超声在剖宫产切口瘢痕妊娠早期诊断及介入治疗中的应用

Application of ultrasonography in the early diagnosis and interventional therapy of cesarean scar pregnancy

目的探讨彩色多普勒超声在子宫下段剖宫产切口瘢痕妊娠早期诊断及介入治疗中的应用。方法对本院收治的15例子宫下段剖宫产切口瘢痕妊娠患者进行彩色多普勒超声检查,确诊后行经阴道超声引导下孕囊穿刺注射甲氨蝶呤治疗,术后动态观察孕囊变化。结果 15例子宫下段剖宫产切口瘢痕妊娠均为胎囊型,孕囊形态结构完整,孕囊前有子宫壁肌层完整覆盖,彩色多普勒示孕囊周边呈较丰富环状血流信号;15例确诊后行经阴道超声引导下孕囊穿刺注射甲氨蝶呤均一次性成功,治愈率为100%;穿刺治疗后孕囊逐渐变小,随后脱落或被吸收,血β-HCG逐渐下降至正常。结论经阴道彩色多普勒超声能早期确诊子宫下段剖宫产切口瘢痕妊娠,还可行超声引导下孕囊穿刺治疗及术后动态观察,值得临床推广应用。

Objective To explore the application value of color doppler ultrasonography in the early diagnosis and interventional therapy of cesarean scar pregnancy （CSP） of lower uterus. Methods Fifteen CSP cases admitted into our hospital received examination of color doppler ultrasonography, and were treated with methotrexate （MTX） injection via centesis of gestational sac under transvaginal sonography guidance. The changes of gestational sac were observed dynamically after operation. Results All of the 15 CSP cases weregestational sac - type. The form and structure of the gestational sacs were intact, which were covered fully by the muscular layer of uterine incision. The gestational sacs became smaller gradually, and fell off or were absorbed after treatment with MTX injection only 1 time via centesis, and β- hCG in blood went down to normal gradually. Its cure rate was 100%. Conclusion CSP of lower uterus can be diagnosed accurately early by transvaginal color doppler ultrasonography. It can also be treated via centesis of gestational sac under ultrasonography guidance and be observed dynamically after operation, which is highly valuable in clinical diagnosis and treatment.