超声诊断子宫肌壁间妊娠一例

doi:10.12280/gjfckx.20230312

摘要/Abstract

摘要：

子宫肌壁间妊娠（intramural ectopic pregnancy，IMP）目前缺乏明确的诊断和治疗标准，当诊断不明确时会导致不恰当的治疗，因此早期及时诊断和选择正确的治疗方式尤为重要，尤其要考虑到保护患者未来的生育功能。回顾性分析1例经阴道彩色超声诊断的IMP病例，行宫腹腔镜联合手术+局部注药术。分析总结该病的高危因素、经阴道超声影像学表现及宫腹腔镜联合治疗经验等，以期提高临床医师对该病的认识，降低IMP的误诊和漏诊。经阴道彩色超声可以早期明确胎囊的大小、位置及与肌壁间的关系，可以作为早期诊断子宫肌壁间妊娠的首选方法，宫腹腔镜联合探查是一种较为有效的方法，可进一步明确诊断并治疗。

关键词: 妊娠, 异位, 超声检查, 宫腔镜检查, 腹腔镜检查, 子宫肌壁间妊娠

Abstract:

Intramural ectopic pregnancy(IMP) currently lacks clear diagnostic and therapeutic criteria. When the diagnosis is not clear, it can lead to inappropriate treatment. Therefore, early diagnosis and correct treatment are particularly important, especially in view of preserving the patient′s future reproductive function. A case of IMP diagnosed by transvaginal gynecological color Doppler ultrasound was retrospectively analyzed. Hysteroscopy combined with laparoscopy and local injection were performed. The high risk factors, transvaginal ultrasound imaging manifestations and experience of hysteroscopy and laparoscopy in the treatment of IMP were analyzed and summarized in order to improve clinicians′ understanding of the disease and reduce the misdiagnosis and underdiagnosis of IMP in clinical practice. Transvaginal color Doppler ultrasound can early determine the size, location and relationship between the fetal sac and the muscle wall, which can be used as the first choice for early diagnosis of intramural pregnancy. Hysteroscopy combined with laparoscopy is a more effective method for further clarifying the diagnosis and treatment.

Key words: Pregnancy, ectopic, Ultrasonography, Hysteroscopy, Laparoscopy, Intramural ectopic pregnancy

张驰, 闫颖, 梁学梅, 李婧雨. 超声诊断子宫肌壁间妊娠一例[J]. 国际妇产科学杂志, 2023, 50(5): 526-529.

ZHANG Chi, YAN Ying, LIANG Xue-mei, LI Jing-yu. Ultrasound Diagnosis of Intramural Ectopic Pregnancy: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2023, 50(5): 526-529.

图/表 4

图1 经阴道彩色超声图注：A 左图为子宫冠状切面，右图为子宫矢状切面，箭头所示为子宫宫底肌壁内偏左的胎囊，CDFI示妊娠囊周边可见血流信号。B 箭头所示为胎囊内卵黄囊。

图2 腹腔镜下子宫图注：箭头所示为腹腔镜下子宫宫底偏左外凸胎囊。

图3 腹腔镜下可见外凸部位透光实验阳性

图4 术后腹腔镜下子宫图注：术后外凸部位回缩。

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