经阴道彩色多普勒超声在剖宫产术后子宫瘢痕妊娠中的临床价值(1)
摘要：目的 探讨经阴道彩色多普勒超声在剖宫产术后子宫瘢痕妊娠(CSP)中的临床价值。方法 选取我院2014年1月～2016年1月47例剖宫产术后子宫瘢痕妊娠患者，均得到手术及病理确定，均经阴道彩色多普勒超声检查，且经超声引导实施瘢痕妊娠病灶的穿刺注药治疗，观察超声影像学特征及治疗效果。结果 早早孕型为4例，胚囊型为22例，不均质包块型为16例；治疗后，子宫前壁下段肌层厚度显著增加，与治疗前比较有明显统计学差异(P<0.05)，患者病灶与周围肌层回声明显下降，病灶周围血流信号显著降低，RI值与治疗前比较显著提高，对比差异有统计学意义(P<0.05)。结论 经阴道彩色多普勒超声在剖宫产术后子宫瘢痕妊娠中具有重要应用价值，可有效诊断CSP，并可引导穿刺注药治疗，应用价值较高。
关键词：经阴道彩色多普勒超声；剖宫产；术后；子宫瘢痕妊娠
Abstract：Objective To investigate the clinical value of transvaginal color Doppler ultrasonography in uterine scar pregnancy(CSP)after cesarean section.Methods A total of 47 patients with uterine scar after cesarean section were selected from January 2014 to January 2016.They were treated by surgery and pathology.All of them were examined by transvaginal color doppler ultrasonography and subjected to ultrasound.Lesions of the puncture drug treatment，observation of ultrasound imaging features and treatment.Results There were 4 cases of early pregnancy type，22 cases of embryo type and 16 cases of heterogeneous mass.After treatment，the thickness of myometrium in the anterior wall of the uterus increased significantly，which was significantly different from that before treatment(P<0.05).The echo of the lesion and the surrounding muscle layer decreased significantly，and the blood flow around the lesion was significantly reduced.The RI value was significantly higher than that before treatment，the difference was statistically significant(P<0.05)Conclusion Transvaginal color doppler ultrasonography has an important value in the treatment of uterine scar after cesarean section.It can effectively diagnose CSP and can guide the treatment of puncture and injection，and its application value is high.
, http://www.100md.com
Key words：Transvaginal color doppler ultrasound；Cesarean section；Postoperative；Uterine scar pregnancy
剖宫产术后子宫瘢痕妊娠(CSP)作为一种较为特殊的异位妊娠，是指受精卵、滋养叶细胞着床到剖宫产术后子宫瘢痕位置，近些年來，由于使用剖宫产分娩的产妇例数增加，使得CSP发生率明显提高[1]。因子宫瘢痕妊娠早期并无典型的临床症状，与正常怀孕的表现几乎是一样的，有停经史、子宫增大、血和尿HCG阳性等正常早孕表现，故在早期极易出现误诊、漏诊情况[2]。伴随妊娠进展极有可能出现子宫破裂及出血症状，或清宫治疗时，极易发生难以控制的大出血症状，从而对生命安全造成严重威胁[3]。本文选取47例剖宫产术后子宫瘢痕妊娠患者，经阴道彩色多普勒超声检查，探讨其超声特征及治疗效果，报道如下。
1 资料与方法
, 百拇医药 1.1一般资料 选取我院2014年1月～2016年1月47例剖宫产术后子宫瘢痕妊娠患者，均经手术及病理证实。年龄为26～41岁，平均年龄为(32.6±1.9)岁﹔自末次月经到超声检测间隔时间为31～78 d，平均时间为(43.6±4.8)d﹔自上次剖宫产到本次妊娠间隔时间为3个月～12年，平均时间为(3.0±0.5)年；患者的临床表现主要为阴道出血、持续性腹痛，有的患者并未出现显著的临床症状。
