超声显示的剖宫产后子宫切口瘢痕处回声结构的分析

Analysis of the Echoic Structure in Cesarean Section Scars

目的:探讨剖宫产后切口瘢痕处超声显示的回声结构在子宫切口瘢痕缺损和子宫切口瘢痕妊娠诊断中的临床意义。方法:经阴道超声加彩色多普勒超声采集227例有剖宫产史者子宫下段前壁峡部肌层处的声像图,判断子宫切口瘢痕处回声结构与子宫切口瘢痕缺损和子宫切口瘢痕妊娠之间的相互关系,并以50例无剖宫产史月经正常者为对照。结果:227例有剖宫产史者中,切口愈合不良、月经淋漓不净者87例,切口愈合良好、月经淋漓不净者56例,切口愈合良好、月经正常者53例,切口瘢痕妊娠者31例。超声显示子宫切口愈合不良者子宫下段前壁峡部肌层低回声区部分连续中断,肌层变薄,原切口处由黏膜层向浆膜层呈不同程度的无回声楔形凹陷缺损;切口瘢痕妊娠者子宫下段前壁峡部肌层低回声区明显变薄,甚至消失,以似环状高回声为主,内伴有无回声、低回声等紊乱回声,且瘢痕处似环状高回声周围肌层血流丰富,血流Doppler中阻力指数低。结论:经阴道超声加彩色多普勒超声可以清楚显示剖宫产后子宫切口瘢痕处的回声特征,有助于早期诊断剖宫产后切口瘢痕妊娠及判断剖宫产后月经淋漓不净的原因。

Objective：To evaluate the clinical significance of the ultrasound echo texture of the cesarean scars in the diagnosis of the cesarean scar pregnancy and the uterine scar defects. Methods：The ultrasonographic features of the isthmus of the uterine lower anterior wall in 227 women with history of cesarean section were analyzed with transvaginal ultrasound plus color Doppler ultrasound. The relation of the echo structure of the uterine incision scars with uterine scar defects and uterine cesarean scar pregnancy were analyzed. A total of 50 healthy women with normal menstrual history without cesarean section were enrolled as controls. Results： In 227 women with history of cesarean section, 87 cases had poor healing of incisions with postmenstrual spotting; 56 cases had good healing of incisions with postmenstrual spotting;53 cases had good healing of incisions with normal menstrual cycle; 31 cases had cesarean scar pregnancy. The ultrasonography showed that the myometrium of the lower uterine segment anterior wall was hypoechoic, with continuous interrupting in some areas and thinning myometrium in women with incisions of poor healing and at original incisions. There were anechoic wedge defects in varying degrees in mucosa protruding to serosa. The low echo of the uterine anterior isthmus wall was significantly thin, and it even disappeared and showed ring like hyperechoie area, with anechoic area and hypoechoic area or achoic area and abundant blood flow and low Doppler resistant index in women with cesarean scar pregnancy. Conclusions： Transvaginal ultrasound plus color Doppler ultrasound can clearly show the ultrasound characteristics of the uterine cesarean section scars, contributing to the diagnosis of cesarean scar pregnancy and the determination of the reasons of postmenstrual spotting after cesarean section.