子宫瘢痕妊娠的影像学特征及临床治疗  

Imaging features and clinical treatment options of cesarean scar pregnancy

作　　者：杨斌[1] 肖梅[1] 陈赛英[1] 丁蓉蓉[2] YANG Bin;XIAO Mei;CHEN Sai-ying;DING Rong-rong(Department of Gynecology and Obstetrics;Department of Outpatient, the 81th Hospital of PLA, Nanjing 210002,Jiangsu,China)

机构地区：[1]解放军第81医院妇产科,南京210002 [2]解放军第81医院门诊部,南京210002

出　　处：《东南国防医药》2017年第6期595-599,共5页Military Medical Journal of Southeast China

摘　　要：目的分析子宫瘢痕妊娠的影像学特征及不同治疗方法和疗效。方法收集解放军第81医院2012-2015年收治的子宫瘢痕妊娠56例患者,分析其超声和磁共振图像特点、临床表现及不同治疗方法的疗效。56例患者全部完成阴道彩超及磁共振检查。结果 56例中阴道彩超正确诊断50例,准确率89.2%,磁共振全部正确诊断,准确率100%。其中50例患者行甲氨喋呤联合米非司酮治疗、子宫动脉栓塞联合甲氨蝶呤后行清宫术治疗、超声引导下清宫术;1例经子宫动脉栓塞后给予清宫术,术后7 d阴道大量出血,再次急诊开腹子宫局部病灶切除治疗;5例行开腹子宫病灶切除术。无一例行子宫切除术,所有患者均痊愈出院。结论早期影像学诊断对于子宫瘢痕妊娠诊断至关重要,超声检查是主要的诊断方法,磁共振更加准确,可以作为超声诊断疑难时的有效补充。明确诊断后,需要尽早选择合适的治疗方案,避免严重的并发症及子宫切除的风险。ObjectiveImaging features and different treatment methods and therapeutic effects of Cesarean scar pregnancy(CSP)will be discussed.MethodsIn the81th hospital of the PLA from2012-2015,the clinical data of56patients with CSP were included into this study.The imaging features and treatment outcomes of these pregnancies were recorded.All of them were undergone transvaginal color Doppler ultrasound and magnetic resonance imaging(MRI)examination.ResultsAmong these patients,50cases were correctly diagnosed by transvaginal color Doppler ultrasound,diagnostic accuracy was89.2%,56cases were correctly diagnosed by MRI,diagnostic accuracy was100%.50cases underwent successful termination by curettage with ultrasonic guidance,mifepristone combined methotrexate,a combination of uterine artery embolization and methotrexate and curettage.Five patients were cured by transabdominal excision of uterus lesion.One patient underwent curettage after the uterine artery embolization,but heavy vaginal bleeding occurred seven days later after the curettage.At last,she was cured by emergency excision of uterus lesion and part uterine horns.In this study,no patients had uterus resection.ConclusionEarly imaging recognition is critically important for CSP.Ultrasound is the main diagnostic choice.MRI can be used as an effective supplement for the diagnosis of ultrasound.The appropriate treatment should be taken as early as possible to minimize maternal complications and preserve future fertility.

关 键 词：子宫瘢痕妊娠 治疗 阴道彩超 磁共振 

分 类 号：R711.74[医药卫生—妇产科学]