经腹及经阴道三维超声在子宫瘢痕妊娠诊治中的价值  

Value of transabdominal and transvaginal three-dimensional ultrasonography in diagnosis and treatment of cesarean scar pregnancy

作　　者：魏珊[1] 林小影 马春燕[1] 朱才义[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院超声医学科,海南海口570208 [2]深圳宝安区妇幼保健院超声医学科

出　　处：《中国妇幼保健》2015年第14期2280-2283,共4页Maternal and Child Health Care of China

摘　　要：目的：分析经腹及经阴道三维超声诊断子宫下段前壁剖宫产术后瘢痕妊娠（CSP）的声像图特征及其对临床治疗的指导价值。方法：2008年1月~2014年9月在该院及深圳宝安区妇幼保健院就诊的CSP患者中选取资料完整的28例进行回顾性分析,利用二维及三维立体成像模式,清晰显示妊娠物（妊娠囊或妊娠包块）与子宫瘢痕分界及空间立体位置关系,观察瘢痕处肌层的厚度、浆膜面的延续情况、妊娠物内部及周边的血流分布、宫腔情况及宫颈情况。结果：28例CSP患者中,在宫内正常部位均未见妊娠囊,在子宫下段切口处可见胚囊或杂乱回声性包块。子宫下段瘢痕处仅见妊娠囊者14例,子宫下段瘢痕处见杂乱回声性包块者4例,妊娠囊部分位于瘢痕处呈＂水滴或茄子＂状凸向宫腔者7例,妊娠囊部分位于瘢痕处呈＂水滴或茄子＂状凸向宫颈管者3例。28例CSP患者的子宫下段肌层呈楔形改变,妊娠物与瘢痕肌层大多数分界不清,瘢痕处肌层均较薄或菲薄,血流信号均集中在瘢痕处,大多数血流较丰富。根据妊娠物内部及周边血流分布情况,参照Adler〔1〕进行分级：0级（无）、Ⅰ级（5例）、Ⅱ级（15例）和Ⅲ级（8例）。结论：利用经腹及经阴道三维超声的彩色血流及立体空间结构能更清楚、更形象地显示子宫瘢痕妊娠物与瘢痕之间的关系,及早作出定位定性诊断,给临床治疗和判断治疗效果提供可靠而重要的依据。Objective： To analyze the ultrasonic characteristics of cesarean scar pregnancy （CSP） in anterior wall of the lower segment of the uterus by transabdominal and transvaginal three-dimensional ultrasonography and the guiding value for clinical treatment of CSP. Methods： Twenty- eight CSP patients with complete data were selected from the hospital and Maternal and Child Health Care Hospital of Baoan District in Shenzhen from January 2008 to September 2014, thenthe clinical data was analyzed retrospectively; two-dimensional and three-dimensional ultrasound modes were used to clearly display the boundary and the relationship between gestational sac and cesarean scar and observe the thickness of muscle layer, the continuation of perimetrium in cesarean scar, blood distribution of the internal and peripheral gestational sac, the situations of uterine cavity and cervix. Results ： Among 28 CSP patients, gestational sac was not found in the normal position of uterus, embryo sac or masses with cluttered echo ; gestational sac was found in the lower segment of the uterus in 14 patients, masses with cluttered echo were found in the lower segment of the uterus in 4 patients, gestational sac convex to uterine cavity liking water drop or eggplant was found in 7 patients, gestational sac convex to cervical canals liking water drop or eggplant was found in 3 patients ; among 28 CSP patients, myometrium of the lower segment of the uterus had a ＂wedge＂ change, the boundary between gestational sac and cesarean scar was not clear, the thickness of muscle layer in cesarean scar was very thin, the blood flow signals were all concentrated in cesarean scar and the most was rich. The patients were graded according to the blood distribution of the internal and peripheral gestational sac with reference to Adler ： grade 0 （zero）, grade Ⅰ （5 patients）, grade Ⅱ （ 15 patients） and grade Ⅲ （8 patients） . Conclusion： The relationship between gestational sac and cesarean scar can be more clearly and more aptl

关 键 词：三维超声 彩色血流 多普勒 声像图 瘢痕妊娠 

分 类 号：R445.1[医药卫生—影像医学与核医学]