经阴道彩色多普勒超声在子宫切口妊娠介入治疗中的应用

目的：评价经阴道彩色多普勒超声检查在子宫动脉化疗栓塞法治疗子宫下段剖宫产切口妊娠中的应用价值。方法：回顾分析2006年—2008年30例子宫切口妊娠病例,其中18例患者接受子宫动脉甲氨蝶呤（MTX）化疗栓塞法治疗＋超声监护下刮宫术,另12例接受全身药物（MTX）治疗＋超声监护下刮宫术,分析两组病例的超声声像图特征及其治疗后超声图像的变化,随访其预后。结果：（1）30例病例初诊诊断符合率为100%,均表现为胚囊型。（2）两组病例化疗后胚囊周围肌层彩色血流的RI值均增高（P〈0.05）,两组RI增高值的差异无统计学意义（P〉0.05）。（3）两组病例治疗后超声声像图均发生规律性的变化。（4）两组病例住院时间的差异无统计学意义（P〉0.05）。（5）动脉化疗组绒毛膜促性腺激素（HCG）下降至正常的时间和肿块完全消失的时间短于全身化疗组（P〈0.05）。结论：经阴道彩色多普勒超声检查对子宫剖宫产切口妊娠能提供较准确的早期诊断,在其治疗和随访中发挥着重要的监测作用。在治疗子宫切口妊娠的过程中,子宫动脉化疗栓塞法可能更优于传统的全身化疗法。

Application of Transvaginal Color Doppler Ultrasonography in the Treatment of Cesarean Section Pregnancy with Uterine Artery Chemotherapy and Embolization

Objective：To evaluate the value of transvaginal color Doppler ultrasonography in the treatment of cesarean section pregnancy（CSP） with bilateral uterine artery chemotherapy and embolization（UACE）.Methods： Thirty cases of CSP were studied retrospectively diagnosed and managed from 2006 to 2008.All the patients were administered methotrexate chemotherapy and ultrasonography-guided dilatation and curettage（DC）.Among the patients,18 cases were treated with UACE and DC,and the other 12 cases were given systemic chemotherapy and DC.Color Doppler sonographic findings,clinical treatments and value,pathologic results and prognosis were followed up and analyzed.Results：（1）The rate of preliminary diagnosis coincidence was 100%.（2）Resistent index（RI） of the blood flow in the myometrium rised in the two groups（P0.05）.The changes of RI in the UACE group had no statistical significance compared with the other groups（P0.05）.（3） The ultrasonic images in the two groups changed regularly after clinical treatment.（4）The hospital day（HOD） of the UACE group had no statistical significance compared with the HOD of the other groups（P0.05）.（5）The periods that human chorionic gonadotropin（HCG） dropped to natural level and the periods that the masses disappeared completely in the UACE group were both shorter than the ones in the other group（P0.05）.Conclusions： Transvaginal color Doppler ultrasound may give an early and precise diagnosis for CSP,especially for that has a gestation sac,and may direct the exact therapy and predict prognosis.UACE may be better than the traditional systemic chemotherapy in the treatment of CSP.