持续性单纯宫内无回声的临床结局分析

Clinical outcome analysis of persistent simple intrauterine anechoic areas

摘要

目的 分析持续性单纯宫内无回声的临床结局。方法 回顾性收集我院于2015年3月至2021年5月收治的持续性单纯宫内无回声患者共3759例,并收治1例因单纯宫内无回声于外院清宫后血β-HCG下降不良,进一步转诊至我院处理的患者,共计3760例,分析所有患者临床特点及特殊临床结局。结果 3760例患者中,3745例患者的临床结局为稽留流产,15例患者的临床结局为非稽留流产.非稽留流产患者中,有11例患者术后第一天查血β-HCG下降＞50％,其病理报告均提示为“葡萄胎”;有3例患者术后第一天查血β-HCG较前不降反升,幅度均＜15％,其病理报告均为“蜕膜组织”,因病理报告时间具有延后性,故均及时行盆腔超声检查,提示为异位妊娠,并及时进行腹腔镜检术;1例外院转诊来院患者,术后第7天血β-HCG下降幅度较小,我院复查发现血β-HCG为8754mIU/mL,盆腔超声提示为间质部妊娠,并行腹腔镜检术＋左侧间质部切开取胚术。结论 临床工作中超声提示持续性单纯宫内无回声患者大部分表现为稽留流产,但仍有部分患者存在葡萄胎和异位妊娠的可能性,因此清宫前后均应密切监测血β-HCG,注重病理检查,必要时复查盆腔超声,谨防葡萄胎和异位妊娠,防止漏诊误诊.

Abstract

Objective To analyze the clinical outcomes of persistent simple intrauterine anechoic areas. Methods A total of 3759 patients with persistent simple intrauterine anechoic areas were retrospectively collected from our hospital between March 2015 and May 2021. Additionally, one case was included where a patient was transferred to our hospital for further treatment due to poor β-HCG decline after curettage at another hospital for a simple intrauterine anechoic area. In total, 3760 cases were analyzed to examine the clinical characteristics and special clinical outcomes of all patients. Results Among the 3760 patients, the clinical outcome for 3745 patients was missed abortion, while the clinical outcome for 15 patients was non-missed abortion. Among the patients with non-missed abortion, 11 had a decline in blood β-HCG of more than 50% on the first day after surgery, and their pathological reports showed “hydatidiform mole”. In 3 patients, blood β-HCG levels increased rather than decreased on the first day after surgery, with an increase of less than 15%. Their pathological reports all showed “decidual tissue”. Since there is a delay in obtaining the pathological reports, timely pelvic ultrasound examinations were conducted, which indicated ectopic pregnancy, and laparoscopic surgery was promptly performed. One patient transferred from another hospital had a small decrease in blood β-HCG on the 7th day after surgery. Reexamination at our hospital found the blood β-HCG level to be 8754mIU/mL. Pelvic ultrasound suggested an interstitial pregnancy, and laparoscopy with left interstitial incision and embryo extraction was performed. Conclusion In clinical work, ultrasound indicates that most patients with persistent simple intrauterine anechoic areas present as missed abortion. However, there remains a possibility of hydatidiform mole and ectopic pregnancy in some patients. Therefore, blood β-HCG should be closely monitored before and after curettage, pathological examination should be emphasized, and pelvic ultrasound should be rechecked if necessary to prevent missed or misdiagnosed cases of molar pregnancy and ectopic pregnancy.

关键词

盆腔超声 / 宫内无回声 / 稽留流产 / 葡萄胎 / 异位妊娠

Key words

pelvic ultrasound / intrauterine anechoic area / missed abortion / hydatidiform mole / ectopic pregnancy

参考文献

[1] 彭美莲, 林开武, 翁宗杰, 等. 妊娠滋养细胞疾病的影像学特征及意义[J]. 中国实用妇科与产科杂志, 2022, 38(7): 680-684.

[2] 郑峥, 顾向应, 刘欣燕, 等. 早期妊娠稽留流产治疗专家共识[J]. 中国实用妇科与产科杂志, 2020, 36(1): 70-73.

[3] 秦佳乐, 王双燕, 吕卫国. 超声在葡萄胎病变中的应用价值分析[J]. 临床超声医学杂志, 2018, 20(1): 41-43.

[4] Soper JT. Gestational trophoblastic disease: current evaluation and management[J]. Obstet Gynecol, 2021, 137(2): 355-370.

[5] Ning F, Hou H, Morse AN, et al. Understanding and management of gestational trophoblastic disease[J]. F1000Res, 2019, 8: F1000 Faculty Rev-428.

[6] 孙琦, 袁芳. 完全性葡萄胎1例诊疗体会并文献复习[J]. 临床医学进展, 2022, 12(9): 8355-8358.

[7] Hirschler LE, Soti V. The utility of monitoring beta-human chorionic gonadotropin levels in an ectopic pregnancy[J]. Cureus, 2023, 15(1): e34063.

[8] Mullany K, Minneci M, Monjazeb R, et al. Overview of ectopic pregnancy diagnosis, management, and innovation[J]. Womens Health (Lond), 2023, 19: 17455057231160349.

[9] 杜云芳, 周红梅, 郑笑, 等. 三种不同超声方法对异位妊娠的诊断价值[J]. 中国妇幼健康研究, 2019, 30(6): 752-755.

[10] 王闽, 于玮惠. 超声对稽留流产的诊断与鉴别价值分析[J]. 影像研究与医学应用, 2019, 3(4): 210-211.

[11] 郑敏. 稽留流产超声形态学表现及临床应用[J]. 医学信息, 2014(6): 208- 208.

[12] Puttagunta S, Lee SY. Pseudoembryo associated with pseudogestational sac: a novel sonographic finding in ectopic pregnancy[J]. Eur J Radiol Open, 2019, 6: 281-283.

[13] 杨智利, 赵锦洪, 谢季平, 等. 超声下子宫内膜厚度与形态对孕早期异位妊娠的预测价值[J]. 实用临床医学, 2022, 23(5): 62-64.

基金资助

湖北省卫生健康委员会科研项目(WJ2021M187)