输卵管异位妊娠的超声和生化标志物与后续治疗成功之间的关系。

Relationship Between Ultrasonographic and Biochemical Markers of Tubal Ectopic Pregnancy and Success of Subsequent Management.

作者信息

Nadim Batool, Lu Chuan, Infante Fernando, Reid Shannon, Condous George

机构信息

Acute Gynecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.

Department of Computer Sciences, Aberystwyth University, Aberystwyth, Wales.

出版信息

J Ultrasound Med. 2018 Dec;37(12):2899-2907. doi: 10.1002/jum.14652. Epub 2018 Apr 20.

DOI:10.1002/jum.14652

PMID:29675930

Abstract

OBJECTIVES

To determine whether there is an association between morphologic types of tubal ectopic pregnancy (EP), 0-hour human chorionic gonadotropin (hCG) levels, and subsequent management success.

METHODS

We conducted a prospective study (November 2006-December 2015). Women had a diagnosis of EP by transvaginal ultrasonography if they had an inhomogeneous mass adjacent to the ovary and moving separately from it ("blob" sign), a mass with a hyperechoic ring around the gestational sac ("bagel" sign), or a gestational sac with an embryonic pole with or without a yolk sac with or without cardiac activity. The morphologic type, EP size, and 0-hour hCG level were analyzed. A multivariate analysis determined any correlation between these variables and nonsurgical management success.

RESULTS

A total of 7350 consecutive women underwent transvaginal ultrasonography, of whom 301 (4.2%) had a diagnosis of tubal EP; 181 (60.1%) had the blob sign; 90 (29.9%) had the bagel sign; and 23 (7.6%) were noted to have an embryo (14 viable and 9 nonviable). Eighty-three of 301(27.5%) women had expectant management; 67 of 301(22.2%) were given methotrexate; and 151 of 301 (50%) had surgery. Success rates for the groups were 77%, 75%, and 100%, respectively. No difference between the morphologic type and success rate of treatment was noted. Although there was a significant correlation between the EP mass size and 0-hour hCG level, the mass size itself was not correlated with the success rate of either medical or expectant management. Overall higher 0-hour hCG levels were associated with management failure. In the expectant group, median hCG level for failure was 589 IU/L versus 366 IU/L for success, whereas in the medical group, the median for failure was 1244 IU/L versus 7629 IU/L for success.

CONCLUSIONS

There is no significant correlation between the morphologic type and size of EP with a nonsurgical management outcome. A likely successful outcome is related to a lower level of serum hCG at presentation.

摘要

目的

确定输卵管异位妊娠（EP）的形态学类型、0小时人绒毛膜促性腺激素（hCG）水平与后续治疗成功率之间是否存在关联。

方法

我们进行了一项前瞻性研究（2006年11月至2015年12月）。如果女性经阴道超声检查发现卵巢旁有不均匀包块且与卵巢分开移动（“斑点”征）、妊娠囊周围有高回声环的包块（“百吉饼”征）或有胎芽（有或无卵黄囊、有或无心脏活动）的妊娠囊，则诊断为EP。分析其形态学类型、EP大小和0小时hCG水平。多因素分析确定这些变量与非手术治疗成功率之间的相关性。

结果

共有7350名连续女性接受经阴道超声检查，其中301名（4.2%）诊断为输卵管EP；181名（60.1%）有“斑点”征；90名（29.9%）有“百吉饼”征；23名（7.6%）发现有胚胎（14名存活，9名未存活）。301名女性中有83名（27.5%）接受期待治疗；301名中有67名（22.2%）给予甲氨蝶呤治疗；301名中有151名（50%）接受手术治疗。各组的成功率分别为77%、75%和100%。未发现形态学类型与治疗成功率之间存在差异。虽然EP包块大小与0小时hCG水平之间存在显著相关性，但包块大小本身与药物治疗或期待治疗的成功率均无相关性。总体而言，较高的0小时hCG水平与治疗失败相关。在期待治疗组中，失败组的hCG水平中位数为589 IU/L，成功组为366 IU/L；而在药物治疗组中，失败组的中位数为1244 IU/L，成功组为7629 IU/L。