探讨经阴道三维超声联合断层超声显像技术（TUI）在早期异位妊娠诊断中的应用价值。

对停经4～6周临床疑似异位妊娠的120例患者行经阴道二维及三维超声联合TUI技术检查，做出超声分型诊断；与手术病理及临床随访结果对照，对经阴道二维及三维超声联合TUI技术诊断早期异位妊娠患者的超声声像图特征及漏误诊病例图像特征进行总结分析。

120例患者手术病理及临床随访结果证实异位妊娠102例，宫内妊娠18例。与手术病理诊断结果及临床随诊结果对照显示：（1）输卵管妊娠92例，经阴道二维超声正确诊断80例（86.9%，80/92），漏诊8例，误诊4例；经阴道三维超声联合TUI成像正确诊断84例（91.3%，84/92），漏诊8例，无误诊病例。超声声像图示附件区类妊娠囊回声包块，呈"Donut"征或边界不清的不规则包块，多数包块边界和内部结构清晰或较清晰，包块与输卵管位置关系清晰或较清晰。超声诊断未破裂型输卵管妊娠36例，流产型43例，破裂型5例。（2）子宫角妊娠10例，经阴道二维超声正确诊断6例（60.0%，6/10），误诊4例；经阴道三维超声联合TUI成像正确诊断9例（90.0%，9/10），误诊1例。超声声像图示妊娠囊位于一侧子宫角处向外突出，经阴道二维超声显示10例中6例妊娠囊与子宫内膜不相连，4例妊娠囊周边蜕膜包绕显示不清，4例见间质线征；经阴道三维超声联合TUI成像，通过多平面断层图像，尤其冠状面清晰显示9例妊娠囊与子宫内膜不相连，妊娠囊周边蜕膜包绕不完整，6例见间质线征。（3）102例早期异位妊娠因包块小、超声显示不清，经阴道二维及三维超声联合TUI成像均漏诊输卵管妊娠8例；因宫腔内出现"假妊娠囊"结构、妊娠囊偏向一侧与宫内妊娠难以分辨等原因，经阴道二维超声误诊输卵管妊娠4例及子宫角妊娠4例，经阴道三维超声联合TUI成像后清晰显示异位妊娠包块及妊娠囊位置而明确诊断7例，仅误诊1例子宫角妊娠。

经阴道三维超声联合TUI成像能提供更详尽的早期异位妊娠超声声像图诊断信息，减少早期异位妊娠漏误诊，经阴道三维超声联合TUI成像对早期异位妊娠超声诊断有较好的临床应用价值。

To investigate the application value of transvaginal three-dimensional ultrasound combined with tomographic ultrasound imaging (TUI) in the diagnosis of early ectopic pregnancy.

One hundred and twenty patients with 4 to 6 weeks menopause were collected. All of the cases were clinical suspected of ectopic pregnancy and the surgical pathology and clinical follow-up results of each case were obtained. Both transvaginal two dimensional ultrasound imaging and three-dimensional ultrasound imaging combined with TUI technique were applied in order to make a diagnosis based on ultrasonographic characteristics for each of the case; surgical pathology and clinical follow-up results were compared with the ultrasonographic diagnosis so as to analysis and conclude the ultrasonographic imaging characteristics of cases misdiagnosed or missed diagnosed by transvaginal two-dimensional ultrasound imaging and three-dimensional ultrasound imaging joint TUI technique.

One hundred and two cases were confirmed as ectopic pregnancy by surgical pathology and clinical follow-up results among 120 patients and eighteenth cases were confirmed as intrauterine pregnancy. Comparing surgical pathology and clinical follow-up results with the ultrasonographic diagnosis showed: (1) Ninety-two cases of tubal pregnancy: 80 cases were correctly diagnosed by transvaginal two-dimensional ultrasound imaging (86.9%, 80/92) while 84 cases by three-dimensional combined with TUI technique (91.3%, 84/92); 8 cases were missed diagnosed by both two methods; 4 cases were misdiagnosed by transvaginal two-dimensional ultrasound imaging while zero case by three-dimensional combined with TUI technique. Ultrasonographic imaging characteristics: adnexal masses presented as "Donut" sign which was similar to gestational-sac or masses with irregular boundary. The majority of the masses presented as clear boundaries and internal structure and had obvious margins with fallopian tube. A total 36 cases of unruptured tubal pregnancy were correctly diagnosed by the two methods while 43 cases of abortion type and 5 cases of ruptured type were correctly diagnosed. (2) Ten cases of uterine cornual pregnancy: 6 cases were correctly diagnosed by transvaginal two-dimensional ultrasound imaging (60.0%, 6/10) while 9 cases by three-dimensional ultrasound imaging joint TUI technique (90.0%, 9/10); 4 cases were misdiagnosd by transvaginal two-dimensional ultrasound imaging and 1 case by three-dimensional ultrasound imaging joint TUI technique. Ultrasonographic imaging characteristics: the gestational-sac was located in the uterine horn, 6 cases of gestational-sac was not connected with endometrium showed by transvaginal two-dimensional ultrasound imaging while 9 cases were clearly showed by three-dimensional ultrasound imaging joint TUI technique that the gestational-sac was connected with endometrium, especially in the coronal-section. The surrounding decidua circumvoluted the gestational-sac was unclear in 4 cases by transvaginal two-dimensional ultrasound imaging and in 9 cases by three-dimensional ultrasound imaging joint TUI technique. And 'interstitial line’ sign appeared in 4 cases showed by transvaginal two-dimensional ultrasound imagingwhile 6 cases by three-dimensional ultrasound imaging joint TUI technique. (3) Cases missed diagnosed and misdiagnosed: 8 cases of early ectopic pregnancy were missed diagnosed both by transvaginal two-dimensional ultrasound imaging and three-dimensional ultrasound imaging joint TUI. The reasons we concluded were as follow: 'false gestational-sac’ located in the uterine cavity; the location of the gestational-sac was so closed to uterine cavity. Four cases of tubal pregnancy and 4 cases of uterine cornual pregnancy were misdiagnosed by transvaginal two-dimensional ultrasound imaging. The location of the ectopic pregnancy mass and the gestational-sac of 7 cases of uterine cornual pregnancy were clearly showed by three-dimensional ultrasound imaging joint TUI and only 1 case was misdiagnosed.

Transvaginal three-dimensional ultrasound imaging combined with TUI technique can provide more detailed ultrasound diagnostic information and reduced missed diagnosis and misdiagnosis of the early ectopic pregnancy. The clinical application value of transvaginal three-dimensional ultrasound imaging combined with TUI technique in the diagnosis of early ectopic pregnancy was good.