经阴道超声介入配合药物治疗剖宫产术后瘢痕妊娠

目的：探讨经阴道超声在子宫瘢痕处妊娠的诊断和保守治疗中的意义。方法：回顾性分析12例子宫瘢痕处妊娠患者的临床资料及诊治经过,并总结其声像图特点。12例患者均有血人绒毛膜促性腺激素升高,其中人工流产术后阴道出血9例,不明原因停经3例。12例均行经阴道超声检查。10例于超声引导下向胎囊内注射氨甲喋呤（MTX）并联合米非司酮口服治疗。2例血管造影检查后行子宫动脉栓塞及清宫。结果：12例患者经阴道超声检查显示子宫前壁下段胎囊,周边及内部血流信号丰富,呈高速低阻型,阻力指数（RI）〈0.6,诊断为剖宫产术后子宫瘢痕处妊娠。经过以上保守治疗后全部病灶内血流信号明显减少,RI〉0.6。结论：经阴道超声检查是诊断剖宫产术后子宫瘢痕处妊娠的主要方法;经阴道超声介入配合药物治疗是其重要治疗方法,对该病的保守治疗具有较大的作用。

Exploration of the diagnosis and therapy of cesarean scar pregnancy by transvaginal color Doppler ultrasonography

Objective：To observe the effects of transvaginal color Doppler ultrasonography（TVCDU） on the diagnosis and conservative therapy of cesarean scar pregnancy（CSP）.Methods：12 cases of cesarean scar pregnancy from 2007 to 2010 were analyzed retrospectively.The β-HCG levels of all the patients were higher than normal.9 cases had vaginal bleeding after artificial abortion,3 cases had menolipsis without definite reasons.10 cases were treated by TVCDU-guided injection of MTX to gestational sac and oral administration of mifepristone.2 cases were treated by embolisation of uterine artery and cesarean delivery after vasography.Results：12 cases were diagnosed as cesarean scar pregnancy by TVCDU,RI〈0.6.After above-mentioned treatments,the blood flow in the gestational sac was decreased,RI〉0.6.Conclusion：TVCDU is an important method for diagnosis of CSP.Combination of TVCDU-guided intervention with oral administration of mifepristone is an important method of conservative treatment,which is advantageous to the therapy results.