经阴道彩色多普勒超声在宫内妊娠及异位妊娠中的诊断价值

摘要

目的探讨经阴道彩色多普勒超声在宫内妊娠和异位妊娠中的诊断价值。方法选取2013年1月至2014年12月于本院就诊要求终止妊娠的患者273例，经动态追踪后确诊为宫内早孕者167例，异位妊娠者106例。通过经阴道彩色多普勒超声观察孕囊、卵黄囊和孕囊外结构（子宫内膜、妊娠黄体），通过彩色多普勒血流显像评价血流动力学指标（子宫内膜血流、子宫动脉血流及黄体血流等）。结果宫内妊娠孕囊轮廓光滑完整，呈现双环征，囊壁厚度＞2mm，有均匀一致的较强回声，子宫内膜厚度≥15mm且随妊娠周期增加而增厚，其下螺旋动脉血流丰富，阻力指数（resistance index，RI）＜0.4；宫内妊娠卵黄囊为圆形、壁薄、透明的囊状结构，血流丰富，彩色血流束明显变粗，流速增加，舒张期血流成分丰富，RI变小。而异位妊娠孕囊多为假孕囊与空孕囊，不显示双环征，孕囊内不能见到卵黄囊及胚胎回声、原始心血管搏动，子宫内膜厚度比宫内妊娠稍薄（＜12mm），收缩期峰值血流速度明显低于宫内妊娠，血流速度曲线为低速高阻型；早期异位妊娠黄体周边血流以条状、点状或无明显血流为主，血流速度偏低。结论通过经阴道彩色多普勒超声观察孕囊及孕囊外结构、彩色多普勒血流显像评价血流动力学指标，可为临床早期准确诊断宫内妊娠及异位妊娠提供依据，具有较高的临床应用价值。%Objective To explore the diagnostic value of transvaginal ultrasound with color Doppler flow imaging between intrauterine pregnancy and ectopic pregnancy, and provide the characteristic evidences of diagnosis and distinctive diagnosis for intrauterine pregnancy or ectopic pregnancy.Method Retrospectively analyzing 273 patients who wanted to stop pregnancy in our hospital during 2013.1~2014.12, final diagnosis of 167 patients was early intrauterine pregnancy and 106 ectopic pregnancy. Furthermore the pregnant sack and extrasack including yolk sac, corpus luteum, endometrium were observed and the hemodynamics markers such as blood stream of, corpus endometrium, uterine artery, luteum, et al were evaluated through transvaginal ultrasound with color Doppler flow imaging.Result The color Doppler flow imaging of intrauterine pregnancy exhibited that the outline of pregnant sack was slick and complete, the thickness was more than 2mm and the ultrasound echo was homogeneous with the sign of “double circular”. The blood stream of yolk sac was affluent, flow rate was quick and RI was low. The depth of endometrium was more than 15mm and increase with time, moreover blood stream of spiral artery was abundant. While the imaging of ectopic pregnancy is different: the pregnant sack was pseudosack or empty sack without the sign of “double circular”, there was no echo of yolk sac, fetus, or the beat of heart tube. The depth of endometrium was less than 12mm and the peak systolic velocity (PSV) of spiral artery was lower than intrauterine pregnancy. The blood stream color sign around ectopic pregnancy mass was strip, punctiform, or no obvious sign with a low speed.Conclusion There are enormous clinic applied value to observe the pregnant sack and extrasack and evaluate the hemodynamics markers through transvaginal ultrasound with color Doppler flow imaging, which could offer the early and accurate proof of diagnosis for intrauterine pregnancy and ectopic pregnancy.