Atri Mostafa, Valenti David A, Bret Patrice M, Gillett Peter
Department of Radiology, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada.
J Clin Ultrasound. 2003 Jan;31(1):1-8. doi: 10.1002/jcu.10131.
Our purpose was to determine the effect of transvaginal sonography (TVS) on the diagnostic evaluation of patients with suspected ectopic pregnancy (EP). Specifically, we wished to determine what effect TVS had on the use of invasive procedures.
This was a retrospective review of the medical records of 290 patients with a surgically documented diagnosis of EP. It included 147 consecutive patients from the era of use of suprapubic sonography (SPS) (1982-1987) and 143 consecutive patients from the era of use of TVS (1987-1995). We compared the percentages of patients who had undergone sonographic examinations, the rates of use of the invasive procedures dilatation and curettage (D&C) and diagnostic laparoscopy (DL), time from presentation to diagnosis, necessity for transfusion, status of EP at surgery, and various other characteristics of the patients (eg, demographics, serum level of beta human chorionic gonadotropin, and presenting symptoms).
In the SPS era, 46.9% of the patients had undergone sonography, compared with 78.3% in the TVS era (p = 0.001). Sonographic sensitivity was 60.9% in the SPS era and 93.8% in the TVS era (p = 0.001). D&C was performed in 53.1% and DL in 76.2% of patients in the SPS era, compared with 14.0% and 30.8%, respectively, in the TVS era (p = 0.001). In the last full year of the study, only 9% of the patients had undergone D&C and 9%, DL. The overall time from presentation to diagnosis significantly decreased from 45.6 hours in the SPS era to 16.8 hours in the TVS era (p = 0.002). We found no significant difference between the 2 eras in the need for transfusion and the percentage of ruptured EPs at surgery (p > 0.05).
The introduction of TVS has had an important effect on the evaluation of patients with EP by nearly eliminating the need for D&C and DL and permitting clinicians to take a more conservative approach to managing EP.
我们的目的是确定经阴道超声检查（TVS）对疑似异位妊娠（EP）患者诊断评估的影响。具体而言，我们希望确定TVS对侵入性检查使用的影响。
这是一项对290例经手术确诊为EP患者的病历进行的回顾性研究。其中包括147例耻骨上超声检查（SPS）时代（1982 - 1987年）的连续患者和143例TVS时代（1987 - 1995年）的连续患者。我们比较了接受超声检查的患者百分比、侵入性检查刮宫术（D&C）和诊断性腹腔镜检查（DL）的使用率、从就诊到诊断的时间、输血必要性、手术时EP的状况以及患者的各种其他特征（如人口统计学、β-人绒毛膜促性腺激素血清水平和就诊症状）。
在SPS时代，46.9%的患者接受了超声检查，而在TVS时代这一比例为78.3%（p = 0.001）。超声检查的敏感性在SPS时代为60.9%，在TVS时代为93.8%（p = 0.001）。在SPS时代，53.1%的患者进行了D&C，76.2%的患者进行了DL，而在TVS时代，这两个比例分别为14.0%和30.8%（p = 0.001）。在研究的最后一整年中，只有9%的患者进行了D&C，9%的患者进行了DL。从就诊到诊断的总时间从SPS时代的45.6小时显著缩短至TVS时代的16.8小时（p = 0.002）。我们发现两个时代在输血必要性和手术时破裂EP的百分比方面没有显著差异（p > 0.05）。
TVS的引入对EP患者的评估产生了重要影响，几乎消除了对D&C和DL的需求，并使临床医生能够采取更保守的方法来管理EP。
