阴道内超声诊断剖宫产切口瘢痕处妊娠26例

Diagnosis of 26 cases with cesarean scar pregnancy by transvaginal endosonography

目的对经阴道超声诊断子宫下段剖宫产切口瘢痕处妊娠（CSP）进行总结分析,探讨阴道内超声诊断CSP的特点和意义。方法用彩色多普勒超声诊断仪腔内探头对患者行经阴道扫查。结果 26例患者妊娠囊均着床在子宫下段切口处,彩色多普勒血流成像（CDFI）显示滋养血流来自切口部位。子宫轻度增大18例、无增大8例。24例患者宫腔内无异常回声改变、2例宫腔内可见不均质高回声。14例表现为子宫前壁峡部切口处单纯孕囊,子宫浆膜层与孕囊之间肌层部分缺如;12例表现为不均质团块型,子宫下段内膜形态失常,切口处肌层菲薄,其中10例子宫下段非均质病灶区内及周边均见丰富的血流信号,并可见五彩状血流,阻力指数（RI）为0.28~0.55。结论经阴道内彩超在早期诊断CSP方面有确诊率高的优点,可作为首选方法。

Objective To analyze the patients with lower uterine segment cesarean scar pregnancy（CSP） diagnosed by transvaginal ultrasound, and to explore the ultrasonic characteristics of CSP. Methods Color Doppler ultrasonography was used to perform transvaginal ultrasound diagnosis in 26 cases. Results 26 patients had gestational sac implantation in the lower uterine segment incision. CDFI displayed the trophoblast blood from the surgical incision site. Uterus slightly increased in 18 cases, and did not increase in 8 cases. 24 cases had no abnormal echoes in the uterus, and 2 cases had heterogeneou high echoes. 14 cases showed gestational sac alone in anterior uterine isthmus cesarean incision site, and partial deletion of the muscular layer between gestational sac and uterine serosa layer. 12 cases showed heterogeneous masses, with abnormal morphology of the lower uterine segment and very thin wall in the incision site. Among the 12 cases, 10 cases showed rich blood flow signals in the heterogeneous lesion and its surroundings. The resistance index（RI） was 0.28-0.55. Conclusion Transvaginal endosonography can be used as the preferred method in the early diagnosis of CSP.