卢菁菁+乔丽+何立红+冯明初

【摘要】 目的 分析卵巢妊娠的超声图像特点， 总结漏诊及误诊原因。方法 回顾性分析28例卵巢妊娠的临床表现及实验室检查资料， 总结彩色多普勒超声图像特点。结果 本组卵巢妊娠28 例， 经阴道超声术前明确诊断3 例， 确诊率为10.7%。误诊25例， 其中阴道超声诊断为输卵管妊娠22例， 另3例同时伴有宫内妊娠， 将卵巢妊娠误诊为妊娠黄体（其中1例伴有宫内妊娠及对侧输卵管妊娠）。结论 卵巢妊娠在临床表现及体症与输卵管妊娠、黄体破裂相似， 其声像图也极为相似。经阴道彩色多普勒超声结合多角度、按压手法及实验室检查可提高卵巢妊娠的诊断率， 尤其是对早期卵巢妊娠的诊断具有重要的临床应用价值。

【关键词】 超声检查；卵巢妊娠

DOI：10.14163/j.cnki.11-5547/r.2016.18.024

【Abstract】 Objective To analyze ultrasonic image characteristics of ovarian pregnancy， and to summarize causes of misdiagnosis. Methods A retrospective analysis was made on clinical manifestations and laboratory examination data of 28 ovarian pregnancy cases， and features of color Doppler ultrasound were summarized. Results Among the 28 ovarian pregnancy cases， there were 3 diagnosed cases by transvaginal ultrasound before operation， with the diagnosis rate as 10.7%. Among 25 misdiagnosed cases， 22 cases were diagnosed by transvaginal ultrasound as tubal pregnancy， the other 3 cases complicating with uterine pregnancy were misdiagnosed as corpus luteum of pregnancy （1 case of them had complicated uterine pregnancy and contralateral tubal pregnancy）. Conclusion Ovarian pregnancy contains similar clinical manifestations and ultrasound image as tubal pregnancy and rupture of corpus luteum. Combination of transvaginal color Doppler ultrasound， multi-angle press and laboratory examination can improve diagnosis rate of ovarian pregnancy， and it contains extremely important value for clinical application in diagnosis of early ovarian pregnancy.

【Key words】 Ultrasonic examination； Ovarian pregnancy

卵巢妊娠是指受精卵在卵巢组织内着床和发育， 发病率为1∶7000～1∶50000[1]。输卵管妊娠的典型症状是腹痛、闭经和出血， 然而， 单独慢性盆腔痛这一症状并不易让人联系到其病因， 但它是卵巢妊娠最常见的临床表现[2]。卵巢妊娠因其独特的妊娠位置常被误诊， 其血管丰富， 且缺乏肌性组织， 卵巢妊娠一旦破裂， 易引起腹腔内出血、休克甚至死亡， 故卵巢妊娠早期诊断尤为重要。本研究回顾分析中山市博爱医院经手术及病理证实卵巢妊娠病例， 报告如下。

1 资料与方法

1. 1 一般资料 选取2013年10月～2015年4月于本院经阴道超声检查， 后经手术及病理确诊的卵巢妊娠患者28例， 均符合Spiegelberg卵巢妊娠诊断标准[3]：①双侧输卵管必须完整， 并与卵巢分开；……