不同途径彩色多普勒超声诊断剖宫产瘢痕妊娠44例比较分析

Evaluation of Different Approaches of Color Doppler Ultrasonography in Diagnosis of Caesarean Scar Pregnancy

目的:探讨3种不同途径的彩色多普勒超声诊断方法对剖宫产瘢痕妊娠(CSP)诊断的准确性。方法:选择2009年1月至2013年12月,泰山医学院附属医院以及泰安市中心医院共收治经临床以及术后病理证实的CSP患者44例,根据彩色多普勒超声的不同途径分为经腹组(13例)、经阴道组(17例)、经腹联合经阴道组(14例),比较3组的诊断准确率和误诊率,以及误诊导致的误治情况。结果:1经腹组诊断准确8例(61.5%),误诊5例(38.5%);经阴道组诊断准确13例(76.5%),误诊4例(23.5%),经腹联合经阴道组诊断准确13例(92.9%),误诊1例(7.1%)。210例误诊患者中,经腹组误诊为稽留流产的3例患者以及经阴道组误诊为稽留流产的1例患者口服戊酸雌二醇后行负压吸引术时发生大出血,其中3例术后给予纱条填塞宫腔压迫方止血,另1例因出血难以控制中转开腹行局部病灶切除术加子宫修补术。经腹组误诊为宫颈妊娠的2例患者,经阴道组误诊为宫颈妊娠的3例患者以及经腹部联合阴道组误诊为宫颈妊娠的1例患者均行子宫动脉栓塞术并动脉内注射甲氨蝶呤,然后行负压吸引术,方治疗成功。结论:经腹联合经阴道彩色多普勒超声检查较经腹及经阴道彩色多普勒超声检查的诊断准确率高,而误诊率最低,推荐临床上选择经腹联合经阴道彩色多普勒超声检查作为诊断CSP检查方法。

Objective ：Taccuracy evaluate 3 approaches of Color Doppler Ultrasonography in diagnosis of caesarean scar pregnancy. Methods ：44 cases with cesarean scar pregnancy ,who were admitted to affiliated Hospital of Taishan Medical University and the Central Hospital of Taian City in the period June 2009 and June 2013, were examined with trans-abdominal ultrasound （ 13 cases）, trans-vaginal ultrasound （ 17 cases）, or trans-abdominal together with trans-vaginal ultrasound（ 14 cases）. The treatment and clinical outcomes also were analyzed retrospectively. Results：①ln 13 cases with trans-abdominal ultrasound,8 were diagnosed correctly（61.5% ）and 5 were misdiagnosed（38.5%）. In 17 cases with trans-vaginal ultrasound,13 were diagnosed correctly（76.5% ）and 4 were misdiagnosed （23.5%）. In 14 cases with trans-abdominal together with trans-vaginal ultrasound,13 were diagnosed correctly（92.9% ）and 1 were misdiagnosed（7. 1%）. ②ln 10 cases with misdiagnosis,3 who misdiagnosed as missed abortion by trans-abdominal ultrasound and 1 who misdiagnosed as missed abortion by trans-vaginal ultrasound received uterus curettage after oral estradiol valerate. 2 cases who misdiagnosed as cervical pregnancy by trans-abdominal ultrasound,3 who misdiagnosed as cervical pregnancy by trans-vaginal ultrasound and 1 who misdiagnose as cervical pregnancy by trans-abdominal together with trans-vaginal ultrasound received uterine artery embolisation with arterial injection MTX,and artificial abortion-vacuum aspiration. Conclusions.The trans-abdominal together with trans-vaginal ultrasound had a higher diagnosis accuracy and a lower misdiagnosis rate of caesarean scar pregnancy than trans-abdominal ultrasound or trans-vaginal ultrasound. We recommend trans-abdominal together with trans-vagihal ultrasound in the diagnosis of cesarean scar pregnancy.