剖宫产切口疤痕妊娠与宫颈妊娠的超声监测

Application of ultrasound in surveillance of cesarean section scar pregnancy and cervical pregnancy

目的:分析剖宫产切口疤痕妊娠与宫颈妊娠的超声声像变化特征,评价经阴道彩色多普勒超声在子宫下部异位妊娠诊治中的监测价值。方法:总结1995～2005年6月本院住院诊治的子宫下段剖宫产切口疤痕妊娠和宫颈妊娠病例,分析其彩色多普勒超声声像特征,追踪其临床转归及手术、病理结果。结果:剖宫产切口疤痕妊娠9例,宫颈妊娠5例,均由临床手术病理证实,根据经阴道彩色多普勒超声声像学特征分为4型:I型为胚胎存活型(5例),II型为胚胎停育有孕囊型(2例),III型为类滋养细胞疾病型(4例),IV型为绒毛退变型(3例)。I型全宫切除3例,保守治疗2例,II型2例均行全宫切除;III型全宫切除1例,经腹宫颈切开取绒毛术1例,余2例保守治疗;IV型均为保守治疗。结论:经阴道彩色多普勒超声对子宫下部异位妊娠能够提供较准确的定位定性诊断,正确的超声分型有助于临床选择合适的治疗方案,估计病程及转归。

Objective： To analyze the ultrasonic features of cesarean section scar and cervical pregnancies and to evaluate the diagnostic value of transvaginal color Doppler ultrasound for the diseases. Materials and Methods： Cases of cesarean scar and cervical pregnancy diagnosed and managed from 1995 to 2005 were included. Transvaginal color Doppler sonographic （TVS） findings, clinical treatments, pathologic results were followed up and analyzed. Results： Nine cesarean section scar pregnancies and five cervical pregnancies diagnosed with TVS were confirmed by surgery and pathological examination. All cases were classified into four subtypes according to their ultrasonic characteristics. Type Ⅰ： gestational sac with embryo alive（5 cases）. Type Ⅱ： gestational sac with demise embryo（2 cases）. Type Ⅲ： like trophoblastic disease（4 cases）. Type IV： villus degeneration（3 cases）. Three cases undertook hysterectomy and two cases received conservative management in type Ⅰ. Both cases of type Ⅱ undertook hysterectomy. In type Ⅲ, one underwent hysterectomy, villus was evacuated through cervical incision in one case and conservative management was applied in 2 cases. All cases of type IV had received conservative management. Conclusions： Transvaginal color Doppler ultrasound may give precise diagnosis for lower part of uterus pregnancies. The elassifieations according to the uhrasonographic features may direct the exact clinical therapy and to predict prognosis.