超声在剖宫产瘢痕妊娠中的应用

Value of Sonography in the Diagmosis of Caesarean Scar Pregnany

目的:探讨超声在剖宫产瘢痕妊娠诊断的价值。方法:回顾性分析166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166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(70例),瘢痕处及宫腔内孕囊型(26例)、包块型(70例)。前两型的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-HCG水平异常(82.9%)。166例中通过超声检查正确诊断为剖宫产瘢痕妊娠者142例,诊断符合率为85.5%。26例瘢痕处肌层内孕囊型、22例瘢痕处及宫腔内孕囊型和4例包块型的患者采用经腹超声监测下清宫术治疗;4例瘢痕处肌层内孕囊型、2例瘢痕处及宫腔内孕囊型和10例包块型的患者采用经腹超声引导下的病灶局部注射氨甲蝶呤治疗。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 rhe diangnosis and treatment of caesaean scar pregnancy.Methods：166 patients with caesarean scar pregnancy confirmed by surgery and pathology were reviewde retrospectively,and their clinical features,sonographic appearances,and sonographic assistant treatment were analyzed.Results：166 patients were classified into three types： the first type included 70 patients with gestational sac implanted in the caesarean scar,the second type included 26 patients in which the gestational sac mostly located at the uterine cavity and only the infeior part implanted in the caesarean scar,and the third type included 70 patients with abnormal sonographic mass.The main clinical features for the former two types（60.0%and 61.5%）were amenorhea and vaginal bleeding,and most patients in the third type（82.9%）were presented with vaginal bleeding or abnormal level in serum-HCG after dilation and curettage or systemic methotrexate（MTX）injection.Among them,142 patients（85.5%） wsere diagnosed accurately by sonography.Thirteen patients of the first type,22 patients of the second type and 4 patients of the third type underwent suction curettage with the sonographic guidance;and 4 patients of the first type,2 patients of the aecond type and 10 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.