超声检测子宫内膜下血流对早期异位妊娠的鉴别诊断价值

目的:探讨经阴道能量多普勒超声(TV-PDU)检测子宫内膜下血流对异位妊娠(EP)的早期诊断价值。方法:应用TV-PDU对可疑EP患者(184例)子宫内膜下血流进行分型、分级,检测最高流速(PSV)和阻力指数(RI),根据最终诊断结果分为EP组(62例)和宫内妊娠组(122例),比较两组子宫内膜下血流类型和超声参数。结果:EP组TV-PDU较难显示子宫内膜下血流信号,只有9例(14.5%)能检出内膜下动脉血流频谱,血流速度曲线为低速高阻型,13例为静脉血流频谱。而宫内妊娠者子宫内膜下可见丰富的动、静脉血流信号,血流速度曲线为低阻型。两组病例动脉血流分级、RI、PSV比较差异均有统计学意义(P<0.01)。EP组子宫内膜为蜕膜样组织、蜕膜组织和A-S反应病理类型的比例较高。结论:内膜下低阻血流是诊断宫内妊娠的有力证据,能有效排除EP的可能。TV-PDU有助于准确地评价子宫内膜的血供情况,对早期可疑EP有很好的鉴别诊断价值,与血清β-hCG比值相结合可早期诊断EP。

Differential Diagnosis of Early Ectopic Pregnancy with Ultrasonic Detection of the Endometrial Blood Flow

Objective: To evaluate the diagnostic value of transvaginal power Doppler ultrasonography(TV-PDU) for ectopic pregnancy(EP) by detection of the endometrial blood flow.Methods: The endometrial blood flows were classified and graded among the suspected EP patients(184 cases),and the peak systolic velocity(PSV) and the resistant index(RI) were detected using TV-PDU.All cases were divided into the EP group(62 cases) and the intrauterine pregnancy group(122 cases),according to the final diagnosis.The types and ultrasound parameters of the endometrial blood flow were compared between the two groups.Results: It was difficult to show the signals of the endometrial blood flow in the EP group,and only 9 cases were detected the arterial flow frequency spectrum,with the flow velocity curves of low-speed and high-resistance.And the detection of other 13 cases showed venous flow frequency spectrum.While rich signals of arterial and venous flow were detected in the intrauterine pregnancy group,with the flow velocity curves of low-resistance.The arterial blood flow grades,RI and PSV were compared between the two groups,and the differences were statistically significant(P<0.01).And the pathological findings showed that more patients in the EP group were examined with similar decidual tissue,decidual tissue and A-S reaction pathological types.Conclusion: Endometrial blood flow of low-resistance is a strong evidence of intrauterine pregnancy,which can effectively exclude the possibility of EP.TV-PDU can contribute to the accurate assessment of endometrial blood supply,and play important roles in the differential diagnosis of suspected EP.TV-PDU combined with the ratio of serum β-hCG can be used for the early diagnosis of EP.