中文摘要：

目的总结子宫肌壁间妊娠超声图像特征及鉴别诊断要点。方法对2008年1月至2013年12月南方医科大学附属深圳市妇幼保健院收治的4例子宫肌壁间妊娠患者临床、超声分型表现及手术病理检查、临床诊治结果进行总结分析。结果 4例患者中1例早期超声诊断正确,3例超声误诊,手术及病理检查证实为子宫肌壁间妊娠后重新对超声图像予以分型。4例子宫肌壁间妊娠患者超声分型表现及临床诊治结果：（1）妊娠囊型2例,1例入院前超声显示子宫底后壁肌层内妊娠囊回声,与子宫腔不相通,与子宫内膜不相连接,妊娠囊四周肌层包绕,周边肌层内血管扩张、血流丰富,超声诊断为子宫底后壁肌壁间妊娠,经甲氨蝶呤保守治疗成功。另一例术前超声显示左侧子宫腔内妊娠囊回声,胚胎存活,误诊为子宫左侧宫内妊娠,清宫手术失败后再次超声检查显示子宫下段左侧后壁肌层内妊娠囊,胚胎存活,妊娠囊内缘与子宫内膜不相连接,四周肌层包绕;剖腹探查术后病理诊断为子宫下段左侧后壁肌壁间妊娠。（2）包块型1例,入院前超声显示子宫右侧宫角处混合回声包块,包块内缘紧贴子宫内膜,周边可见菲薄肌层包绕,包块内部及周边肌层血管扩张、血流丰富,超声误诊为子宫右侧宫角妊娠,宫腔镜及腹腔镜手术后病理诊断为子宫右侧宫角前壁肌壁间妊娠。（3）破裂型1例,入院前超声显示子宫后方偏右侧混合回声包块,包块紧贴子宫右后壁,与子宫肌层关系密切,盆腔内透声差的无回声区,超声误诊为右侧输卵管异位妊娠破裂,腹腔镜手术后病理诊断为子宫右侧后壁肌壁间妊娠。3例患者明确诊断后均经临床治愈。结论子宫肌壁间妊娠罕见,超声显示妊娠囊（或包块）位于子宫肌层内,与子宫腔不相通,与子宫内膜不相连接,四周由子宫肌层包绕,肌层内血管扩张、血流丰富者可提示为子宫肌?

英文摘要：

Objective To summarize ultrasound image features of intramural pregnancies and the key points of differential diagnosis.Methods From January 2008 to December 2013,four cases of intramural pregnancy found in Shenzhen Maternity Child Health Care Hospital Affi liated to Nangfang Medical University were enrolled,whose clinical data and ultrasound images were comparatively analyzed with surgical and pathological diagnosis results.Results In the four cases,one case was diagnosed correctly and three cases were misdiagnosed by ultrasound.After confi rmed by surgical and pathological diagnosis with intramural pregnancies,the preoperative ultrasound images of these cases were re-typing.Ultrasound image,diagnosis and treatment results of these four cases were as followed.（1） Gestational sac type（two cases）：the ultrasound image of one case showed a gestational sac in the posterior wall of the uterine fundus.The gestational sac was not connected with the uterine cavity and endometrium,but embeded into the myometrium.There was hemangiectasis and abundant boold flow in the surrounding myometrium.This case was diagnosed correctly as intramural pregnancy in posterior wall of the fundus and successfully treated conservatively with methotrexate.The ultrasound image of the other case showed a gestational sac in the left side of uterine cavity and the embryo survived.This case was misdiagnosed as left side intrauterine early pregnancy.Ultrasonography after curettage failure showed a gestational sac in the left posterior wall of the lower uterine segment and the embryo survived.The gestational sac was not connected with the uterine cavity and endometrium,but embeded into the myometrium.This case was treated by laparotomy and diagnosed as intramural pregnancy in the left posterior wall of the lower uterine segment by exploratory laparotomy and pathology.（2） Mass type（one case）：the ultrasound image showed a mixed mass in the right uterine horn.The mass was closed to uterine cavity and endometrium and embedded into th