超声诊断子宫瘢痕妊娠分型对选择临床治疗方式的价值分析

Study on the value of ultrasound diagnosis of uterine scar pregnancy classification in the choice of clinical treatment

目的 探讨超声诊断子宫瘢痕妊娠分型对选择临床治疗方式的价值。方法 选择2020年5月—2021年5月在温岭市妇幼保健院住院并确诊为剖宫产术后子宫瘢痕妊娠(CSP)的160例患者为研究对象,所有患者在进行治疗前均接受经腹部B超检查,并将超声结果与手术探查结果进行对比,分析经腹超声诊断Ⅰ型、Ⅱ型及Ⅲ型的诊断符合率;对确诊的不同分型CSP患者进行相对应的治疗,并将治疗结果进行记录分析。结果 160例患者经过检查确诊:诊断为Ⅰ型瘢痕妊娠51例,Ⅱ型瘢痕妊娠43例,Ⅲ型瘢痕妊娠36例。患者均进行了超声检查,根据超声检查结果,共有154例患者确诊,与手术病理确诊对比,诊断符合率为96.25%(P>0.05);不同类型CSP声像特征比较:Ⅲ型患者血供明显高于Ⅱ型以及Ⅰ型患者(P<0.05),Ⅱ型与Ⅰ型患者血供情况比较,差异无统计学意义(P>0.05);子宫前壁下段肌层厚度:Ⅲ型与Ⅱ型的子宫前壁下段肌层厚度均显著小于Ⅰ型(P<0.05),Ⅲ型子宫前壁下段肌层厚度小于Ⅱ型(P<0.05);绒毛侵入肌层:Ⅲ型、Ⅱ型与Ⅰ型对比绒毛侵入肌层情况显著(P<0.05),Ⅲ型与Ⅱ型绒毛侵入肌层情况比较,差异无统计学意义(P>0.05);将不同分型的治疗效果进行两两比较,治疗2方案采取概率以Ⅲ型患者最高(P<0.05);且Ⅱ型高于Ⅰ型(P<0.05);Ⅰ型采用1方案的概率高于Ⅱ型与Ⅲ型(P<0.05),且Ⅱ型高于Ⅰ型(P<0.05)。结论 超声诊断剖宫产瘢痕妊娠患者可提高不同分型的检出率,对于临床治疗选择治疗方案与评估患者预后具有一定的帮助,有推广价值。

Objective To explore the value of ultrasound diagnosis of uterine scar pregnancy classification in the choice of clinical treatment.Methods Selected 160 patients who were hospitalized in our hospital from May 2020 to May 2021 and were diagnosed with cesarean scar pregnancy(CSP) as the research subjects. All patients received transabdominal ultrasound before treatment Check and compare the ultrasound results with the surgical exploration results, analyze the diagnostic coincidence rate of transabdominal ultrasound diagnosis of type Ⅰ, type Ⅱ and type Ⅲ;conduct corresponding treatments for patients with different types of CSP diagnosed and perform treatment results Record analysis.Results 160 patients were diagnosed after examination: 51 cases were diagnosed as type Ⅰ scar pregnancy, 43 cases were type Ⅱ scar pregnancy, 36 cases were type Ⅲ scar pregnancy. All patients underwent ultrasound examination. According to the results of ultrasound examination, a total of 154 patients were diagnosed. Compared with the surgical pathological diagnosis, the diagnosis coincidence rate was 96.25%(P>0.05). Comparison of the acoustic and image characteristics of different types of CSP: blood supply of type Ⅲ patients, Compared with type Ⅱ and type Ⅰ patients, it was significantly higher(P<0.05), compared with type Ⅱ and type Ⅰ patients, there was no significant difference(P>0.05);the lower uterine muscular layer Thickness: The thickness of the lower anterior uterine muscular layer of type Ⅲ and type Ⅱ is less than that of type I(P<0.05), and the thickness of type Ⅲ anterior uterine muscular layer is less than type Ⅱ(P<0.05);villi invade the muscle layer: Ⅲ Type Ⅱ and type I compared villi invaded the muscular layer significantly(P<0.05), compared with type Ⅲ and Ⅱ, the villi invaded the muscular layer had no significant difference in percentage comparison(P>0.05);the different types were classified The treatment effect of the patients was compared in pairs. The probability of adopting treatment 2 plans was the highest in type Ⅲ patients(P<0.05);and type Ⅱ was higher than type Ⅰ(P<0.05);the probability of using 1 regimen in type Ⅰ was higher than that of type Ⅱ and Ⅱ and Type Ⅲ(P<0.05) and type Ⅱ is higher than type Ⅰ(P<0.05).Conclusion Ultrasound diagnosis of cesarean section scar pregnancy patients can improve the detection rate of different types. It is helpful for clinical treatment to choose treatment plan and evaluate the prognosis of patients, and has promotion value.