经腹部超声及经阴道超声对剖宫产术后瘢痕妊娠的诊断价值

Diagnostic Value of Transabdominal Ultrasound and Transvaginal Ultrasound in Cesarean Scar Pregnancy

目的:探讨经腹部超声与经阴道超声检查在剖宫产术后瘢痕妊娠(CSP)诊断中的价值。方法:CSP患者70例,分别采用单纯经腹部超声、单纯经阴道超声或两种方法联合的方式诊断CSP,以病理检查结果为标准,比较3种检查方法对CSP的诊断符合率、准确性和特异性,同时观察治疗前不同类型CSP阴道超声的影像学特征、比较治疗前后CSP患者瘢痕长度和宽度、子宫前壁下段肌层厚度和阻力指数(RI)值变化。结果:70例患者中有58例经病理检查诊断为CSP,经腹部联合经阴道超声检查对CSP诊断的敏感性、特异性最高,高于经腹超声检查(P<0.05),但与经阴道超声检查比较,差异无统计学意义(P>0.05);经阴道超声检查对CSP诊断符合率、敏感性和特异性均高于经腹超声(P<0.05);经阴道超声示,58例CSP患者有孕囊型36例(69.23%),不均质包块型18例(20.69%),混合型4例(6.90%);治疗前后CSP瘢痕长径和宽径比较,差异无统计学意义(P>0.05);与治疗前比较,治疗后子宫前壁下段肌层厚度增加,病灶周围血流信号减少,RI值增大(P<0.05)。结论:经腹超声联合经阴道超声检查对于CSP的诊断准确性更高。

Objective： To discuss the diagnostic value of transabdominal ultrasound and transvagntal ultrasound in cesarean scar pregnancy（CSP）. Methods： 70 eases of CSP patients were diagnosed by simple transabdominal ultrasound or simple transvaginal ultrasound respectively or combination of the two methods. The diagnostic accordance rate, accuracy and specificity of the 3 methods for the diagno- sis of CSP were compared with the results of pathological examination. The imaging features of different types of CSP vaginal ultrasound before treatment were observed, and the scar length and width, the thickness of the anterior myometrium and the resistance index （RI） of the lower anterior wall were compared before and after treatment in CSP patients. Results： Among the 70 patients, 58 patients were diagnosed as CSP by pathological examination, and the sensitivity and specificity of transabdomi- hal combined transvaginal ultrasonography in the diagnosis of CSP were higher than those of transab- dominal uhrasonography（P 〈 0.05 ）. But compared with transvaginal ultrasonography, the difference was not statistically significant （ P 〉 0.05 ）. The diagnostic accuracy, sensitivity and specificity of transvaginal uhrasonography in CSP were higher than those of transabdominal ultrasound （ P 〈0. 05 ）. Transvaginal sonography showed that 58 patients with CSP had gestational sac type in 36 cases （69.23%） , heterogeneous masses in 18 cases （20.69%） and mixed type in 4 cases （6.90%）. The length, diameter and width of CSP scar were compared, and the difference was not statistically signifi- cant before and after treatment（P 〉0.05）. Compared with before the treatment, the thickness of the myometrium in the lower anterior wall of the uterus increased, the blood flow signals around the lesion decreased, and RI value increased after treatment （ P 〈 0.05 ）. Conclusion： Transabdominal ultra- sound combined with transvaginal ultrasonography is more accurate in the diagnosis of CSP.