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中华医学超声杂志(电子版) ›› 2017, Vol. 14 ›› Issue (02) : 99 -104. doi: 10.3877/cma.j.issn.1672-6448.2017.02.006

所属专题: 妇产科超声影像学 文献 妇产科超声

妇产科超声影像学

经阴道超声对侵蚀性葡萄胎的早期及精准诊断的预期观察
苏娜1, 姜玉新1,(), 戴晴1, 杨萌1, 张波1, 张冰1, 赵辰阳1, 王铭1   
  1. 1. 100730 中国医学科学院 北京协和医学院 北京协和医院超声诊断科
  • 收稿日期:2016-12-13 出版日期:2017-02-01
  • 通信作者: 姜玉新
  • 基金资助:
    国家自然科学基金(81301268); 北京市科技新星计划(Z131107000413063)

Prospective observation of early diagnosis and accurate diagnosis of invasive mole by transvaginal ultrasound

Na Su1, Yuxin Jiang1,(), Qing Dai1, Meng Yang1, Bo Zhang1, Bing Zhang1, Chenyang Zhao1, Ming Wang1   

  1. 1. Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2016-12-13 Published:2017-02-01
  • Corresponding author: Yuxin Jiang
  • About author:
    Corresponding author: Jiang Yuxin, Email:
引用本文:

苏娜, 姜玉新, 戴晴, 杨萌, 张波, 张冰, 赵辰阳, 王铭. 经阴道超声对侵蚀性葡萄胎的早期及精准诊断的预期观察[J/OL]. 中华医学超声杂志(电子版), 2017, 14(02): 99-104.

Na Su, Yuxin Jiang, Qing Dai, Meng Yang, Bo Zhang, Bing Zhang, Chenyang Zhao, Ming Wang. Prospective observation of early diagnosis and accurate diagnosis of invasive mole by transvaginal ultrasound[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(02): 99-104.

目的

深度探讨侵蚀性葡萄胎的超声声像图特点,观察有无特异性超声征象,旨在对侵蚀性葡萄胎的早期诊断及精准诊断提供更多诊断依据。

方法

对20例于2014年1月至2016年1月在北京协和医院经临床综合诊断确诊为侵蚀性葡萄胎的初治患者进行经阴道超声检查,全面观察超声动态图像,以期发现侵蚀性葡萄胎的早期超声声像图特点及特异性超声征象。

结果

经阴道超声在20例患者中发现4例直径<2.0 cm的病灶,表现为在葡萄胎清宫术后,子宫肌层内出现异常不均质回声,伴有局部血流信号明显增多紊乱;在8例患者子宫肌层病灶中观察到水肿绒毛的囊状无回声水泡结构。

结论

葡萄胎清宫术后,在子宫肌层内发现血流异常丰富区域有助于早期诊断侵蚀性葡萄胎。子宫肌层病灶中发现囊状无回声水泡结构有助于精准诊断侵蚀性葡萄胎,并可与绒毛膜癌相鉴别。

Objective

To explore the characteristics of sonographic patterns of invasive mole (IM), observe specific ultrasonic signs and provide more evidences for early and precise diagnosis of IM.

Methods

Twenty patients diagnosed with IM at the PUMC Hospital from 2014 January to 2016 January were evaluated by transvaginal ultrasonography. These sonographic dynamic images were observed comprehensively and carefully in order to discover the early ultrasound characteristics and specific ultrasonic representations of IM.

Results

It was indicated by transvaginal ultrasonography that there were myometrial lesions in 4 patients with diameters less than 2.0 cm, performing as heteroechoic lesions in myometrium with obviously increased and disorder blood flow signals after the curettage of uterine cavity. Meanwhile, the myometrial lesions of 8 patients showed hydropic fluid-filled molar vesicles, representing swollen villi.

Conclusions

After the curettage of uterine cavity, presentations of the myometrial lesions with abnormally rich blood flow contribute to early diagnosis of IM. And the patterns of myometrial hydropic fluid-filled molar vesicles can play an important role in the accurate diagnosis of IM, and may distinguish it from choriocarcinoma.

图1~4 侵蚀性葡萄胎患者经阴道灰阶及彩色多普勒超声声像图。患者26岁,葡萄胎2次清宫术后3 d,β-hCG值131.8 IU/L;图1,2灰阶超声声像图示子宫后壁中段肌层内直径约1.0 cm的异常中高回声,边界不清;图3,4彩色多普勒显示该处血流信号明显增多紊乱
图8~10 侵蚀性葡萄胎患者经阴道灰阶及彩色多普勒超声声像图。患者42岁,葡萄胎清宫术后近2个月,β-hCG测值升高7 d,为41000.2 IU/L,灰阶超声声像图示子宫宫底处肌层内直径约2.0 cm的异常混合回声,边界不清,其内可见裂隙状无回声(箭头所示),能量多普勒显示该处及周边肌层血流信号明显增多紊乱,无回声区域内亦充满血流信号,频谱多普勒示病灶边缘内可探及高速低阻动脉频谱,RI:0.25
图14~16 侵蚀性葡萄胎经阴道灰阶及彩色多普勒超声声像图。患者23岁,葡萄胎2次清宫术后2个月,β-hCG测值下降后又上升,为82814.6 IU/L,灰阶超声声像图示子宫左侧壁肌层内直径约5.0 cm的异常混合回声,边界不清,其内可见裂隙状无回声,另可见多个直径0.2~0.6 cm小囊状无回声水泡样结构(箭头所示),彩色多普勒示病灶区血流信号明显增多紊乱,囊泡状无回声内未见血流信号
图17~19 侵蚀性葡萄胎经阴道灰阶及彩色多普勒超声声像图。患者22岁,葡萄胎清宫术后58 d,血β-hCG测值持续高水平,为54352.6 IU/L,灰阶超声声像图示子宫宫底肌层内直径约3.5 cm的异常混合回声,边界不清,其内可见裂隙状无回声,另可见多个直径0.3~0.8 cm囊状无回声水泡样结构(箭头所示),彩色多普勒示病灶区血流信号明显增多紊乱,囊泡状无回声内未见血流信号
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