超声在剖宫产术后子宫切口瘢痕妊娠诊断及治疗中的价值  

The value of ultrasonography in the diagnosis and treatment of cesarean scar pregnancy

作　　者：王鑫 张华伟 WANG Xin;ZHANG Huawei(Department of Ultrasomography, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P.R.China)

机构地区：[1]山东第一医科大学附属省立医院超声诊疗科,山东济南250021

出　　处：《医学影像学杂志》2020年第12期2271-2273,共3页Journal of Medical Imaging

摘　　要：目的探讨彩色多普勒超声在早期筛查诊断剖宫产术后子宫切口瘢痕妊娠对治疗及预后评估的临床价值。方法选取2015年10月~2019年11月于我院行彩色多普勒超声检查及术后病理诊断确诊为切口妊娠的住院患者82例,根据术中出血量分为观察1组≥200 ml(36例)和观察2组<200 ml(46例),根据治疗方式分为直接清宫组与动脉栓塞后清宫组。对与出血相关的危险因素进行单因素分析及有序多分类Logistic回归分析。结果单因素分析两组中年龄、剖宫产次数、HCG值与出血量无明显相关性(P>0.05),直接清宫组与动脉栓塞后清宫组差异无统计学意义;停经时间、病灶最大径、瘢痕处肌层厚度、彩色多普勒血流信号分级与出血量有相关性,经有序多分类Logistic回归分析病灶最大径为手术中出血量唯一有意义的危险因素(P=0.046,OR=1.745,95%CI=1.011~3.012)。结论彩色多普勒超声能早期诊断子宫切口处妊娠,且测量病灶最大径可预测术中子宫出血量,可为临床治疗方案的制定提供重要参考。Objective To explore the clinical value of color Doppler ultrasound in early screening and diagnosis of cesarean scar pregnancy.Methods 82 patients with incisional pregnancy diagnosed by color Doppler ultrasound and postoperative pathology in our hospital from October 2015 to November 2019 were divided into two groups group 1≥200 ml(n=36)and group 2<200 ml(n=46).According to the mode of treatment,they were divided into direct uterine curettage group and arterial embolization group.Univariate analysis and ordered multi-classification Logistic regression analysis were used to analyze the risk factors related to bleeding.Results Univariate analysis showed that there was no significant correlation between age,number of cesarean section,HCG value and bleeding volume between the two groups(P>0.05).There was no significant difference between direct uterine curettage group and arterial embolization group.The time of menopause,the maximum diameter of the lesion,the thickness of the muscular layer at the scar,and the classification of color Doppler blood flow signals were correlated with the amount of bleeding.The ordered multi-classification Logistic regression analysis showed that the maximum diameter of the focus was the only significant risk factor for the amount of bleeding during the operation.Conclusion Color Doppler ultrasound can diagnose early pregnancy at uterine incision,and the measurement of the maximum diameter of the focus can predict the amount of uterine bleeding during operation,which can provide important guiding significance for the formulation of clinical treatment plan.

关 键 词：剖宫产瘢痕妊娠 彩色多普勒超声 个性化治疗 

分 类 号：R714.22[医药卫生—妇产科学] R445.1[医药卫生—临床医学]