经阴道超声与超声造影联合临床因素评估剖宫产术后瘢痕妊娠治疗方式的研究  

Transvaginal ultrasound and contrast-enhanced ultrasound combined with clinical factors to assess the treatment options of cesarean scar pregnancy

作　　者：肖汀 黄伟俊[1] 张四友[2] 甄朝炯 温影红[1] 曹韵清[1] Xiao Ting;Huang Weijun;Zhang Siyou;Zhen Chaojiong;Wen Yinghong;Cao Yunqing(Ultrasonic Diagnosis and Treatment Center,the First People′s Hospital of Foshan,Foshan 528000,China;Department of Obstetrics and Gynecology,the First People′s Hospital of Foshan,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院超声诊疗中心,佛山528000 [2]佛山市第一人民医院妇产科,佛山528000

出　　处：《中华超声影像学杂志》2022年第3期231-235,共5页Chinese Journal of Ultrasonography

基　　金：佛山市"登峰计划"专项资金(2019D051);广东省科学技术奖培育项目(2020001003309);佛山市卫生健康局医学科研课题(20220054)。

摘　　要：目的探讨经阴道超声与超声造影联合临床因素对剖宫产术后瘢痕妊娠治疗方案选择的指导意义。方法回顾性分析2016年1月至2021年6月佛山市第一人民医院120例剖宫产术后子宫瘢痕妊娠患者的临床、经阴道超声及超声造影指标,将其按治疗方式分为宫腔镜/超声引导下吸宫组(91例)和腹腔镜组(29例),比较两组间临床及超声指标的差异,确定影响治疗方式选择的相关临床及超声指标。结果两组间孕囊/包块是否向浆膜突出、孕囊/包块长径、超声造影显示孕囊/包块主要供血部位、绒毛膜/早期胎盘部位、瘢痕厚度比较差异有统计学意义(均P<0.05)。Logistic回归分析显示,超声造影显示孕囊/包块主要供血部位(OR=6.029,P=0.003)、子宫瘢痕厚度(OR=12.998,P=0.002)是微创手术治疗剖宫产术后瘢痕妊娠的独立危险因素。结论经阴道超声与超声造影联合临床因素对剖宫产术后瘢痕妊娠治疗方案选择有一定价值,超声造影评估子宫瘢痕厚度、孕囊/包块主要供血部位可能是影响微创手术治疗剖宫产术后瘢痕妊娠的关键因素。Objective To investigate the significance of clinical factors combined with transvaginal ultrasound and contrast-enhanced ultrasound(CEUS)in guiding the choice of treatment plan for cesarean scar pregnancy(CSP).Methods The clinical and transvaginal ultrasound and CEUS data of 120 patients with CSP from January 2016 to June 2021 in the First People′s Hospital of Foshan were retrospectively analyzed,and they were divided into ultrasound-guided curettage/hysteroscopic group(Group A,91 cases)and laparoscopic group(Group B,29 cases)according to treatment option,and the differences in clinical and ultrasound factors between the two groups were compared,and to determine the relevant clinical and ultrasound indicators for the choice of treatment option.Results There were statistical differences between the 2 groups in comparison of whether the gestational sac/mass protruded toward the plasma membrane,gestational sac/mass diameter,the main blood supply site of the gestational sac/mass,the site of the chorion/early placenta and scar thickness(all P<0.05).Logistic regression analysis indicated that CEUS showing major blood supply site of the gestational sac/mass(OR=6.029,P=0.003)and uterine scar thickness(OR=12.998,P=0.002)were independent risk factors for minimally invasive surgery for CSP.Conclusions Ultrasound combined with clinical factors have a certain value in the selection of treatment options for CPS,and the thickness of the uterine scar and the main blood supply site of the gestational sac/mass showed in CEUS may be key factors affecting the minimally invasive surgical treatment of CSP.

关 键 词：超声检查 超声造影 瘢痕妊娠 手术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.22[医药卫生—诊断学]