经阴道超声对子宫瘢痕妊娠的早期诊断

Early Diagnosis of Cesarean Scars Pregnancy Using Transvaginal Ultrasonography

目的分析剖宫产术后子宫瘢痕妊娠(CSP)的超声图像特征,探讨经阴道超声对CSP的早期诊断价值。资料与方法回顾性分析经病理证实的32例CSP患者的经阴道超声图像特征,观察包块的位置及其与子宫切口的关系、包块与切口的回声及血流情况。结果 32例经阴道超声检查均提示妊娠异常,其中27例(84.38%)明确提示CSP。早期CSP的超声图像特征为:①宫腔正常部位未见孕囊;②子宫下段切口可见囊性或混合性包块;③包块部位子宫肌层连续性中断,呈楔形凹陷或变薄;④包块位于宫颈内口上方,宫颈回声正常、内外口闭合;⑤彩色多普勒血流显像示包块内及其周边可见少许点状或丰富血流信号。结论①②的超声图像特征是妊娠异常的诊断前提,③④的图像特征是早期超声诊断CSP的关键。彩色多普勒血流显像对CSP的鉴别诊断有帮助。

Purpose To analyze the ultrasound image features of uterine cesarean scars pregnancy（CSP）,and to evaluate the early diagnostic value of transvaginal ultrasonography in CSP.Materials and Methods Thirty-two patients with CSP proved by pathology underwent transvaginal ultrasonography.Image features of transvaginal ultrasonography were analyzed including the position of the gestational sac or mass and its relationship with the incision,echo and the blood flow of the mass and incision.Results Thirty-two cases of CSP were indicated with abnormal gestation by ultrasound,and 27 cases were proved by pathology.Early CSP had the following ultrasound imaging features：① no pregnant sac was found in the exact part of uterine cavity;② abnormal cystic or mixed masses were seen at the uterine incision site;③ the myometrial discontinuity was found with wedge-shaped concavity or thinning;④ mass was located above the internal cervical os,the internal cervical os was normal,internal and external cervical os was closed;⑤ color Doppler flow imaging（CDFI） showed some spot or rich blood flow signal in and around the mass.Conclusion Ultrasonic image features of ①② are the premise of diagnosing abnormal pregnancy,③④ are the key of diagnosing early CSP.CDFI is helpful for differential diagnosis of CSP.