目的·探讨超声检查诊断输卵管复合妊娠（fallopian tubal heterotopic pregnancy，THP）的临床价值。方法·选择2010年1月至2022年12月于上海交通大学医学院附属国际和平妇幼保健院出院诊断为异位妊娠的13 082例患者中疑似THP的88例孕妇作为研究对象，收集并分析其术前超声检查结果及临床资料，并按照接受超声检查时的孕龄将孕妇分为3组：孕≤38 d组、孕39~45 d组、孕46~73 d组。回顾性分析孕妇的THP发生率、妊娠结局，术前超声诊断的灵敏度、特异度，以及术后病理结果、出院诊断结果与术前超声诊断结果的一致性（即准确率），并采用受试者操作特征（receiver operating characteristic，ROC）曲线分析3组孕妇超声检查对THP诊断的价值。结果·在88例疑似THP病例中，72例经术后病理诊断或进一步超声检查证实为THP，其在13 082例异位妊娠患者中的发生率为0.5%。72例确诊THP患者术前超声检查图像可分为2种类型，其中Ⅰ型（孕囊型包块）占30.6%，Ⅱ型（低回声及混合回声包块）占69.4%。THP患者中行输卵管切除术者占54.2%，宫内妊娠活产率为59.7%。超声检查对THP诊断的总灵敏度、特异度、准确率分别为91.7%、81.3%、89.8%，3组间差异有统计学意义（均P<0.05）。孕≤38 d组的灵敏度、特异度与孕46~73 d组差异有统计学意义；该组的准确率与孕39~45 d组和孕46~73 d组差异也存在统计学意义（均P<0.05）。ROC曲线结果显示，超声检查对孕≤38 d组THP的诊断价值较低，但对孕39~45 d组和孕46~73 d组THP具有一定诊断价值。结论·超声检查对THP的诊断价值较高。超声诊断时的孕龄与确诊THP的灵敏度、特异度、准确率密切相关。应特别加强对孕龄大于46 d孕妇的超声检查以辅助THP的诊断。

Objective ·To assess the value of ultrasonography in the diagnosis of fallopian tubal heterotopic pregnancy (THP). Methods ·From January 2010 to December 2022, among the 13 082 cases of ectopic pregnancy diagnosed and discharged from the International Peace Maternity ＆Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 88 cases suspected of having THP were selected as the study objects. Pre-admission ultrasound images and clinic data from these cases were collected. Then these cases were divided into three groups according to their gestational age at the time of ultrasonography: Group Ⅰ, gestational age within 38 d; Group Ⅱ, gestational age of 39?45 d; Group Ⅲ, gestational age of 46?73 d. The incidence of THP, pregnancy outcomes, the sensitivity and specificity of ultrasound diagnostic results, and the consistency between postoperative pathological results, discharge diagnosis and preoperative ultrasound diagnosis results (i.e. accuracy) were retrospective analyzed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of ultrasonography for THP in these three groups. Results ·In all the ectopic pregnancy cases, 72 THP cases were confirmed by postoperative pathology or further ultrasonography. The incidence rate of THP was 0.5% among the 13 082 patients with ectopic pregnancy. There were two types of preoperative ultrasound images of these 72 THP cases: Type Ⅰ, echogenic mass in gestational sac, accounting for 30.6%; Type Ⅱ, hypoechoic and mixed echogenic mass, accounting for 69.4%. In addition, 54.2% of TPH patients underwent salpingectomy, and the intrauterine live birth rate in TPH patients was 59.7%. There were significant differences between groups in the overall sensitivity (91.7%), specificity (81.3%), and accuracy (89.8%) of ultrasonography in the diagnosis of THP (all P<0.05). Sensitivity and specificity in Group Ⅰ were significantly lower than those in Group Ⅲ; the accuracy of Group Ⅰ was significantly lower than that of Group Ⅱ and Group Ⅲ (all P<0.05). ROC curve analysis further showed that the diagnostic value of ultrasonography for THP was low for cases within 38 d of pregnancy, whereas for cases with gestational ages of 39?45 d and 46?73 d, ultrasonography demonstrated notable diagnostic value. Conclusion ·Ultrasonography has high diagnostic value for THP. The gestational age at the time of ultrasonography is closely related to the sensitivity, specificity, and accuracy of diagnosing THP. Special attention should be paid to ultrasonography for pregnant women with a gestational age over 46 d to assist in the diagnosis of THP.