CAJ | 학술논문

目的：总结包块型子宫角妊娠超声声像图特征及定位、定性诊断要点。方法对23例于2011年1月至2013年1月在北京协和医院超声检查并经手术及病理检查证实为包块型子宫角妊娠患者的超声声像图特征进行总结分析。结果23例包块型子宫角妊娠患者（18例经阴道超声检查，5例经腹部超声检查）超声声像图均表现为位于一侧子宫角处向外突出的混合回声包块，其中20例包块边界清晰或较清晰，经腹部超声显示3例包块边界不清晰；15例可见间质线征，8例因包块与子宫内膜紧邻未显示间质线征；包块周边子宫肌层厚度为0.1~0.3 cm。23例中3例血清β-hCG检测值较高（＞20000 IU/L）的患者超声可观察到子宫角包块中典型的中高回声绒毛结构；彩色多普勒血流成像示22例包块周边可见丰富环绕血流信号（其中9例伴内部较丰富血流信号），1例包块周边示少许条状血流信号，动脉频谱均为低阻改变。23例包块型子宫角妊娠患者中，7例因包块呈蜂窝状混合回声、血流丰富及低阻动脉频谱误诊为滋养细胞肿瘤（5例经腹部超声检查，2例经阴道超声检查），16例术前超声与手术病理诊断一致，声像图特征：包块均位于子宫角内膜延长线上；包块边界清晰、血流分布以周边环绕为主；血清β-hCG检测值较高的患者声像图中或可观察到典型的中高回声绒毛结构。结论超声诊断包块型子宫角妊娠应根据包块位置、边界、血流分布、有无绒毛结构并结合病史及血清β-hCG检测值与滋养细胞肿瘤相鉴别。经阴道超声检查在包块型子宫角妊娠定位、定性及鉴别诊断中有重要价值。
목적：총결포괴형자궁각임신초성성상도특정급정위、정성진단요점。방법대23례우2011년1월지2013년1월재북경협화의원초성검사병경수술급병리검사증실위포괴형자궁각임신환자적초성성상도특정진행총결분석。결과23례포괴형자궁각임신환자（18례경음도초성검사，5례경복부초성검사）초성성상도균표현위위우일측자궁각처향외돌출적혼합회성포괴，기중20례포괴변계청석혹교청석，경복부초성현시3례포괴변계불청석；15례가견간질선정，8례인포괴여자궁내막긴린미현시간질선정；포괴주변자궁기층후도위0.1~0.3 cm。23례중3례혈청β-hCG검측치교고（＞20000 IU/L）적환자초성가관찰도자궁각포괴중전형적중고회성융모결구；채색다보륵혈류성상시22례포괴주변가견봉부배요혈류신호（기중9례반내부교봉부혈류신호），1례포괴주변시소허조상혈류신호，동맥빈보균위저조개변。23례포괴형자궁각임신환자중，7례인포괴정봉와상혼합회성、혈류봉부급저조동맥빈보오진위자양세포종류（5례경복부초성검사，2례경음도초성검사），16례술전초성여수술병리진단일치，성상도특정：포괴균위우자궁각내막연장선상；포괴변계청석、혈류분포이주변배요위주；혈청β-hCG검측치교고적환자성상도중혹가관찰도전형적중고회성융모결구。결론초성진단포괴형자궁각임신응근거포괴위치、변계、혈류분포、유무융모결구병결합병사급혈청β-hCG검측치여자양세포종류상감별。경음도초성검사재포괴형자궁각임신정위、정성급감별진단중유중요개치。
Objective To summarize the sonographic features and differential diagnosis points of mass-type cornual pregnancy. Methods The sonographic ifndings of 23 pathological proven mass-type cornual pregnancy cases enrolled in PUMCH from 2011 January to 2013 January were retrospectively analyzed. Results All pathological proven mass-type cornual pregnancy were located at one corner of the uterus presenting as a heterogenous outward mass. Well-deifned margins were found in 20 cases, and interstitial-line signs were found in 15 cases. The surrounding muscle thickness is 0.1-0.3 cm. Typical hyperechoic villi were found on sonography in cases with bloodβ-hCG>20 000 IU/L. On Doppler, the lesion showed abundant peripheral vascularity with low resistance in 22 cases, 9 lesions also showed abundant internal vascularity. Among 23 mass-type cornual pregnancy cases, 7 cases were misdiagnosed as gestational trophoblastic neoplasia (GTN) due to the similar sonographic characteristics including mixed-echo and abundant vascularity with low resistance. Sixteen cases were diagnosed by ultrasound preoperatively, with featured sonographic signs including mass located in the endometrial extension line;clear margin;peripheral vascularity;or detection of interstitial-line sign and typical villus. Conclusions Mass-type cornual pregnancy may be correctly diagnosed according to the location, boundary of the mass and the distribution of blood flow combining with clinical manifestation and bloodβ-hCG level. Transvaginal sonography could play an important role in diagnosis of cornual pregnancy.