超声在剖宫产切口瘢痕妊娠中的临床价值

Application of ultrasound in surveillance of cesarean section scar pregnancy

目的:评价彩色多普勒超声检查在子宫下段剖宫产切口瘢痕妊娠诊断及治疗中的价值。方法:收集2006年1月至2007年12月本院住院的59例子宫下段剖宫产切口瘢痕妊娠患者的资料,分析其彩色多普勒超声图像特征,并追踪其临床转归、治疗及病理结果。结果:治疗前,59例患者中诊断为子宫下段剖宫产切口瘢痕妊娠者54例,初诊符合率为91.5%(另5例分别被诊断为剖宫产切口瘢痕妊娠可能、难免流产不能除外3例;剖宫产切口瘢痕妊娠可能、滋养细胞疾病不能除外1例;滋养细胞肿瘤1例)。38例患者采用氨甲蝶呤(MTX)保守治疗加超声监护下刮宫术,13例患者仅采用MTX保守治疗,6例患者采用米非司酮和米索前列醇治疗加超声监护下刮宫术,2例患者采用子宫前壁病灶切除术加子宫修补术治疗。结论:彩色多普勒超声检查可为子宫下段剖宫产切口瘢痕妊娠提供较准确的定位、定性诊断,有助于临床选择合适的治疗方案、估测患者的病程及转归。

Objective To evaluate the role of uhrasonography in the diagnosis and treatment of cesarean section scar pregnancy. Methods Patients with cesarean section scar pregnancy diagnosed and managed from 2006 to 2007 were enrolled. Color Doppler sonographic features, pathologic findings, clinical treatment, and follow up result were analyzed. Results Of the 59 patients 54 were diagnosed correctly before treatment, and the diagnostic accurate rate was 91.5%. Among the 59 patients with cesarean section scar pregnancy, 38 patients were treated with MTX and curratage with the help of ultrasound. 13 patients were treated with MTX solely, 6 patients were treated with mifepristone, misoprostol and curattage with the help of ultrasound. 2 patients were treated by local resection and repair. Conclusions Color Doppler uhrasonography may provide localization and qualitation diagnosis for cesarean section scar pregnancy, and is helpful for the selection of appropriate therapy, assessing the disease course and predicting prognosis.