经阴道超声在子宫切口妊娠诊断和治疗中的应用  

Application of transvaginal ultrasound in diagnosis and treatment of cesarean scar pregnancy

作　　者：杨婷[1] 吴婷婷 唐纳[2] 顾继英[3] 

机构地区：[1]上海交通大学附属第一人民医院妇产科,上海200080 [2]上海交通大学附属第一人民医院影像医学科,上海200080 [3]上海交通大学附属第一人民医院超声医学科,上海200080

出　　处：《上海交通大学学报（医学版）》2017年第10期1398-1401,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·探讨剖宫产术后子宫切口妊娠(CSP)经阴道超声检查的表现,并评估经阴道超声结合MRI在CSP诊断和治疗中的价值。方法·回顾性分析上海交通大学附属第一人民医院3年内收治的42例CSP患者的经阴道超声检查表现、MRI结果及临床资料。结果·42例中确诊为CSP共36例,经阴道超声漏诊1例,误诊5例,诊断准确率85.7%;经MRI检查36例,漏诊3例,误诊1例,诊断准确率88.9%。其中孕囊型CSP 30例,混合包块型CSP 6例。根据超声检查提示子宫下段切口处肌层厚度,对孕囊型CSP患者采取不同处理方式:>3 mm者采用吸宫术;≤3 mm者进一步结合MRI检查,选择手术切除妊娠物或子宫动脉栓塞+甲氨蝶呤化学治疗+吸宫术。结论·经阴道超声和MRI诊断CSP的准确率均较高。经阴道超声结合MRI可为CSP治疗方案选择提供重要的参考。Objective · To investigate the performance of transvaginal ultrasound （TVS） on cesarean scar pregnancy （CSP）, and evaluate the value of TVS combined with MRI in the diagnosis and treatment of CSP. Methods · A retrospective analysis was made in 42 patients with CSP in Shanghai General Hospital in recent 3 years. The TVS performance, MRI results, and clinical data of the patients were analyzed. Results · In all 42 cases, 36 were diagnosed as CPS. TVS missed one case, and misdiagnosed 5 cases, which diagnostic accuracy was 85.7%. Thirty-six cases were tested by MRI, therein 32 cases were diagnosed correctly, 3 cases missed, 1 case misdiagnosed, which diagnostic accuracy rate was 88.9%. Among the 36 CSP cases, 30 were simple sac type and 6 were mixedmass type. For the simple sac type, different treatment was chosen according to the muscle thickness of the lower uterine segment incision measured by TVS. When it was more than 3 mm, suction surgery was used. But when it was no more than 3 mm, MRI examination was further used, and the surgical resection or uterine artery embolism＋MTX＋suction surgery was chosen. Conclusion · Both TVS and MRI have a high diagnostic accuracy for CSP, and TVS combined with MRI can provide important reference for CSP treatment options.

关 键 词：子宫切口妊娠 经阴道超声 诊断 治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]