剖宫产后子宫瘢痕妊娠的MRI分型及临床价值  

The MRI classification and clinical value of cesarean scar pregnancy

作　　者：魏常辉[1] 蔡春仙[1] 赵世胜[1] 闵凡[1] WEI Changhui;CAI Chunxian;ZHAO Shisheng;MIN Fan(Imaging Center,the Second People's Hospital of Neijiang,Neijiang,Sichuan Prooince 641000,China)

机构地区：[1]内江市第二人民医院影像中心,四川内江641000

出　　处：《实用放射学杂志》2021年第1期84-87,96,共5页Journal of Practical Radiology

基　　金：四川省医学科研青年创新课题(Q17050).

摘　　要：目的应用MRI观察剖宫产后子宫瘢痕妊娠(CSP)孕囊与切口憩室的关系,评价其临床价值.方法回顾分析31例经手术、病理证实的CSP患者MRI资料,对孕囊与切口憩室的关系进行分型,探讨不同类型的临床意义.结果31例妊娠孕囊均位于子宫前下段切口憩室处,病理标本显微镜下均见绒毛及蜕膜组织(100%);结合术中表现、术后出血量及送检标本确诊CSP穿透子宫壁7例、植入子宫壁7例、与子宫壁粘连17例.根据MRI孕囊与切口憩室的关系将31例CSP分为充满型(15例,占48.39%)、部分充填型(7例,占22.58%)、掩盖型(9例,占29.03%)3种类型.充满型CSP中,MRI表现为囊性型孕囊13例、包块型2例,阴道流血率占73.33%(11/15),孕囊平均体积(16.78±11.62)cm3;部分充填型CSP中,MRI表现为囊性型孕囊6例、包块型1例,阴道流血率57.14%(4/7),孕囊平均体积(38.85±15.55)cm3;掩盖型CSP中,MRI表现为囊性型孕囊1例、包块型8例,阴道流血率22.22%(2/9),孕囊平均体积(127.92±86.96)cm3.结论MRI能直观显示CSP孕囊与切口憩室的关系,对其进行较准确的分型.Ohjective To assess the clinical value of MRl in observing the relationships between gestational sac and scear diverticulumin cesarean scar pregnancy(CSP).Methodls The MRI findings of 31 patients with CSP confirmed by surgery and pathology were analyzedretrospectively.The relationships between gestational sac and scar diverticulum were classified and the clinical significance of differenttypes was discussed.Results The gestational sacs of 3l patients were located in scar diverticulum at the lower anterior uterus wall Villi and deciduas were found under microscope within pathological specimens(1l00%).Combined with intraoperative performance,post-operative bleeding volume,post-operative specimens,it was diagnosed definitely that 7 cases pencetrated uterine wall,7 cases implanteduterine wall and 17 cases was adhesion with uterine wall.All 31 cases were classified to fulled CSP(15 cases,48.39%),partial filled CSP(7 cases,22.58%)and covered CSP(9 cases,29.03%)according to the relationships of gestational sac and scar diverticulum.Ilnthe fulled CSP group,13 cases were presented with eystic type and 2 were mass type on MRI,with the incidence rate of vagina bleedingwas73.33%(11/15)and the average volume of gestational sac was(16.78±11.62)cm^3.In the partial filled CSP group,there were 6cases presented with cystic type and 1 with mass type on MRIl,and the incidence rate of vagina bleding was 57.14%(4/7),the averagevolume of gestational sac was(38.85±15.55)cm^3.Only 1 case was presented with eystic type and other 8 were mass type on MR1 inthe covered CSP group,meanwhile,the incidence rate of vagina bleeding was 22.22%(2/9)and the average volume of gestational sacwas(127.92±86.96)cm^3.Conclusion MRI can indicate the relationships between gestational sac and scar diverticulum visually andoffer a precise typing.

关 键 词：瘢痕妊娠 磁共振成像 剖宫产术 

分 类 号：R714.2[医药卫生—妇产科学] R445.2[医药卫生—临床医学]