孕囊型与包块型剖宫产瘢痕妊娠的超声特征及临床特点分析  

Ultrasound characteristics and clinical features of gestational and mass cesarean scar pregnancy

作　　者：胡孝辉 桂霜 Hu Xiaohui;Gui Shuang(Department of Gynecology,First Maternity and Infant Hospital to Tongji University,Shanghai 201204;Department of Ultrasound,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201999,P.R.China)

机构地区：[1]同济大学附属第一妇婴保健院妇科,上海201204 [2]上海交通大学医学院附属第九人民医院超声医学科,上海201999

出　　处：《中国计划生育和妇产科》2023年第8期70-73,78,I0001,共6页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的比较分析孕囊型剖宫产瘢痕妊娠(gestational cesarean scar pregnancy,GCSP)与包块型剖宫产瘢痕妊娠(mass cesarean scar pregnancy,MCSP)的超声特征及临床特点。方法回顾性分析2016年8月至2021年12月在上海交通大学医学院附属第九人民医院经临床随访或手术病理证实的剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)108例,根据超声内部回声分为孕囊型与包块型,其中GCSP 86例,MCSP 22例,比较分析两种分型的超声特征及临床特点。结果GCSP组86例,其中66例孕囊部分或小部分着床于瘢痕处,大部分位于宫腔下段,38例瘢痕处剩余肌层厚度>3 mm,28例瘢痕处剩余肌层厚度≤3 mm;20例孕囊完全着床于瘢痕处,瘢痕处剩余肌层厚度≤3 mm。MCSP组22例,混合性包块完全着床于子宫下段前壁瘢痕处,瘢痕处剩余肌层厚度≤3 mm。超声特征:MCSP组较GCSP组病灶更大、瘢痕处剩余肌层更薄、病灶血供更丰富(P<0.05);在子宫位置、宫底部子宫内膜厚度及盆腔积液方面两组差异无统计学意义(P>0.05)。临床特点:MCSP组年龄更大,停经天数、流产次数、阴道出血病例数更多,开腹或腹腔镜下清除妊娠物+瘢痕处修复术比例更高、术中出血量更多、但术前及术后3 d血β-hCG值低(P<0.05);在剖宫产次数、距离前次剖宫产时间方面两组差异无统计学意义(P>0.05)。结论MCSP组较GCSP组超声特征更复杂,发生大出血及开腹手术干预的概率增加,结局愈后更加不良,须引起超声及临床医生高度重视,及时正确处理。Objective To compare and analyze the ultrasonic and clinical characteristics of gestational cesarean scar pregnancy(GCSP)and mass cesarean scar pregnancy(MCSP).Methods 108 cases of cesarean scar pregnancy(CSP)in Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,confirmed by clinical follow-up or surgical pathology were collected from August 2016 to December 2021.According to the ultrasonic internal echo,they were divided into 86 cases of GCSP and 22 cases of MCSP.The ultrasonic characteristics and clinical features of the two groups were compared and analyzed.Results 86 cases of GCSP,including 66 cases with gestational sac implanted small of the scar and mostly intrauterine,38 cases with the remaining muscular thickness at the scar>3 mm,and 28 cases≤3 mm,20 cases with gestational sac completely implanted in the scar,and the thickness of the remaining muscle layer≤3 mm;22 cases of MCSP which showed mixed echo mass in the scar of lower uterine segment,the remaining muscular thickness≤3 mm.Ultrasound characteristics:compared with GCSP group,MCSP group had larger lesions,thinner remaining muscle layer in scar and more blood supply(P<0.05);the uterine position,endometrial thickness at the bottom of theuterus and pelvic effusion had no difference(P>0.05).Clinical features:The MCSP group was older,had more days of menopause,more abortions and vaginal bleeding,higher rates of gestation removal and scar repair under laparoscopy or laparoscopy,more intraoperative blood loss,but had lower bloodβ-hCG value before and three days after surgery(P<0.05).The number of cesarean sections,the interval time from the previous cesarean section between two groups had no difference(P>0.05).Conclusion Compared with GCSP group,the ultrasonic characteristics of MCSP group are more complex,the probability of massive hemorrhage and open surgery intervention is increased,and the outcome is worse after recovery.Therefore,ultrasound and clinicians should pay high attention to it and deal with it timely and c

关 键 词：剖宫产瘢痕妊娠 超声特征 临床特点 

分 类 号：R714.22[医药卫生—妇产科学]