超声对剖宫产瘢痕妊娠的诊断价值

Value of sonography in the diagnosis of caesarean scar pregnancy

目的探讨超声在剖宫产瘢痕妊娠诊断与治疗中的价值。方法回顾性分析83例经手术及病理证实的剖宫产瘢痕妊娠病例，总结其主要临床表现、超声特点及超声辅助的治疗方法。结果在83例剖宫产瘢痕妊娠病例中，根据其超声图像特点分为三型：瘢痕处肌层内孕囊型（35例）、瘢痕处及宫腔内孕囊型（13例）、包块型（35例）。前两型的主要临床表现为停经后不规则阴道出血（分别为60．0％和61．5％），包块型的主要临床表现为清宫术或药物治疗后持续性阴道出血或血β-HCG水平异常（82．9％）。83例中通过超声检查正确诊断为剖宫产瘢痕妊娠者71例，诊断符合率为85．5％。13例瘢痕处肌层内孕囊型、11例瘢痕处及宫腔内孕囊型和2例包块型的患者采用经腹超声监测下清宫术治疗；2例瘢痕处肌层内孕囊型、1例瘢痕处及宫腔内孕囊型和5例包块型的患者采用经腹超声引导下病灶局部注射甲氨蝶呤治疗。结论超声对剖宫产瘢痕妊娠的诊断具有重要临床意义，在选择治疗方案、指导治疗及治疗后随诊方面起到重要作用。

Objective To explore the efficacy of sonography in the diagnosis and treatment of caesarean scar pregnancy. Methods Eighty-three patients with caesarean scar pregnancy confirmed by surgery and pathology were reviewed retrospectively, and their clinical features, sonographic appearances, and sonographic assistant treatment were analyzed. Results Eighty-three patients were classified into three types：the first type included 35 patients with gestational sac implanted in the caesarean scar, the second type included 13 patients in which the gestational sac mostly located at the uterine cavity and only the inferior part implanted in the caesarean scar, and the third type included 35 patients with abnormal sonographic mass. The main clinical features for the former two types （60.0% and 61.5%） were amenorrhea and vaginal bleeding,and most patients in the third type （82.9%） were presented with vaginal bleeding or abnormal level in serum β-HCG after dilation and curettage or systemic methotrexate （MTX） injection. Among them, 71 patients （85.5%） were diagnosed accurately by sonography. Thirteen patients of the first type, 11 patients of the second type and 2 patients of the third type underwent suction curettage with the sonographic guidance; and 2 patients of the first type, 1 patients of the second type and 5 patients of the third type received intra-amniotic administration of MTX under sonographic guidance. Conclusions Sonography is valuable for the diagnosis and treatment of caesarean scar pregnancy, and it also has an important role in therapies of suction curettage and local MTX injection.