经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值

Clinical value of transvaginal color Doppler ultrasonography in the diagnosis of cesarean scar pregnancy

目的探讨经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠(CSP)的临床价值。方法收集2012年10月至2014年10月沈阳市妇婴医院收治的64例经阴道超声诊断为剖宫产切口瘢痕妊娠患者的影像及临床资料,分析其超声声像图特征及与临床结局的关系。结果超声诊断为CSP的64例患者中59例(92.2%)经病理证实,5例为难免流产。根据超声声像图特征将59例CSP分为2型:孕囊型(41例)和混合回声型(18例)。孕囊型分为3个亚型:I型妊娠囊边缘位于切口处(24例),Ⅱ型妊娠囊陷入切口内(15例),Ⅲ型妊娠囊向膀胱方向凸出(2例)。I型治疗以宫腔镜为主,Ⅱ型、Ⅲ型及混合回声型治疗以腹腔镜为主。结论经阴道彩色多普勒超声为诊断CSP的有效方法,正确的超声分型及对切口瘢痕厚度的准确测量有助于临床医生选择更加适合患者的个体化治疗方案。

Objective To explore the clinical value of transvaginal color Doppler ultrasonography in the diagnosis of ce- sarean scar pregnancy （CSP）. Methods The imaging and clinical data of 64 cases of CSP diagnosed by transvaginal ul- trasound between October 2012 and October 2014 in Shenyang Women and Children＇ s Hospital were collected to ana- lyze the correlation between uhrasonographic features and clinical outcomes.Results Among the 64 cases, 59 cases （92.2%） were CSP proved by pathology and 5 cases were inevitable abortion. Based on ultrasonographic features, 59 cas- es of CSP were divided into 2 types （41 cases of gestational sac type and 18 cases of mixed echo type）. Forty-one cases of gestational sac type were divided into 3 subtypes. The first subtype （24 cases） was gestational sac edge located in the incision. The second subtype （15 cases） was gestationa] sac fully implanted in the incision. The third subtype （2 cases） was gestational sac protruding into the bladder direction. Cases of the first subtype were treated by hysteroscopy mainly. The second, third subtypes and the mixed echo type were treated by laparoscopy mainly.Conclusion Transvaginal color Doppler ultrasonography is an effective method in the diagnosis of CSP. Correct uhrasound typing and accurate scar thickness measurement may contribute to selecting the individualized treatment.