MRI在特殊类型剖宫产术后子宫瘢痕妊娠中的影像特征及术前评估

MRI imaging features and preoperative evaluation in postpartum scar pregnancy after special types of cesarean section

目的探讨MRI在特殊类型剖宫产术后子宫瘢痕妊娠(CSP)中的影像特征及术前评估。方法回顾性分析经甘肃省妇幼保健院临床术后病理确诊的28例特殊类型CSP患者的MRI影像及临床资料,总结其影像特征及临床治疗方式。结果28例病理结果均提示含有绒毛和(或)蜕膜组织,MRI显示包块型CSP位于子宫前壁下段瘢痕处,表现为囊实性病灶和混杂信号病灶,对病灶及周围软组织清楚显示。其中,合并有动静脉畸形8例,合并绒毛、底蜕膜植入肌层4例并穿透浆膜层。所有患者术前均行子宫动脉介入栓塞术后再行妊娠物清除术,其中3例腹腔镜下行盆腔粘连松解术,4例行腹腔镜瘢痕妊娠物切除术及子宫修补术。结论MRI不仅能清晰直观地显示特殊类型剖宫产术后子宫瘢痕妊娠的位置、大小、形态,以及其内部结构和其他并发症,通过测量妊娠囊着床于瘢痕处的肌层厚度进行CSP的分型,可更好地选择CSP的手术方式,对临床医生选择合适的治疗方案具有一定的指导意义。

Objective To investigate the imaging characteristics and preoperative evaluation of MRI in hysterectomy scar pregnancy(CSP)after cesarean section.Methods The MRI images and clinical data of 28 patients with special type of CSP diagnosed by pathology after clinical operation in our hospital were retrospectively analyzed,and the imaging characteristics and clinical treatment were summarized.Results All the 28 cases showed villi and/or decidual tissue,and MRI showed that the CSP was located in the scar of the lower anterior wall of the uterus,presenting as cystic solid lesions and mixed signal lesions,showing clear structures of the lesions and surrounding tissues.Among them,there were 8 cases with arteriovenous fistula,4 cases with villi and basal decidua implanted into the muscular layer and penetrated the serous layer.All the patients underwent the removal of pregnancy objects after the interventional embolization of uterine artery,including 3 cases of laparoscopic pelvic adhesion release,and 4 cases of transabdominal scar pregnancy objects resection and hysterectomy.Conclusion MRI can not only clearly and intuitively show special type cesarean section of uterine scar pregnancy(CSP)the location,size,shape and internal structure and other complications,and by measuring the gestational sac implantation was conducted in the scar in the muscle layer thickness of CSP classification,can be a better choice of CSP operation method,the choice of clinical treatment has a certain guiding role.