标题：早孕期超声在宫角妊娠诊断及临床决策中的应用

      作者：胡永铭 1，陈晶 2，唐蓉 1，李小清 1，余琦 1，黄翠莹 1，陈红 2    1.海口市妇幼保健院超声影像科，海南 海口 570203；2.中南大学湘雅医学院海口市医院放射科，海南 海口 570100

      卷次： 2020年31卷20期

      【摘要】 目的 探讨早孕期宫角妊娠的超声图像特征，评估超声对宫角妊娠的诊断和临床应用价值。方法 回顾性分析2015年7月至2019年7月在海口市妇幼保健院就诊，且经手术(或产后)和病理证实的34例孕早期诊断为宫角妊娠孕妇的临床资料，依据妊娠物在宫角种植部位与宫腔内膜的关系、蜕膜包绕情况、突出浆膜程度等超声图像特征分为Ⅰ型和Ⅱ型，评估其妊娠转归，为临床决策提供依据。结果 (1)Ⅰ型18例：其中8例孕囊内胚芽种植于宫腔侧，转归宫内妊娠可能性大，超声监测下继续妊娠，但 1例胎盘植入，16周胎死宫内，其余 7例足月顺产；7例胚芽种植于宫角外侧，药流+超声监测下人流；3例胚胎未发育，药流+宫腔镜下妊娠物清除术。(2)Ⅱ型 16例：其中 3例可见胚芽及心血管搏动；13例显示宫角混合型包块或胎盘样高强回声，为稽留流产。16例妊娠物均不同程度突向间质部，转归间质部妊娠风险大，选择药流+腹腔镜监测下宫腔镜妊娠物病灶清除术，过程顺利。结论 宫角妊娠Ⅰ型胚芽种植于宫腔侧属“宫内偏位妊娠”范畴，可酌情选择超声监测下继续妊娠；对其它孕囊有突向间质部生长趋势者，需尽早根据超声影像特征选择不同手术治疗；早孕期超声对宫角妊娠诊断并评估、监测，能为临床决策提供可靠的依据，具有重要作用。
      【关键词】 早孕期；超声；宫角妊娠；诊断；临床决策
      【中图分类号】 R714.22+4 【文献标识码】 A 【文章编号】 1003—6350（2020）20—2658—04

Application of ultrasound in diagnosis and clinical decision-making of cornual pregnancy.
HU Yong-ming 1, CHENJin 2, TANG Rong 1, LI Xiao-qing 1,YU Qi 1, HUANG Cui-ying 1, CHEN Hong 2. 1. Department of Ultrasound, Haikou Womenand Children Hospital, Haikou 570203, Hainan, CHINA. 2. Department of Radiology, Haikou Hospital, Xiangya School ofMedicine, Central South University, Haikou 570100, Hainan, CHINA
【Abstract】 Objective To explore the ultrasonographic features of uterine horn pregnancy in early pregnancyand evaluate the diagnostic and clinical value of ultrasound in uterine horn pregnancy. Methods The clinical data of 34cases of uterine horn pregnancy in early pregnancy confirmed by surgery (or postpartum) and pathology in Haikou Wom-en and Children Hospital from July 2015 to July 2019 were retrospectively analyzed. According to ultrasonic image char-acteristics such as the relationship between angle of planting area and uterine endometrium, decidua surrounding, degreeof protrusion of serosa and blood supply, the patients were divided intoⅠ type andⅡ type, which was used to evaluatethe pregnancy outcome and provide the basis for clinical decision making. Results (1) Among the 18 cases ofⅠ type:8 cases of pregnancy pouch embryo grown in uterine cavity side, likely outcome intrauterine pregnancy, under ultra-sound monitoring continue to pregnancy, but 1 case of placenta implantation, fetal intrauterine death at 16 weeks, the restof the 7 cases of full-term birth; 7 cases of embryo were planted in the lateral corner of the uterine horn; 3 cases of unde-veloped embryos, and the pregnancy was removed by drug abortion and hysteroscopy. (2) 16 cases ofⅡ type: 3 cases ofgerm and cardiovascular pulsation; 13 cases showed mixed uterine horn mass or placental high echogenicity, which weremissed abortions. All the 16 cases of gestation had different degrees of protrusion to the interstitium, and the risk of re-version to the interstitial pregnancy was high. Drug abortion and hysteroscopic pregnancy lesion removal under laparo-