彩色多普勒超声在子宫动脉化疗栓塞术治疗子宫瘢痕妊娠中的应用

Significance of color Doppler ultrasonography in the scar pregnancy treated with uterine arterial chemoembolization

目的:探讨彩色多普勒超声在子宫动脉栓塞术治疗子宫瘢痕妊娠中的应用价值。方法:回顾性分析彩色多普勒超声在30例子宫瘢痕妊娠患者子宫动脉化疗栓塞术前的诊断价值、对栓塞术后的疗效评价及超声引导下刮宫术及术后随访中的作用。结果:术前诊断:超声显示25例表现为子宫峡部包块型,5例表现为子宫峡部孕囊型;27例孕囊周边有较丰富的血流信号,25例阻力指数<0.5;峡部最薄处厚度(2.31±0.42)mm。子宫动脉栓塞术后24～72h超声表现:29例包块内或孕囊周边均未见明显血流信号,1例仍可见丰富血流信号,再次行子宫动脉栓塞术,24h后复查超声示病灶内血流消失。栓塞术后超声成功引导刮宫术,超声随访所有患者两个月内包块均消失,月经恢复。结论:超声既能准确诊断CSP又可对子宫动脉栓塞术后的疗效进行全面评价并引导清宫术及术后有效随访,值得进一步推广应用。

Obstract:To discuss the application value of color Doppler ultrasonography in the therapy for cesarean scar pregnancy treated with bilateral uterine arterial chemoembolization.Methods:Ultrasonographic data were retrospectively analyzed in thirty patients with cesarean scar pregnancy before and after uterine arterial chemoembolization,for evaluation of therapeutic efficiency,guiding uterine curettage operation and following-up.Results:Cesarean scar pregnancies were classfied into two types of asymettrical mass and embryo sac according to ultrasonic characteristics.The thickness of scar were(2.31±0.42)mm.25 cases had rich blood flow and lower resistance index(RI) before treatment.In 24~72h after bilateral uterine arterial chemoembolization,there were no blood flow signal in 29 cases while rich in one.In this case with rich blood flow,bilateral uterine arterial chemoembolization was performed once more.Ultrsound successly guided uterine curettage operation and followed up until disappearing of masses and restoring menstruation in all 30 cases.Conclusion:Color doppler ultrasound may precisely diagnose cesarean scar pregnancy and play an important role in evaluating the therapeutic effect of uterine arterial chemoembolization,guiding uterine curettage operation and following-up of these patients.