评价经阴道超声及磁共振成像联合数字减影血管造影技术在早期剖宫产瘢痕妊娠诊治中的作用  

Assessm ent of TVS,MRI and DSA together in the Application of Diagnosis and Treatment of Early Cesarean Scar Pregnancy

作　　者：李园[1] 陆雯[1] 陈苏宁[1] 尚鸣异[1] 宋烨[1] 

机构地区：[1]上海市同济医院,上海200065

出　　处：《实用妇产科杂志》2015年第9期673-676,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：探讨经阴道超声（TVS）及磁共振成像（MRI）联合数字减影血管造影技术（DSA）在早期剖宫产瘢痕妊娠（CSP）诊治中的应用价值。方法：选择我院收治的临床拟诊CSP患者23例,停经时间41-49天,分别行TVS、MRI、DSA检查,所有患者行子宫动脉栓塞术,术后TVS随访。结果：1TVS明确诊断CSP 17例,不能明确诊断6例,其中3例于子宫下段见孕囊回声,不能明确孕囊与瘢痕的位置关系;3例包块周边环状血流信号不明显,不能除外难免流产孕囊滞留于瘢痕处。MRI检查23例均明确诊断。2所有患者行DSA下子宫动脉栓塞术,手术成功。术后3天TVS检查：2例孕囊自行排出,1例包块完全吸收,15例见包块缩小且周围血流信号明显减少,5例包块未见明显缩小但周围血流信号明显减少。314例于治疗后1周行刮宫手术,手术顺利,术中术后24小时出血量60-155 ml;6例经MRI诊断包块位于肌层的患者未行刮宫术,密切随访血β-HCG及TVS,包块于栓塞术后4-10周后完全吸收。结论：TVS是CSP的首选诊断方法及子宫动脉栓塞术后评价疗效的方法,当超声检查不能明确诊断时,MRI是必要的辅助手段。DSA下行子宫动脉栓塞术对于早期CSP是一种安全、有效的治疗方法。Objective：To discuss the application value of trans-vaginal sonography,magnetic resonance ima- ging,digital subtractive angiography in the diagnosis of early Cesarean Scar Pregnancy. Methods：23 patients with suspected cesarean scar pregnancy were studied by trans-vaginal sonography, magnetic resonance imaging,digital subtractive angiography respectively and all of them underwent uterine artery embolization and accepted trans-vaginal sonography Follow-up. Results.17 cases were diagnosed clearly by trans-vaginal sonography,3 cases showed that gestational sacs were in the lower segment of uterus for which we could not tell the clear rela- tionship between gestational sacs and the scar;3 cases showed that gestational sacs are in the scar but had no obvious peripheral blood flow which is the typical appearance of scar pregnancy,we should make differential diag- nosis with inevitable abortion. 23 cases were diagnosed scar pregnancy clearly by MRI. GAll the patient under- went uterine artery embolization under DSA. Three days later,all the patients had a TVS Follow-up.2 cases that the sacs discharged were confirmed by ultrasound; 1 case showed that the scar became vanished; 15 cases showed that the sac became smaller and the peripheral blood flow signals reduced ;5 cases showed that the size of gestational sac did not diminished obviously but the peripheral blood signal became less. 14 cases had curet- tage surgery in 1 week after treatment,6 cases diagnosed by MRI which the sacs in the muscular layer did not had the curettage surgery, but had close follow-up of blood HCG and TVS, sacs were absorbed after 4 -10 weeks which were confirmed by TVS. Conclusions：TVS and MRI together can diagnose early cesarean scar and the uterine artery embolization under the DSA is a safe and effective method for early cesarean scar pregnancy.

关 键 词：经阴道超声 磁共振 数字减影血管造影 剖宫产瘢痕妊娠 子宫动脉栓塞 

分 类 号：R719[医药卫生—妇产科学]