阴道彩超对剖宫产子宫瘢痕妊娠的监测价值  

Clinical value in treatment of cesarean scar pregnancy by transvaginal color Doppler ultrasound

作　　者：张耀[1] 郭道宁[2] 李燕华[1] 舒晓芳[1] 王亮[1] 

机构地区：[1]绵阳市中心医院妇产科,四川绵阳621000 [2]绵阳市中心医院超声科,四川绵阳621000

出　　处：《西部医学》2015年第3期443-445,共3页Medical Journal of West China

摘　　要：目的探讨经阴道彩色多普勒超声在诊断治疗剖宫产子宫瘢痕妊娠的监测价值。方法回顾分析2007年5月~2013年5月经治的剖宫产子宫瘢痕妊娠患者43例,全部入选病例均为不均质包块型,分析阴道彩超在治疗剖宫产子宫瘢痕妊娠中的临床应用价值,通过超声观察瘢痕处病灶包块超声影像学特征进行诊断,观察保守治疗中剖宫产子宫瘢痕妊娠病灶包块的消长情况,以及在经阴道彩超导向下病灶包块局部注射氨甲喋呤（MTX）介入治疗剖宫产子宫瘢痕妊娠。结果其中15例经两侧子宫动脉灌注MTX,剂量100mg后行手术病灶清除、子宫修复治疗;4例经两侧子宫动脉灌注MTX,剂量100mg,包块逐渐缩小,β-HCG水平下降而治愈;12例超声介入注射MTX,剂量100mg后行手术病灶清除、子宫修复治疗;5例超声介入注射MTX,剂量100mg,包块逐渐缩小,β-HCG水平下降而治愈;9例直接行手术治疗。结论经阴道彩超对剖宫产子宫瘢痕妊娠早期正确诊断、治疗以及随访具有非常重要的作用,经阴道彩超导向病灶包块局部注射MTX介入治疗是治疗剖宫产子宫瘢痕妊娠的可供选择地有效手段。Objective To investigate the clinical value in treatment of cesarean scar pregnancy（CSP）by transvaginal color Doppler ultrasound.Methods 43 cesarean scar pregnancies were analyzed.All the cases were non-homogeneous mass type.The patients were treated with conservative treatment or local injection of 100 mg methotrexate（MTX）under transvaginal color Doppler ultrasound guidance.The masses of the patients were observed.Results 15 cases were treated with uterine artery perfusion 100 mg methotrexate（MTX）,followed by surgical lesion tissue dissection and uterine incision repair.The masses of 4cases after uterine artery perfusion 100 mg MTX gradually reduced,and the level ofβ-HCG decreased.12 cases were treated with interventional ultrasound injection 100 mg MTX,followed by surgical lesion tissue dissection and uterine incision repair.9cases were treated with direct surgical treatment.Conclusion Transvaginal color Doppler ultrasound has a very important role in correct diagnosis,treatment,and follow-up of cesarean scar pregnancy.

关 键 词：彩色多普勒超声 剖宫产子宫瘢痕妊娠 甲氨喋呤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.2[医药卫生—诊断学]