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1、宫外孕阴道超声23例漏诊误诊研究摘要目的:探讨异位妊娠阴道超声漏诊及误诊发生的原因,以提高阴道超声诊断准确率。方法:对本资料23例异位妊娠病例的阴道超声漏诊、误诊进行回顾分析。结果:23例患者中误诊为盆腔炎性包块者5例,黄体破裂者2例,宫内宫外复合妊娠2例,宫内早早孕者4例,不全流产2例,子宫肌壁间妊娠误诊2例,卵巢肿大2例、输卵管积液1例、宫内孕1例、2例宫内及附件未见明显异常。结论:阴道超声对异位妊娠误诊、漏诊原因很多,医生必须认真采集临床资料,仔细检查,全面考虑诊断,在宫内外均未见明显孕囊及高度怀疑异位妊娠
2、时,必须结合尿HCG或血HCG检查,并结合阴道彩色多普勒超声检查.临床症状进行全面分析诊断。关键词异位妊娠阴道超声检查误诊漏诊doi:10.3969/j.issn.1007-614x.2010.17.072nAbstractObjective:Toexplorethemisseddiagnosisofectopicpregnancy,transvaginalultrasonographyandmisdiagnosiscanoccurbecauseinordertoimprovediagnosticaccuracy
3、oftransvaginalsonography.Methods:23casesofectopicpregnancythisinformationvaginalultrasoundmissedcasesofmisdiagnosiswereanalyzedretrospectively.Results:23casesofmisseddiagnosis,misdiagnosisforPelvicInflammatorymassin5cases,corpusluteumrupturein2cases,2casesofi
4、ntrauterinepregnancy,extrauterinecompound,intrauterineearlypregnancyin4cases,2casesofincompleteabortion,uterinemusclewallmisdiagnosedtwocasesofinter-pregnancy,ovarianenlargementin2cases,1caseoftubalfluid,intra-uterinepregnancyin1case,2caseshadnoobviousintra-u
5、terineandaccessories.Conclusion:Thetransvaginalsonographyofectopicpregnancymisdiagnosisaremanyreasons,doctorsmustcarefullycollectclinicaldata,double-check,takefullaccountofthediagnosis,intheuteruswerenosignificantpregnancyoutsidethecapsuleandahighdegreeofsusp
6、icionofectopicpregnancy,mustbecombinedurineHCG,orHCGbloodexamination,combinedwithtransvaginalcolorDopplerultrasoundexamination,clinicalsymptoms,toconductacomprehensiveanalysisanddiagnosis.KeywordsEctopicpregnancy;transvaginalultrasoundexamination;misdiagnosis
7、;missed资料与方法2005年2月〜2009年3月在我院用阴道超声检查或外院超声检查到我院作阴道超声复查的23例异位妊娠,通过手术和病理检查确诊;23例患者年龄18~43岁,未婚2例,初孕5例;其中有停经史者19例、宫内有节育环者10例;停经时间33〜72天不等,无停经史者4例。其中阴道超声漏诊6例,误诊15例。23例中,就诊前有不同程度腹痛及不规则阴道流血者17例,无腹痛及无阴道流血者5例。B超检查前作了尿HCG检查22例,尿HCG弱阳性者5例,阳性者仃例,1例做超声前未查尿HCG。仪器和方法:采用340A
8、彩色多普勒超声显像仪,腔内探头频率5口5〜7D5MHZ。采用经阴道超声超生检查,无需膀胱充盈,患者取膀胱截石位,将探头涂上耦合剂套入一次性避孕套后缓慢置于阴道内,达宫颈后采用旋转、抽送、倾斜等几种基本手法作多切面检查,必要时左手在腹部加压配合右手检查⑴,观察记录子宫腔内有无孕囊回声、子宫内膜厚度输卵管、卵巢及盆腔有无积液、包块,包块大小、形态与周边组织关系、内部回声[2]