经阴道彩色多普勒超声在诊断子宫瘢痕妊娠中的价值

Value of Transvaginal Color Doppler Ultrasound in Differential Diagnosis of Uterine Scar Pregnancy

目的研究经阴道彩色多普勒超声在诊断子宫瘢痕妊娠中的价值。方法选取2010年2月至2014年6月武汉市江夏区第一人民医院经过手术和病理证实的子宫瘢痕妊娠患者880例作为研究对象。观察患者超声诊断和超声声像图特点,研究经阴道超声对子宫瘢痕妊娠的诊断意义。结果采用经阴道超声共诊断832例切口妊娠,诊断准确率为94.6%,误诊48例,32例为宫颈部妊娠,16例为滋养细胞疾病,误诊率为5.4%。超声图像结果显示,880例患者的子宫前壁下段瘢痕处肌层均成呈楔形凹陷,272例(30.9%)患者表现出杂乱回声区;360例(40.9%)患者瘢痕处呈现不规则的无回声区;168例(19.1%)患者瘢痕处见妊娠囊回声,其中56例见卵黄囊和胚芽组织的回声,112例患者妊娠囊内见有卵黄囊。结论经阴道彩色多普勒超声检查清晰地显示患者子宫内部情况,有效提示妊娠囊和子宫切口之间的位置关系,确切观察到切口部位血流的特点,在早期对子宫切口妊娠进行定位和定性诊断,对临床诊断以及进一步治疗具有积极的作用,适合在临床上推广应用。

Objective To study the value of transvaginal color Doppler ultrasound in the differential diagnosis of uterine scar pregnancy. Methods Total of 880 patients with surgically and pathologically con- firmed uterine scar pregnancy from Feb. 2010 to Jun. 2014 in Jiangxia District First People＇s Hospital were included in the study. Characteristics of ultrasound diagnosis and sonography were observed, and the diagnos- tic significance of transvaginal ultrasound in uterine scar pregnancy was studied. Results Altogether 832 cases of incision pregnancy were diagnosed using transvaginal ultrasound, the diagnostic accuracy was 94. 55 %, and there were 48 cases of misdiagnosis,including 32 cases of cervical pregnancy and 16 cases of trophoblastic disease,with misdiagnosis rate of 5.45%. Ultrasound images showed that in the 880 patients, the myometrium in lower anterior uterine scars was in wedge-shaped depression. There were 272 （30.9%） patients showing a clutter echo area, 360 patients （40.9%） with irregular echo-free zone in scar, 168 patients （19. 1% ） with gestational sac echo in scar,56 cases with echo in yolk sac and embryo tissue and the other 112 patients with yolk sac in gestation sac. Conclusion Transvaginal color Doppler ultrasound exam＇mation can clearly display the internal situation in uterus,and effectively show the positional relationship between the gestational sac and uterine incision. In addition, characteristics of blood flow in incision position can also be observed, which is helpful to local and qualitative diagnosis of uterine incision pregnancy, playing a positive role in the clinical diagnosis and further treatment, thus is suitable for the clinical application.