子宫切口瘢痕妊娠合并出血的影像学诊断及介入临床联合治疗  

THE IMAGING DIAGNOSIS AND THE INTERVENTIONAL THERAPY OF CESAREAN SCAR PREGNANCY WITH HEMORRHAGE

作　　者：孙静涛[1] 董芳芳[1] 张莉[1] 刘蕊[1] 李文会[1] 

机构地区：[1]河北省唐山市妇幼保健院放射科,063000

出　　处：《中国煤炭工业医学杂志》2014年第8期1299-1302,共4页Chinese Journal of Coal Industry Medicine

基　　金：2013年唐山市科学技术研究与发展指导计划项目(课题编号:13130238a)

摘　　要：目的总结子宫切口瘢痕妊娠合并出血的彩超、DSA影像学诊断，并探讨其介入和临床联合治疗价值。方法选择收集该院近3年经病理证实的子宫切口瘢痕妊娠合并出血的80例患者资料，术前B超确诊后行介入诊断性造影及双侧子宫动脉栓塞术，并在24～48h内行超声引导下清宫术。结果彩超表现为子宫前壁下段肌层内不均质混合回声，内见囊状及迂曲管状元回声，边界不清，向宫外突出，其前方与膀胱之间肌层变薄。彩色多普勒血流显像示包块内部及周边血流信号非常丰富。DSA表现为不同程度的子宫动脉增粗，子宫常大或稍大，不同程度的峡部增宽，其内均可见不均质染色，有造影剂渗出。80例介入双例子宫动脉栓塞术联合清官术均成功。但首次术后出现23例宫腔残留及2例感染的并发症，占31．3％。结论彩超是子宫切口瘢痕妊娠首选、可靠的诊断方法。DSA不仅能明确出血及部位，而且同时行介入双侧子宫动脉栓塞术能较好的治疗出血、起到杀灭胚胎细胞的作用。并联合清宫术彻底治愈疾病，保留子宫。但首次治疗仍有一定的并发症，需要二次处理。Objective To analyze the clinical value of the imaging diagnosis and the interventional therapy of cesarean scar pregnancy with hemorrhage by color ultrasound and DSA. Methods Eighty patients with cesarean scar pregnancy were selected and they were confirmed by surgery and pathology in author＇s hospital in recent 3 years. All the 80 cases were taken bilateral uterine artery embolization after ultrasound diagnose and underwent ultrasound- guided suction curettage in 24 to 48 hours. Results The color ultrasound hin- ted heterogeneity mixed echo in the muscular layer of antetheea uterine lower segment where could observed cystic and circuitous tubulous anecho, unclear boundary, extrude the uterus. The muscular layer between its front and bladder became thin and the color Doppler hinted plentiful signals of blood stream in the internal and surrounding of the mass. DSA prompted different degrees of uterine arterial thickening, the size of uterus were normal or slightly larger, different degrees of lower uterine segment broadening with heteroge- neity colouration and effusion of contrast medium. All the 80 cases were embolized and curettage success- fully, but 23 cases had intrauterine residue and 2 cases took intrautorine infection after the first treatment, they reached to 31.3M. Conclusions Color ultrasound is a preferred, reliable way to diagnose cesarean scar pregnancy. DSA can define the position of bleeding, meanwhile uterine artery embolization can cure the hemorrhage and kill the embryonic ceils. Combined with suction curettage, it can retain the uterus but thoroughly cure the disease. There are a certain of complications at the first treatment and the patients need secondary settlement.

关 键 词：子宫切口瘢痕妊娠 B超 数字减影血管造影 介入栓塞术 清宫术 并发症 

分 类 号：R711.75[医药卫生—妇产科学]