1.2方法 患者均经阴道彩色多普勒成像技术(TVCD)进行超声检查，经阴道探头频率设定为6.5MHz，阴道超声检查前嘱患者排空膀胱，取膀胱截石位，探头套入无菌避孕套，放置到阴道后穹隆或侧壁处，先实施常规妇科扫查，然后对孕囊或团块的着床部位进行重点检查，测量孕囊或包块的长径和横径，妊娠物及妊娠物处于子宫肌壁的厚度，注意内部是否出现卵黄囊、胎芽或胎心搏动，并观察病灶与原手术切口的位置关系及切口处子宫肌层的回声，测量孕囊或包块外缘与子宫狭部浆膜的肌层厚度、回声、周边血流分布及动脉血流阻力指数(RI)，注意观察妊娠囊与剖宫产瘢痕、宫壁、宫腔的关系，重点观察彩色血液信号图像、妊娠物附着部位与子宫切口处的关系。, 百拇医药(刘虹)
关键词：经阴道彩色多普勒超声；剖宫产；术后；子宫瘢痕妊娠
Abstract：Objective To investigate the clinical value of transvaginal color Doppler ultrasonography in uterine scar pregnancy(CSP)after cesarean section.Methods A total of 47 patients with uterine scar after cesarean section were selected from January 2014 to January 2016.They were treated by surgery and pathology.All of them were examined by transvaginal color doppler ultrasonography and subjected to ultrasound.Lesions of the puncture drug treatment，observation of ultrasound imaging features and treatment.Results There were 4 cases of early pregnancy type，22 cases of embryo type and 16 cases of heterogeneous mass.After treatment，the thickness of myometrium in the anterior wall of the uterus increased significantly，which was significantly different from that before treatment(P<0.05).The echo of the lesion and the surrounding muscle layer decreased significantly，and the blood flow around the lesion was significantly reduced.The RI value was significantly higher than that before treatment，the difference was statistically significant(P<0.05)Conclusion Transvaginal color doppler ultrasonography has an important value in the treatment of uterine scar after cesarean section.It can effectively diagnose CSP and can guide the treatment of puncture and injection，and its application value is high.
, http://www.100md.com
Key words：Transvaginal color doppler ultrasound；Cesarean section；Postoperative；Uterine scar pregnancy
剖宫产术后子宫瘢痕妊娠(CSP)作为一种较为特殊的异位妊娠，是指受精卵、滋养叶细胞着床到剖宫产术后子宫瘢痕位置，近些年來，由于使用剖宫产分娩的产妇例数增加，使得CSP发生率明显提高[1]。因子宫瘢痕妊娠早期并无典型的临床症状，与正常怀孕的表现几乎是一样的，有停经史、子宫增大、血和尿HCG阳性等正常早孕表现，故在早期极易出现误诊、漏诊情况[2]。伴随妊娠进展极有可能出现子宫破裂及出血症状，或清宫治疗时，极易发生难以控制的大出血症状，从而对生命安全造成严重威胁[3]。本文选取47例剖宫产术后子宫瘢痕妊娠患者，经阴道彩色多普勒超声检查，探讨其超声特征及治疗效果，报道如下。
1 资料与方法
, 百拇医药 1.1一般资料 选取我院2014年1月～2016年1月47例剖宫产术后子宫瘢痕妊娠患者，均经手术及病理证实。年龄为26～41岁，平均年龄为(32.6±1.9)岁﹔自末次月经到超声检测间隔时间为31～78 d，平均时间为(43.6±4.8)d﹔自上次剖宫产到本次妊娠间隔时间为3个月～12年，平均时间为(3.0±0.5)年；患者的临床表现主要为阴道出血、持续性腹痛，有的患者并未出现显著的临床症状。
1.2方法 患者均经阴道彩色多普勒成像技术(TVCD)进行超声检查，经阴道探头频率设定为6.5MHz，阴道超声检查前嘱患者排空膀胱，取膀胱截石位，探头套入无菌避孕套，放置到阴道后穹隆或侧壁处，先实施常规妇科扫查，然后对孕囊或团块的着床部位进行重点检查，测量孕囊或包块的长径和横径，妊娠物及妊娠物处于子宫肌壁的厚度，注意内部是否出现卵黄囊、胎芽或胎心搏动，并观察病灶与原手术切口的位置关系及切口处子宫肌层的回声，测量孕囊或包块外缘与子宫狭部浆膜的肌层厚度、回声、周边血流分布及动脉血流阻力指数(RI)，注意观察妊娠囊与剖宫产瘢痕、宫壁、宫腔的关系，重点观察彩色血液信号图像、妊娠物附着部位与子宫切口处的关系。, 百拇医药(刘虹)
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