规范化超声检查在剖宫产瘢痕妊娠诊治中的应用-现代医学

规范化超声检查在剖宫产瘢痕妊娠诊治中的应用

单位：1. 南京医科大学, 江苏南京 210029;
2. 南京大学医学院附属鼓楼医院医学影像科, 江苏南京 210008;
3. 南京大学医学院附属鼓楼医院妇产科, 江苏南京 210008;
4. 南京大学医学院附属鼓楼医院妇产科超声室, 江苏南京 210008

关键词：瘢痕妊娠经阴道超声彩色多普勒超声剖宫产术

分类号：R445.1;R714.2

出版年·卷·期（页码）：2017·36·第九期（1287-1290）

摘要：

目的：探讨剖宫产瘢痕妊娠的超声声像图表现，为临床诊断及治疗提供较为准确的信息。方法：回顾分析近3年来78例剖宫产瘢痕妊娠患者的超声表现，将其归纳分类，分别分析各型患者临床治疗效果。结果：所有患者均在宫腔下段子宫瘢痕部位可见胚囊或包块，根据彩超声像图特征将其分为两类：孕囊型和包块型。结合超声分类结果及临床治疗效果分析，孕囊型患者病灶距子宫浆膜面的肌层厚度（d）≥ 2 mm时可尝试行直接超声监护下清宫术；超声表现包块型的患者多为剖宫产瘢痕妊娠清宫不全或不全流产后并发症所致，可根据患者具体情况选择经腹腔镜或经腹病灶切除及瘢痕修补手术、长期保守治疗等。结论：经阴道彩超对剖宫产子宫瘢痕妊娠诊断有着重要的价值，严格质控超声检查对临床制定治疗方案具有重要意义。

Objective: To investigate the sonographic features of cesarean scar pregnancy (CSP) in early stage and summarize the key points during ultrasound examination so as to provide more accurate information for clinical treatment. Methods: The sonographic features of 78 cases of CSP in the past 3 years were analyzed retrospectively, including classification of the types of CSP and the effect of clinical treatment accordingly. Results: In all the cases, the embryo sac or masses were found in the cesarean scar in lower segment of uterine instead of the normal uterine cavity. The sonographic features were divided into two types:gestational sac and masses of mixed echo. By analyzing the sonographic features and the outcome of clinical treatment accordingly, for patients with gestational sac, curettage was appropriate when gestational sac located in the uterine cavity mostly and the thickness of the muscle was more than 2 mm. For patients with mixed echo, laparoscopic or abdominal resection of the masses lesion and scar repair would be recommended. Conclusion: Transvaginal ultrasound is an important approach in the diagnosis of CSP. Strict quality control of ultrasound examination has important significance for clinical diagnosis and treatment.

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