三维彩超在评估剖宫产后子宫瘢痕部位妊娠中的应用

Application of three dimensional color Doppler in the evaluation of cesarean scar pregnancy

目的:探讨三维超声及三维彩色能量多普勒超声(3D-CPA)对子宫瘢痕部位妊娠(CSP)的诊疗价值。方法 :CSP患者共128例,经阴道三维超声观察病灶大小、残余肌层厚度,3D-CPA获取血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)三个参数。根据临床处理方式的不同分为两组,一组直接超声监视下清宫,观察上述参数与术中出血量的关系;另一组行术前预处理(UAE或MTX治疗)后清宫,分析预处理前后几个参数的变化及与术中出血量的关系。结果:直接行超声监视下清宫术者,出血量≥200 mL与出血量<200 mL两组间,病灶大小、VI和VFI值有显著差异。行预处理后,VI、VFI值明显低于预处理前,差异有统计学意义,预处理后清宫过程中出血量多少与病灶大小、残余肌层厚度、VI及VFI值相关。结论:应用三维超声可清晰、全面的显示出病灶及其与周围组织的关系,应用3D-CPA技术可以定量检测病灶的血流灌注情况,与清宫术中的出血量有显著的相关性。

Objective： To investigate the value of three-dimensional ultrasound and three-dimensional color power Doppler ultrasound（3D-CPA） in cesarean scar pregnancy（CSP）. Methods： One hundred and twenty-eight CSP patients were analyzed, the size of lesions, the thickness of the residual musclar thickness were observed by transvaginal three-dimensional ultrasound. 3D-CPA were used to get vascular index（VI）, flow index（FI）, blood vessels and blood flow index（VFI）. According to the difference of clinical treatment, the patients were divided into two groups, one group was treated with dilatation and curettage without pretreatment, the other one was treated with pretreatment（UAE or MTX） and then with dilatation and curettage. The relationship between the above parameters and the amount of bleeding was observed. Results： The group which directly undergo dilatation and curettage： the size of lesions, VI and VFI have significant differences between the two groups（bleeding volume≥200 mL group or 〈200 mL group）. After pretreatment, VI and VFI were significantly lower than that before pretreatment, the differences were statistically significant, and the hemorrhage risk of dilatation and curettage after the pretreatment was related to the lesion size, residual muscle thickness, VI and VFI. Conclusion： The application of three-dimensional ultrasound can show the relationship between the lesion and peripheral tissue clearly and comprehensively, 3D-CPA technology can quantitatively analyze the perfusion in lesion, which was significantly correlated with the amount of bleeding during operation.