不同类型剖宫产切口妊娠的MRI特征及诊断价值  

MRI features and clinical analysis of different types of cesarean incision pregnancy

作　　者：邓娟[1] 赵良清[1] 庞孟春 DENG Juan;ZHAO Liangqing;PANG Mengchun(Radiology Department, The People’s Hospital of Jianyang City, Chengdu 610000, P.R.China)

机构地区：[1]四川省简阳市人民医院放射科,四川成都610000

出　　处：《医学影像学杂志》2020年第5期806-809,共4页Journal of Medical Imaging

摘　　要：目的探讨剖宫产切口妊娠(CSP)的MRI特征及诊断价值。方法选取我院120例疑似CSP患者行MRI检查,比较孕囊种植瘢痕最薄厚度、孕囊与瘢痕接触面长度、孕囊大小、孕囊类型、血供情况以及清宫术中出血量、血绒毛膜促性腺激素(β-HCG)转阴时间、行子宫动脉化疗栓塞例数以及子宫切除例数。结果CSP分为内生型和外生型,手术病理显示120例疑似CSP患者中诊断105例。MRI检查显示120例疑似CSP患者中,诊断100例。MRI检查结果与手术病理诊断结果的一致性较强,MRI检查的敏感度、特异度、准确度分别为95.24%、93.33%、95.00%。MRI和手术病理诊断均为剖宫产切口妊娠患者100例中,外生型57例,内生型43例。外生型CSP患者的瘢痕厚度、孕囊大小低于内生型患者,血供丰富、包块状孕囊例数高于内生型CSP患者,差异均有统计学意义。外生型CSP患者清宫术中出血量、β-HCG转阴时间、行子宫动脉化疗栓塞率均明显高于内生型患者,差异均有统计学意义。结论MRI对CSP的诊断效果较佳,并且外生型CSP患者的瘢痕厚度、孕囊大小均小于内生型,血供丰富,包块状孕囊多于内生型,清宫术中出血量、β-HCG转阴时间、行子宫动脉化疗栓塞率均显著高于内生型患者。Objective To explore the characteristics of magnetic resonance imaging(MRI)of ectogenous and endogenetic cesarean section incision pregnancy(CSP)and the results of operation.Methods We prospectively selected 120 suspected CSP patients who were treated in our hospital as the research objects.MRI was used to obtain the images of arterial phase,venous phase and delayed phase.CSP patients were divided into endogenous and exogenous types by double-blind method.We compared the thinnest thickness of implantation scar,the length of contact surface between gestational sac and scar,the size of gestational sac the types of gestational sac,the blood supply,the amount of bleeding,the time ofβ-hCG turning negative,the number of cases of chemoembolization and hysterectomy.Results The results of operation and pathology showed that 105 out of 120 suspected CSP patients were diagnosed as CSP patients.MRI results showed that among 120 suspected CSP patients.The results of MRI were consistent with those of surgical pathology(kappa=0.795,P<0.05),and the sensitivity,specificity and accuracy of MRI were 95.24%,93.33%and 95.00%,respectively.Of the 100 patients with CSP diagnosed by MRI and operation pathology,57 were exogenetic and 43 were endogenetic.The scar thickness and gestational sac size of the patients with exogenous CSP were lower than those of the patients with endogenous CSP,and the number of cases with abundant blood supply and massive gestational sac were higher than those of the patients with endogenous CSP(P<0.05).The amount of bleeding,the time ofβ-hCG turning negative and the rate of uterine artery chemoembolization were significantly higher in the patients with exogenous CSP than in the patients with endogenous CSP(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion MRI has a better effect on the diagnosis of CSP,and the scar thickness and gestational sac size of the patients with exogenous CSP are smaller than that of the patients with endogenous CSP.The blood supply is rich,and

关 键 词：外生型 内生型 剖宫产切口妊娠 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R711.7[医药卫生—诊断学]