经阴道超声在剖宫产术后子宫瘢痕妊娠中的诊断价值
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摘要
目的:探讨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。方法:回顾性分析2015年6月—2017年5月上海交通大学医学院附属国际和平妇幼保健院住院收治的268例剖宫产术后子宫瘢痕妊娠患者的超声声像图特征及临床资料。结果:268例剖宫产术后子宫瘢痕妊娠患者中,超声确诊250例,诊断符合率93.3%;误诊18例,误诊率6.7%,其中单纯孕囊型212例,混合回声型56例。根据孕囊与子宫前壁峡部浆膜层的距离将单纯孕囊型分为两种亚型:Ⅰ型(>3 mm)130例,Ⅱ型(≤3 mm)82例。结论:经阴道彩色多普勒超声检查是诊断剖宫产术后子宫瘢痕妊娠简便、准确、快捷及有效的诊断方法。
Objective: To explore the clinical value of transvaginal color Doppler ultrasound in the diagnosis of uterine scar pregnancy after cesarean section. Methods: The ultrasonographic features of 268 cases of uterine scar pregnancy hospitalized from Jun. 2015 to May. 2017 were analyzed retrospectively. Result: Among the 268 cases of cesarean scar pregnancy, 250 cases were correctly diagnosed, with the diagnosis accuracy of 93.3%; 18 cases were missed diagnosed, with the missed diagnosis rate of 6.7%. 212 cases were simple gestational sac type and 56 cases were heterogenous masses type. According to the distance between gestational sac and serous layer of the anterior wall isthmus of uterus, there were two subtypes of simple gestational sac: >3 mm(130 cases) and ≤3 mm(82 cases). Conclusion: Transvaginal ultrasonography is a simple, accurate, fast and effective diagnostic method for the diagnosis of cesarean scar pregnancy.
Objective: To explore the clinical value of transvaginal color Doppler ultrasound in the diagnosis of uterine scar pregnancy after cesarean section. Methods: The ultrasonographic features of 268 cases of uterine scar pregnancy hospitalized from Jun. 2015 to May. 2017 were analyzed retrospectively. Result: Among the 268 cases of cesarean scar pregnancy, 250 cases were correctly diagnosed, with the diagnosis accuracy of 93.3%; 18 cases were missed diagnosed, with the missed diagnosis rate of 6.7%. 212 cases were simple gestational sac type and 56 cases were heterogenous masses type. According to the distance between gestational sac and serous layer of the anterior wall isthmus of uterus, there were two subtypes of simple gestational sac: >3 mm(130 cases) and ≤3 mm(82 cases). Conclusion: Transvaginal ultrasonography is a simple, accurate, fast and effective diagnostic method for the diagnosis of cesarean scar pregnancy.
引文
[1]李康宁,戴晴.超声在剖宫产瘢痕评估中的临床应用[J].中华医学超声杂志(电子版),2014,11(4):307-310.
[2]李梅,王怡,王涌.经阴道彩色多普勒超声对不同剂量甲氨蝶呤治疗瘢痕妊娠疗效的评价[J].上海医学影像,2012,21(2):110-112.
[3]焦光琼,凌梅立,钱尚萍.经阴道彩色多普勒超声在诊断剖宫产子宫瘢痕妊娠中的价值[J].上海医学影像,2004,13(1):16-18.
[4]POMORSKI M,FUCHS T,ZIMMER M.Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the non-pregnant uterus:a prospective observational study[J].BMC Pregn Childbirth,2014,14(1):1-7.
[5]左常婷,连岩.凶险性前置胎盘诊治现状[J].山东大学学报(医学版),2016,54(9):1-6.
[6]中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].全科医学临床与教育,2017,15(1):5-9.
[7]GODIN P A,BASSIL S,DONNEZ J.An ectocpic pregnancy developing in a previous cesarean section scar[J].Fertil Steril,1997,67(2):398-400.
[8]THRUMOND A S,HARVEY W J.Cesarean section scar as a cause of abnormal vaginal bleeding:diagnosis by sonohysterography[J].Ultrasound Med,1999,18(1):13-16.
[9]REGNARD C,NOSBUSCH M,FELLEMANS C,et al.Cesarean section scar evaluation by saline contrast sonohysterography[J].Ultrasound Obstet Gynecol,2004,23(3):289-292.
[10]张瑛苹,付雪晴.剖宫产子宫切口瘢痕妊娠的超声诊断价值与误诊分析[J].临床超声医学杂志,2015,17(9):643-644.
[11]孙懿,聂小毳.经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值[J].中国实用妇科与产科杂志,2015,31(2):149-152.
[12]袁岩,戴晴.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):321-324.
[13]苏娜,姜玉新,戴晴,等.经阴道超声对侵蚀性葡萄胎的早期及精准诊断的预期观察[J].中华医学超声杂志(电子版),2017,14(2):99-104.
[2]李梅,王怡,王涌.经阴道彩色多普勒超声对不同剂量甲氨蝶呤治疗瘢痕妊娠疗效的评价[J].上海医学影像,2012,21(2):110-112.
[3]焦光琼,凌梅立,钱尚萍.经阴道彩色多普勒超声在诊断剖宫产子宫瘢痕妊娠中的价值[J].上海医学影像,2004,13(1):16-18.
[4]POMORSKI M,FUCHS T,ZIMMER M.Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the non-pregnant uterus:a prospective observational study[J].BMC Pregn Childbirth,2014,14(1):1-7.
[5]左常婷,连岩.凶险性前置胎盘诊治现状[J].山东大学学报(医学版),2016,54(9):1-6.
[6]中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].全科医学临床与教育,2017,15(1):5-9.
[7]GODIN P A,BASSIL S,DONNEZ J.An ectocpic pregnancy developing in a previous cesarean section scar[J].Fertil Steril,1997,67(2):398-400.
[8]THRUMOND A S,HARVEY W J.Cesarean section scar as a cause of abnormal vaginal bleeding:diagnosis by sonohysterography[J].Ultrasound Med,1999,18(1):13-16.
[9]REGNARD C,NOSBUSCH M,FELLEMANS C,et al.Cesarean section scar evaluation by saline contrast sonohysterography[J].Ultrasound Obstet Gynecol,2004,23(3):289-292.
[10]张瑛苹,付雪晴.剖宫产子宫切口瘢痕妊娠的超声诊断价值与误诊分析[J].临床超声医学杂志,2015,17(9):643-644.
[11]孙懿,聂小毳.经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值[J].中国实用妇科与产科杂志,2015,31(2):149-152.
[12]袁岩,戴晴.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):321-324.
[13]苏娜,姜玉新,戴晴,等.经阴道超声对侵蚀性葡萄胎的早期及精准诊断的预期观察[J].中华医学超声杂志(电子版),2017,14(2):99-104.