Diagnostic value and clinical significance of type I and type II cesarean scar pregnancy by transvaginal color doppler ultrasound
-
摘要:
目的探讨经阴道彩色多普勒超声对Ⅰ型及Ⅱ型子宫瘢痕妊娠(CSP)的诊断价值。 方法对2016年1月~2018年12月期间在我院采用经阴道彩色多普勒超声检测的71例CSP患者的超声图像特点及临床表现进行分析。 结果71例CSP经阴道彩色多普勒超声诊断56例为Ⅰ型CSP、15例为Ⅱ型CSP。CSP的早期临床表现不典型,主要表现为停经后不规则阴道出血34例(47.89%),下腹痛17例(23.95%);住院处理45例,在34例Ⅰ型CSP患者中病理诊断符合率88.24%(30例),误诊4(11.77%)例,在11例Ⅱ型CSP患者中病理诊断符合率100.00%(11例)。 结论经阴道彩色多普勒超声检测有助于早期诊断CSP,早期诊断CSP是降低妊娠风险的关键环节。 -
关键词:
- 剖宫产 /
- 子宫瘢痕妊娠 /
- 经阴道彩色多普勒超声 /
- 早期诊断
Abstract:ObjectiveTo explore the diagnostic value and clinical significance of transvaginal color doppler ultrasound in patients with type I and type II cesarean scar pregnancy (CSP). MethodsSeventy-one CSP patients were detected by transvaginal color Doppler ultrasound from January 2016 to December 2018. The ultrasonographic features and clinical manifestations of 71 patients were collected and analyzed. ResultsIn 71 CSP patients diagnosed by transvaginal color Doppler ultrasound, 56 patients were diagnosed as type I CSP and 15 patients were diagnosed as type II CSP. Thirty-for cases (47.89%) developed symptom of irregular vaginal bleeding after menopause and 17 cases (23.95%) developed symptom of lower abdominal pain, indicating that early clinical manifestations of CSP patients were atypical. Fourty-five patients out of 71 CSP patients received further treatments. The coincidental rate of pathological diagnosis was 88.2% for type I CSP patients, whereas 100.0% for type II CSP patients. ConclusionTransvaginal color Doppler ultrasound is valuable for early diagnosis of CSP and prevention of pregnancy risk. Further prospective multicenter research is necessary to further ascertain the diagnostic value and clinical significance of transvaginal color Doppler ultrasound for CSP patients. -
表 1 不同类型CSP的妊娠囊超声征情况表[n(%)]
类型 例数 瘢痕处可见妊娠囊 卵黄囊 胚芽及原始心管搏动 只见胚芽 未见胚芽及原始心管搏动 Ⅰ型 56 56(100.00) 56(100.00) 23(41.08) 4(7.15) 29(51.79) Ⅱ型 15 15(100.00) 15(100.00) 12(80.00) 1(26.67) 2(13.33) 合计 71 71(100.00) 71(100.00) 35(49.29) 5(7.05) 31(43.66) 表 2 经阴道超声诊断不同类型CSP临床表现与病灶组织物病理检查结果对照表[n(%)]
类型 例数 无任何不适常规早孕检查 停经后不规则阴道出血 下腹隐痛或胀痛 终止妊娠病理确诊数 误诊数 Ⅰ型 34 14(41.18) 19(55.89) 5(14.71) 30(88.24) 4(11.77) Ⅱ型 11 7(63.64) 2(9.09) 2(9.09) 11(100.00) 0(0.00) 合计 45 21(46.67) 21(46.67) 7(15.56) 41(91.12) 4(8.89) -
