MRI检查在剖宫产术后子宫瘢痕妊娠诊治中的应用价值  

Clinical value of MRI in cesarean scar pregnancy

作　　者：种轶文[1] 张坤[1] 周延[1] 韩劲松[1] 朱馥丽[1] 郭红燕[1] 熊光武[1] 

机构地区：[1]北京大学第三医院妇产科,100191

出　　处：《中华妇产科杂志》2014年第12期914-918,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨MRI检查在剖宫产术后子宫瘢痕妊娠（CSP）诊治中的应用价值.方法 回顾性分析2009年1月至2013年1月北京大学第三医院收治的54例CSP患者的临床资料,根据MRI检查分型结合患者的其他临床资料,对CSP1型患者行保守治疗或经阴道手术,对CSP2型患者行经腹联合经阴道手术治疗,分析术中出血量、手术时间、术后住院时间及血清hCG降至阴性（血清hCG＜2.9 U/L为阴性）的时间.结果 54例患者平均年龄（34±5）岁,停经时间平均为（56±16）d,全部患者治疗前生命体征均平稳,治疗前血清hCG水平为23～ 142 962 U/L.MRI检查提示为CSP1型的患者12例,其中5例病灶直径1～2cm,血清hCG水平为436～1 159 U/L,予药物保守治疗,治疗后23～ 32 d血清hCG转为阴性;7例病灶直径2.0～ 4.4 cm,血清hCG水平为2 218～ 63 446 U/L,行宫腔镜或B超监测下经阴道子宫瘢痕处妊娠组织清除术.MRI检查提示为CSP2型的患者42例,病灶直径1.0～ 7.1 cm,血清hCG水平为23～ 142 962 U/L,22例经腹（6例开腹、16例经腹腔镜）行双侧子宫动脉阻断术,20例行双侧子宫动脉栓塞术（UAE）,随后行妊娠组织清除术.CSP1型、2型的手术患者术中出血量分别为平均50.1、267.2 ml,手术时间分别为平均30、128 min,术后住院时间分别为平均4.6、6.7 d;术后13～ 30 d患者血清hCG水平转为阴性.全部患者均保留子宫,接受手术治疗的患者均经一次手术痊愈出院.结论 MRI检查分型是指导临床治疗CSP的有效方法.Objective To explore the clinical value of MRI in diagnosing and treating cesarean scar pregnancy （CSP）.Methods A retrospective analysis was conducted on the clinical manifestations of 54 patients diagnosed with CSP between January 2009 to January 2013 in Peking University Third Hospital.Based on the patients＇ MRI image and other clinical datas,we did transvaginal operation on patients with CSP1,and transvaginal combined with abdominal operations on patients with CSP2.The intraoperative blood loss,operation time,postoperative hospital stay,and the length of time required for of serum hCG dropping to normal of the patients were analyzed.Results The average age of the 54 patients was （34±5） years and the average duration of gestation was （56± 16） days,all patients＇ vital sign were stable,the hCG level was 23-142 962 U/L before treatment.Twelve patients were diagnosed with CSP1 by MRI,and 5 of them had focus of 1-2 cm in diameter,the 5 patients＇ serum hCG level was 436-1 159 U/L and 23-32 days after drug administration,their hCG level returned to normal; the other 7 patients had focus of 2.0-4.4 cm in diameter,and their hCG level was 2 218-63 446 U/L,lesion resection was done on the 7 patients by hysteroscope or under B-uhrasound monitor.Forty-two patients were diagnosed with CSP2,and their focus were 1.0-7.1 cm in diameter,and serum hCG level were 23-142 962 U/L.We did bilateral uterine artery occlusion by laparoscope or laparotomy during operation for 22 patients or bilateral uterine artery embolization （UAE） before operation for 20 patients,then we did lesion resections.The blood loss during operation of CSP1 or CSP 2 was 50.1,267.2 ml; operation time was 30,128 minutes; postoperative hospital stay was 4.6,6.7 days;their serum hCG returned to normal 13-30 days after the surgery.All the 54 patients＇ uterus were preserved,and the patients undergoing operations were all cured without the second operation.Conclusion MRI is an effective method to conduct clinical treatment in CSP.

关 键 词：妊娠 异位 磁共振成像 瘢痕 子宫 剖宫产术 

分 类 号：R714.22[医药卫生—妇产科学] R445.2[医药卫生—临床医学]