Clinical significance of transvaginal three-dimensional ultrasonography in the detection of Cesarean scar pregnancy
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摘要:
目的 探讨经阴道三维超声检测剖宫产子宫疤痕妊娠的临床意义。 方法 回顾性分析我院2015年1月~2017年6月入院收治的剖宫产瘢痕妊娠（CSP）产妇（62例）及普通产妇（56例），分析经阴道三维超声检测对CSP产妇诊断及预后的影响。 结果 CSP患者中49例为孕囊型，位于子宫中下段瘢痕处；24例患者孕囊内可见典型卵黄囊或胎芽，活胎可见胎心搏动，孕囊旁可见丰富的低阻血流信号，血液供应均来源于切口处肌层；13例为包块型，均位于子宫中下段瘢痕处，内部信号多为低回声或中等回声，部分患者无回声，包块周围血流丰富，信号以低阻血流信号为主。62例患者经治疗后均安全出院，其中19例采用保守治疗；15例患者接受保守治疗，恢复不理想后行经阴道子宫瘢痕妊娠病灶切除+子宫修补术；28例患者行刮宫术治疗成功，无患者行子宫切除术。 结论 经阴道三维超声检查能够清晰、准确地显示孕囊或团块与瘢痕的位置关系、血流分布及子宫肌壁等情况，通过图像能够更精准的评估孕囊确切生长的位置及与子宫疤痕关系，可作为早期诊断剖宫产CSP的首选检查方法之一，指导临床治疗方案的选择。 Abstract:Objective To investigate the clinical significance of transvaginal three-dimensional ultrasonography in the detection of Cesarean scar pregnancy (CSP). Methods 62 cases with CSP and 56 healthy parturient women hospitalized in our hospital from January 2015 to June 2017 were included, and the impact of transvaginal three-dimensional ultrasonography on the detection and prognosis of these cases was retrospectively analyzed. Results Of 62 CSP cases, the ultrasonography of 49 cases showed gestational sac type, located in the scar at the middle and lower part of the uterus; inside the gestational sac of 24 cases, typical yolk sac or fetal buds were visible, pulsation of fetal heart detected in live fetus, low resistance blood signal were showed around the gestational sac and all blood was supplied from the muscle layer of the incision; the ultrasonography of 13 cases showed mass type, located in the scare at the middle and lower part of the uterus, the signals inside which were all low echo or hypoecho and some showed no echo at all, and the surroundings of masses showed rich blood flow, with mainly low resistance blood signal. All 62 patients were securely discharged from hospital, among which 19 cases received conservative treatment, 15 patients were treated with transvaginal CSP lesion resection + uterus neoplasty after unsatisfied recovery from conservative treatment, 28 patients received dilatation and curettage successfully, and no patients received hysterectomy. Conclusion Transvaginal three-dimensional ultrasonography can clearly and accurately show the positional relationship between the gestational sac or clumps and scar, blood flow distribution and uterine muscle wall, etc., and doctors can assess the exact location of gestational sac and uterine scar more accurately with the ultrasonography images. Therefore, it can be considered as the primal method for the early diagnosis of CSP and for the guidance of clinical treatment selection. -
Key words:
- transvaginal three-dimensional ultrasound /
- scar pregnancy /
- diagnosis /
- prognosis
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表 1 两组患者一般情况比较（Mean±SD）
组别 年龄（岁） 距上次剖宫产时间（月） 妊娠物均径（cm） CSP组（n=62） 35.38±5.16 49.36±9.37 2.75±0.98 对照组（n=56） 36.71±6.96 51.16±9.98 2.68±0.94 t 1.21 1.04 0.41 P 0.23 0.30 0.69 CSP: 剖宫产瘢痕妊娠. 
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表 2 两组患者子宫下段隆起及妊娠位置情况比较（n）
组别 子宫下段隆起 妊娠物位置 是 否 宫腔中上段 宫腔下段 CSP组（n=62） 47 15 0 62 对照组（n=56） 0 56 27 29 t 70.55 38.76 P 0.00 0.00
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表 3 两组患者声像图像分类及瘢痕肌层情况比较（n）
组别 声像图分类 疤痕肌层内有无妊娠物 胎囊型 包块型 有 无 CSP组（n=62） 49 13 62 0 对照组（n=56） 39 17 0 56 χ2 1.37 118 P 0.24 0.00
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表 4 两组患者胎心搏动及滋养层血流情况比较（n）
组别 胎心搏动 滋养层血流 有 无 有 无 CSP组（n=62） 22 40 55 7 对照组（n=56） 17 39 45 11 χ2 0.35 1.59 P 0.55 0.21
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表 5 两组患者滋养层血流位置及宫腔积液情况比较（n）
组别 滋养层血流位置 宫腔积液 宫腔中上段 宫腔下段 有 无 CSP组（n=62） 62 0* 19* 43 对照组（n=56） 15 41 5 51 χ2 69.56 8.56 P 0.00 0.003 *P<0.05vs 对照组.
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