[1] 中华医学会妇产科学分会计划生育学组. 剖宫产术后瘢痕妊娠诊治专家共识[J]. 中华妇产科杂志, 2016, 51(8): 568-72. doi: 10.3760/cma.j.issn.0529-567x.2016.08.003 [2] Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options[J]. Curr Opin Obstet Gynecol, 2011, 23(6): 415-21. doi: 10.1097/GCO.0b013e32834cef0c [3] Seow KM, Huang LW, Lin YH, et al. Cesarean scar pregnancy: issues in management[J]. Ultrasound Obstet Gynecol, 2004, 23(3): 247-53. doi: 10.1002/uog.974 [4] 马金春, 叶 聪. 疤痕子宫再妊娠孕妇经阴道分分娩的安全性研究[J]. 中外女性健康研究, 2018, 25(15): 13-4. doi: 10.3969/j.issn.2096-0417.2018.15.007 [5] Sel G, Sucu S, Harma M, et al. Successful management of cesarean scar pregnancy with vacuum extraction under ultrasound guidance[J]. Acute Med Surg, 2018, 5(4): 358-61. doi: 10.1002/ams2.2018.5.issue-4 [6] 廖彩华, 陈禄英, 林 丽. 子宫疤痕妊娠的经腹及经阴道彩色多普勒超声诊断分析[J]. 中国临床医学影像杂志, 2016, 27(1): 42-4. [7] 吴新如. 经腹及经阴道彩色多普勒超声对子宫疤痕妊娠的诊断价值研究[J]. 吉林医学, 2017, 38(4): 612-3. doi: 10.3969/j.issn.1004-0412.2017.04.003 [8] 余 萍, 刘 娟. 剖宫产术后子宫疤痕处妊娠18例临床分析[J]. 中国妇幼保健, 2013, 28(6): 920-1, 927. doi: 10.7620/zgfybj.j.issn.1001-4411.2013.06.08 [9] Riaz RM, Williams TR, Craig BM, et al. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes[J]. Abdom Imaging, 2015, 40(7): 2589-99. doi: 10.1007/s00261-015-0472-2 [10] Smith A, Ash A, Maxwell D. Sonographic diagnosis of cesarean scar pregnancy at 16 weeks[J]. J Clin Ultrasound, 2007, 35(4): 212-5. doi: 10.1002/(ISSN)1097-0096 [11] 马新群, 陆 娴. 彩色多普勒血流显像在剖宫产术后子宫瘢痕妊娠诊治中的价值[J]. 中国妇幼保健, 2017, 32(12): 2787-90. [12] 刘静华, 范 义, 刘滨月, 等. 经阴道彩超诊断及鉴别诊断子宫疤痕妊娠的价值[J]. 中国妇幼保健, 2012, 27(5): 767-8. [13] 徐丛剑, 华克勤. 实用妇科学4版[M]. 北京: 人民卫生出版社, 2017: 130-1. [14] Einenkel J, Stumpp P, Kösling S, et al. A misdiagnosed case of caesarean scar pregnancy[J]. Arch Gynecol Obstet, 2005, 271(2): 178-81. doi: 10.1007/s00404-004-0683-1 [15] 周逸雪, 林 英, 李云云. 子宫瘢痕部位妊娠诊治现状及研究进展[J]. 中国妇幼保健, 2018, 33(12): 2869-73. [16] Petersen KB, Langhoff-Roos J, Krebs L, et al. Pregnancy within the uterine scar of a prior caesarean section[J]. Ugeskr Laeger, 2010, 172(33): 2226-31. [17] 袁 岩, 戴 晴, 蔡 胜, 等. 超声对剖宫产瘢痕妊娠的诊断价值[J]. 中华超声影像学杂志, 2010, 19(4): 321-4. doi: 10.3760/cma.j.issn.1004-4477.2010.04.018 [18] 胡友斌, 郭汉青. 子宫疤痕妊娠的诊治进展[J]. 生殖医学杂志, 2018, 27(7): 692-6. doi: 10.3969/j.issn.1004-3845.2018.07.019 [19] 孙雪梅, 王淑云, 梁 梅, 等. 彩色多普勒超声检测滋养细胞血流信号在剖宫产后子宫疤痕妊娠早期诊断中的应用[J]. 临床超声医学杂志, 2014, 16(7): 502-3. [20] 刘淑颖, 成红宇. 阴道内超声诊断剖宫产切口瘢痕处妊娠26例[J]. 肿瘤影像学, 2014, 23(2): 99-101. [21] 孙凤华. 剖宫产瘢痕妊娠超声早期诊断价值[J]. 航空航天医学杂志, 2016, 27(11): 1375-6. doi: 10.3969/j.issn.2095-1434.2016.11.020 [22] 迟明艳. 经阴道彩色多普勒超声诊断剖宫产术后子宫瘢痕妊娠的临床价值评价[J]. 影像研究与医学应用, 2018, 2(12): 158-9. doi: 10.3969/j.issn.2096-3807.2018.12.101 [23] 胡 娟, 朱 宁, 石书霞. 经腹超声和经阴道超声对剖宫产术后子宫瘢痕妊娠的诊断价值比较[J]. 中国妇幼保健, 2018, 33(22): 5262-4. [24] 宋如昕, 盖永浩. 剖宫产术后子宫瘢痕妊娠影像诊断研究进展[J]. 医学影像学杂志, 2018, 28(3): 401-99.