经阴道彩色多普勒超声在瘢痕妊娠诊断中的应用

Application of transvaginal color Doppler ultrasound in the diagnosis of cesarean scar pregnancy

目的对比剖宫产术后子宫瘢痕妊娠(CSP)与对照组的相关数据,为及早诊断CSP提供帮助;对比不同超声分型CSP超声特征及治疗方式,为早期诊断和个体化治疗方案的制定提供客观依据。方法回顾性分析我院收治的41例CSP患者及41例对照患者的超声声像图特征及相关临床指标,总结分析不同分型CSP患者所采取的治疗方式。结果41例CSP患者与41例对照组比较,出现阴道流血的概率更高,差异有统计学意义(P<0.05);根据超声分型将CSP分为4型,分别为Ⅰ、Ⅱ、ⅢA及ⅢB型,Ⅰ型CSP患者与其他3型CSP比较,出现阴道流血的概率要高,差异有统计学意义(P<0.05);Ⅰ型CSP较Ⅱ、Ⅲ、ⅢA型子宫前壁肌层厚,差异有统计学意义(P<0.05);关于治疗:Ⅰ型CSP主要治疗方式为超声引导清宫术;Ⅱ型根据临床实际情况,每一种方式都可选择;Ⅲ型CSP主要采用子宫动脉栓塞后超声引导下清宫术,所有患者术中出血均不多,预后良好并顺利出院。结论1.CSP患者与对照组临床指标对比有一定差异性,但不够特异,故为了及早的诊断CSP,对于有剖宫产史妇女再次妊娠的早孕检查,一定要明确妊娠囊与子宫前壁下段瘢痕及膀胱的关系;2.超声分型有助于制定针对CSP的个体化治疗方案,以改善患者预后。故诊断CSP的同时,还需对CSP进行准确的超声分型。

Objective To compare the data of cesarean scar pregnancy(CSP)after cesarean section with that of the control group,so as to provide help for the early diagnosis of CSP.To compare the ultrasonic characteristics and treatment methods of different ultrasonic types of CSP,so as to provide an objective basis for early diagnosis and individualized treatment.Methods The ultrasonographic features and related clinical indexes of 41 CSP patients and 41 control patients were analyzed retrospectively,the treatment methods adopted by patients with different types of CSP were summarized and analyzed.Results The probability of vaginal bleeding in 41 patients with CSP was higher than that in 41 control patients,the difference was statistically significant(P<0.05).According to ultrasonic classification,CSP is divided into four types:Ⅰ,Ⅱ,ⅢA and ⅢB.Compared with other 3 types CSPs,patients with type Ⅰ CSP had higher probability of vaginal bleeding,which difference was statistically significant(P<0.05).The main treatment of type Ⅰ CSP was ultrasound-guided uterine curettage,each method could be selected according to the actual clinical situation for type Ⅱ CSP,type Ⅲ CSP mainly adopted ultrasound-guided uterine curettage after uterine artery embolization.All patients had little intraoperative bleeding,good prognosis and been discharged successfully.Conclusions There were some differences in clinical indexes between CSP patients and control patients,but they were not specific enough.Therefore,in order to diagnose CSP as soon as possible,for the early pregnancy examination of second pregnancy in patients with cesarean section,we must clarify the relationship between gestational sac and scar of the lower part of the anterior wall of uterus and bladder.Ultrasound typing is helpful to formulate an individualized treatment plan for CSP patients to improve the prognosis.Therefore,accurate ultrasonic typing is also needed when diagnosing CSP.