹部及阴超组（χ2值分别为11．19和5．70，P值分别为0．001和0．017）。结论①对于停经天数较短的早期诊断的宫角妊娠应密切观察，部分可以转为宫内妊娠；②超声是诊断宫角妊娠的有效方法，阴超与腹部超声两种检查方法联合应用能够大大提高诊断的准确率。

Ultrasonic diagnosis and differential diagnosis of cornual pregnancy

Objective To explore the diagnostic and differential diagnostic points of cornual pregnancy. Methods The data of 56 patients diagnosed with cornual pregnancy in outpatient clinic of Wenling Traditional Chinese Medical Hospital between October 2005 arld April 2013 were studied retrospectively. Results There were 10 cases of cornual pregnancy within 40 days of pregnancy converting to pregnancy in 2 weeks, and the other 46 cases were treated by operation and pathological examination, including 38 cases of cornual pregnancy （20 cases at right side, 18 cases at left side）,6 cases of interstitial pregnancy, 1 case of gestational trophoblastic disease and 1 case of pregnancy at mediastinal uterine side. The total diagnostic accuracy rate of cornual pregnancy was 67.86%. Diagnostic accuracy rate of abdominal ultrasound and transvaginal ultrasound was 44.44% and 63.16% , respectively. The diagnostic accuracy rate of combination of two methods was 94.74% , which was significantly higher than single abdominal ultrasound and transvaginal ultrasound （χ2 value was 11.19 and 5.70, P value was 0. 001 and 0. 017, respectively. ） Conclusion Cornual pregnancy within 40 days of pregnancy should be closely observed, and some can convert to intrauterine pregnancy. Uhrasound is an effective method for diagnosis of cotnual pregnancy, and the combination of abdominal ultrasound and transvaginal ultrasound can greatly improve the accuracy rate of diagnosis.