经阴道彩色多普勒超声在剖宫产术后子宫瘢痕妊娠诊治的应用

The application of transvaginal color Doppler ultrasound in the diagnosis and treatment of cesarean scar pregnancy

目的:探讨经阴道彩色多普勒超声在剖宫产术后子宫瘢痕妊娠中的诊断和治疗的应用价值。方法:对2010年3月—2013年6月经阴道彩色多普勒超声诊断的45例子宫瘢痕妊娠患者声像图特征进行分析,并回顾彩色多普勒超声引导下剖宫产瘢痕妊娠病灶穿刺注药治疗及其它不同治疗方法的临床资料。结果:本组病例中,根据声像图特征分为孕囊型19例,团块型23例,混合型3例。经彩色多普勒超声引导下剖宫产瘢痕妊娠病灶穿刺注药治疗16例,超声引导下清宫术3例,药物保守治疗6例,宫腔镜或腹腔镜下子宫瘢痕妊娠病灶清除术加清宫术12例,子宫动脉栓塞化疗7例,经腹子宫瘢痕妊娠病灶切除术1例,所有患者经临床证实,诊断准确率为86.7%,误诊6例,术后诊断2例为宫内妊娠先兆流产,1例为难免流产,1例为稽留流产,1例为宫内妊娠不全流产,1例为宫颈妊娠。结论:经阴道彩色多普勒超声是临床早期诊断子宫瘢痕妊娠的可靠方法,同时经彩色多普勒超声引导下剖宫产瘢痕妊娠病灶穿刺注药治疗也是治疗该病较好的方法。

Objective: To explore the adoption valuation of transvaginal color Doppler ultrasonography flow imaging(TVCDFI) in the diagnosis and treatment of cesarean scar pregnancy(CSP). Methods: The characteristics of TV-CDFI and the different methods of CSP treatment including color Doppler ultrasound-guided punctures(CDUGP) from March 2010 to June 2013 in 45 cases were analyzed. Results: Forty-five cases with CSP were divided into 3 types: gestational sac type(19 cases), mass type(23 cases), mixed type(3 cases). The patients received such treatments as drug intervention by CDUGP(16 cases), curettage of uterine cavity under ultrasound-guidance(3 cases), conservative drug treatment(6 cases), hysteroscopic or laparoscopic treatment and curettage of uterine cavity(12 cases), transuterine artery chemotherapy and embolization(7 cases), transabdominal CSP lesion removal(1 case). Thirty-nine cases were diagnosed correctly, diagnostic accuracy was 86.7%, 6 cases were misdiagnosed, including uterine pregnancy threatened abortion(2 cases), inevitable abortion(1 case), missed abortion(1 case), uterine pregnancy incomplete abortion(1 case), cervix pregnancy(1 case). Conclusions: TV-CDFI is a reliable method for early diagnosing CSP, drug intervention treatment by CDUGP is an effective therapeutic method.