经阴道三维超声及其断层成像技术对剖宫产瘢痕妊娠的鉴别诊断

Diagnosis value of three-dimensional ultrasound and tomography for cesarean scar pregnancy

目的探讨经阴道三维超声及其断层成像技术对剖宫产瘢痕妊娠(CSP)的鉴别诊断价值。方法将58例清宫或宫/腹腔镜术后病理证实为CSP的患者纳入研究,了解其超声检查方法,分析其二维、经阴道三维超声及断层成像的声像图特征。所有超声检查均与病理诊断对照。结果 58例CSP患者中,经腹超声检查诊断7例、误诊4例(误诊率36.4%);经阴道二维超声诊断19例,误诊6例(误诊率24.0%);经阴道三维超声及断层成像诊断21例,误诊1例(误诊率4.5%);经阴道三维超声及断层成像诊断CSP的误诊率显著低于其他两种超声诊断方式(P<0.05)。经腹及经阴道二维、三维超声诊断CSP的声像图特征:瘢痕处孕囊突入型35例(60.34%)、瘢痕处孕囊型17例(29.31%)、瘢痕处混合回声包块型6例(10.34%)。结论经阴道三维超声及断层成像技术能较清楚地显示孕囊或包块与剖宫产瘢痕空间位置关系,有利于寻找胚胎着床位置,为CSP的诊断和鉴别诊断提供重要信息,从而降低误诊率。

To explore the differential diagnosis value of three-dimensional ultrasound and tomography in diagnosing cesarean scar pregnancy(CSP).Methods:Fifty eight patients with cesarean scar pregnancy were diagnosed by pathological examination after curettage of uterine cavity,hysteroscopy and laparoscopy.The sonographic features of cesarean scar pregnancy by two-dimensional ultrasound or three-dimensional ultrasound&tomography were analyzed.All the results of ultrasound examination were compared with the pathological diagnosis.Results:In58patients with CSP,7patients were diagnosed by transabdominal ultrasonography and4patients were misdiagnosed;the rate of misdiagnosis was36.4%.Nineteen patients were diagnosed by transvaginal two-dimensional ultrasound and6patients were misdiagnosed;the misdiagnosis rate was24.0%.Twenty one patients were diagnosed by transvaginal three-dimensional ultrasound and tomography and one patient were misdiagnosed;the misdiagnosis rate was4.5%.The misdiagnosis rate of three dimensional ultrasound and tomography was significantly lower than the other two ultrasound diagnosis instrument(P<0.05).Ultrasound feature of cesarean scar pregnancy were varied,which included35scar pregnancy sac protruding type(60.34%),17scar pregnancy sac type(29.31%),and6mixed echo masses in scar area(10.34%).Conclusions:Three-dimensional and tomographic imaging can clearly show the spatial location between cesarean scar and gestational sac or mass.It helps to find the location of embryo implantation,and provides important information for the diagnosis and differential diagnosis of CSP,thus reducing the misdiagnosis rate.