不同超声分型剖宫产术后子宫瘢痕妊娠的预后分析  

Prognosis Analysis of Cesarean Scar Pregnancy with Different Ultrasound Classification

作　　者：熊明涛 王亚梅[1] 王慧[1] 叶宝英 陈炯[1] 杨钰[1] 孙立群[1] Xiong Mingtao;Wang Yamei;Wang Hui;Ye Baoying;Chen Jiong;Yang Yu;Sun Liqun(Department of Ultrasound,International Peace Maternity&Child Health Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学附属国际和平妇幼保健院超声科

出　　处：《中国超声医学杂志》2019年第11期1027-1029,共3页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金青年项目(No.81601291)

摘　　要：目的对比剖宫产术后子宫瘢痕妊娠(CSP)的超声分型及预后,为早期诊断和个体化治疗方案的制定提供客观依据。方法回顾性分析我院收治283例CSP患者的超声声像图特征,总结不同分型所采取的治疗方式并进行预后分析。结果Ⅰ型103例(妊娠囊边缘位于切口处),Ⅱ型112例(妊娠囊陷入切口内),Ⅲ型10例(妊娠囊向膀胱方向突出),Ⅳ型58例(妊娠囊呈混合回声)。结合临床症状及实验室结果进行对比分析:Ⅳ型较Ⅰ、Ⅱ、Ⅲ型停经时间长(P<0.05),Ⅳ型较Ⅰ、Ⅱ、Ⅲ型血HCG值低(P<0.05),Ⅰ型较Ⅱ、Ⅲ、Ⅳ型子宫前壁峡部肌层厚度大(P<0.05)。Ⅰ型主要治疗方式为超声监护下清宫术;Ⅱ型根据临床实际情况,选择直接超声监护下高危清宫术或预处理后行超声监护下清宫术;所有Ⅲ型均需预处理后行超声监护下清宫术;Ⅳ型主要治疗方式为预处理后行超声监护下清宫术。其中2例CSPⅠ型坚持继续妊娠至足月,1例为凶险性前置胎盘伴胎盘植入,经剖腹产术中出血800ml;1例为前置胎盘伴胎盘粘连,经剖腹产术中出血700ml。结论准确的CSP超声分型有助于制定针对CSP的个体化治疗方案以改善患者预后。Objective To compare the ultrasonographic classification and prognosis of uterine scar pregnancy(CSP)after cesarean section,so as to provide objective basis for early diagnosis and individualized treatment.Methods The ultrasonographic features of 283 patients with CSP admitted to our hospital from were analyzed retrospectively.The treatment methods of different types were summarized and the prognosis was analyzed.Results There were 103 cases of type Ⅰ (the edge of pregnancy sac was located at the incision),112 cases of type Ⅱ (the pregnancy sac was trapped in the incision),10 cases of typeⅢ (the pregnancy sac protruded towards the bladder),and 58 cases of type Ⅳ (the pregnancy was mixed echo).According to clinical symptoms and laboratory results,the duration of menopause of type Ⅳ was longer than that of type Ⅰ,Ⅱ and Ⅲ (P<0.05),the HCG value of type Ⅳ was lower than that of type Ⅰ,Ⅱ and Ⅲ (P<0.05),and the thickness of muscular layer of anterior isthmus of uterus of typeⅠ was thicker than that of type Ⅱ,Ⅲ and Ⅳ (P<0.05).The main treatment methods,Type I with uterine curettage under ultrasound monitoring;TypeⅡ with high-risk uterine curettage under direct ultrasound monitoring or under ultrasound monitoring after pretreatment according to the actual clinical situation;Types Ⅲ with pretreatment and under ultrasound monitoring;Type Ⅳ with uterine curettage under ultrasound monitoring after pretreatment.Among them,2 cases of CSP type Ⅰ insisted on continuing pregnancy to full term,1 case of dangerous placenta previa with placenta implantation,800 ml of bleeding during caesarean section,1 case of placenta previa with placenta adhesion,700 ml of bleeding during caesarean section.Conclusions Accurate ultrasound typing of CSP is helpful to develop individualized treatment for CSP to improve the prognosis of patients.

关 键 词：剖宫产术后 子宫瘢痕妊娠 超声诊断 个体化治疗 预后 

分 类 号：R71[医药卫生—妇产科学]