上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (10): 1398-.doi: 10.3969/j.issn.1674-8115.2017.10.018

• 论著（临床研究） • 上一篇    下一篇

经阴道超声在子宫切口妊娠诊断和治疗中的应用#br#

杨婷 1，吴婷婷 1，唐纳 2，顾继英 3   

  1. 上海交通大学附属第一人民医院 1. 妇产科，2. 影像医学科，3. 超声医学科，上海 200080
  • 出版日期:2017-10-28 发布日期:2017-11-01
  • 通讯作者: 顾继英，电子信箱：gu_angellove@163.com
  • 作者简介:杨婷（1986—），女，住院医师，硕士；电子信箱：pea44@163.com

Application of transvaginal ultrasound in diagnosis and treatment of cesarean scar pregnancy#br#

YANG Ting1, WU Ting-ting1, TANG Na2, GU Ji-ying3   

  1. 1. Department of Obstetrics and Gynecology, 2. Department of Medical Imaging, 3. Department of Ultrasound Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
  • Online:2017-10-28 Published:2017-11-01

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摘要： 目的 · 探讨剖宫产术后子宫切口妊娠（CSP）经阴道超声检查的表现，并评估经阴道超声结合 MRI 在 CSP 诊断和治疗中的价 值。方法 · 回顾性分析上海交通大学附属第一人民医院 3 年内收治的 42 例 CSP 患者的经阴道超声检查表现、MRI 结果及临床资料。 结果 · 42 例中确诊为 CSP 共 36 例，经阴道超声漏诊 1 例，误诊 5 例，诊断准确率 85.7%；经 MRI 检查 36 例，漏诊 3 例，误诊 1 例， 诊断准确率 88.9%。其中孕囊型 CSP 30 例，混合包块型 CSP 6 例。根据超声检查提示子宫下段切口处肌层厚度，对孕囊型 CSP 患者 采取不同处理方式：>3 mm 者采用吸宫术；≤ 3 mm 者进一步结合 MRI 检查，选择手术切除妊娠物或子宫动脉栓塞＋甲氨蝶呤化学治 疗＋吸宫术。结论 · 经阴道超声和 MRI 诊断 CSP 的准确率均较高。经阴道超声结合 MRI 可为 CSP 治疗方案选择提供重要的参考。

关键词: 子宫切口妊娠, 经阴道超声, 诊断, 治疗

Abstract:

Objective · To investigate the performance of transvaginal ultrasound (TVS) on cesarean scar pregnancy (CSP), and evaluate the value of TVS combined with MRI in the diagnosis and treatment of CSP.  Methods · A retrospective analysis was made in 42 patients with CSP in Shanghai General Hospital in recent 3 years. The TVS performance, MRI results, and clinical data of the patients were analyzed.  Results · In all 42 cases, 36 were diagnosed as CPS. TVS missed one case, and misdiagnosed 5 cases, which diagnostic accuracy was 85.7%. Thirty-six cases were tested by MRI, therein 32 cases were diagnosed correctly, 3 cases missed, 1 case misdiagnosed, which diagnostic accuracy rate was 88.9%. Among the 36 CSP cases, 30 were simple sac type and 6 were mixedmass type. For the simple sac type, different treatment was chosen according to the muscle thickness of the lower uterine segment incision measured by TVS. When it was more than 3 mm, suction surgery was used. But when it was no more than 3 mm, MRI examination was further used, and the surgical resection or uterine artery embolism+MTX+suction surgery was chosen.  Conclusion · Both TVS and MRI have a high diagnostic accuracy for CSP, and TVS combined with MRI can provide important reference for CSP treatment options.

Key words: cesarean scar pregnancy, transvaginal ultrasound, diagnosis, treatment