剖宫产瘢痕妊娠经阴道超声图像特征分析

目的:探讨剖宫产瘢痕妊娠(CSP)的阴道超声表现。方法:回顾性分析298例CSP经阴道超声的图像,观察妊娠物的位置、回声及与子宫切口的关系及子宫切口部位的厚度、血流情况。结果:298例CSP根据声像图特征分为2型:孕囊型(182例)和流产型(116例)。结论:CSP由于病史不同声像图各具特征性表现,经阴道超声对CSP的诊断有重要的价值。     

经阴道彩色多普勒超声检查对诊断剖宫产子宫瘢痕妊娠的临床意义

目的 探讨经阴道彩色多普勒超声检查对诊断剖宫产子宫瘢痕妊娠的临床意义。方法 选取50例剖宫产子宫瘢痕妊娠患者,分别实施经阴道彩色多普勒超声检查和经腹部彩色多普勒超声检查。对比两种检查方法患者的误诊率、漏诊率、确诊率、超声声像分型及满意度。结果 经阴道彩色多普勒超声的确诊率为98.00%,高于经腹部彩色多普勒超声诊断的82.00%,经阴道彩色多普勒超声诊断的误诊率低于经腹部彩色多普勒超声（P<0.05）。两种诊断方法显示的超声声像分型比较,差异无统计学意义（P>0.05）。经阴道彩色多普勒超声诊断的满意度明显高于经腹部彩色多普勒超声（P<0.05）。结论 采用经阴道彩色多普勒超声诊断剖宫产子宫瘢痕妊娠,具有较高的诊断确诊率,且能清晰显示声像分型,获得患者的认可与满意。     

剖宫术后瘢痕妊娠经腹部及经阴道彩色多普勒联合应用的误诊分析

目的：经手术及病理证实的67例剖宫术后瘢痕妊娠经腹部彩色多普勒（TAS）及经阴道彩色多普勒（TVS）超声表现及对其中12例误诊原因进行回顾分析,提高超声对其诊断准确率。方法：对67例本院经手术及病理证实的剖宫产术后瘢痕妊娠经腹部及经阴道彩色多普勒检查结果进行回顾性对比分析,并查找其中12例误诊原因。结果：剖宫术后瘢痕妊娠（Caesarean Scar Pregnancy,cps）,TAS＋TVS诊断符合率81％,TAS＋TVS检查诊断符合率较TAS诊断符合率显著提（P〈0．01）。结论：TAS＋TVS可提高剖宫术后瘢痕妊娠的早期诊断准确率,同时能动态观察病灶及血供情况,对指导临床治疗方案及监测治疗效果等方面具有重要意义,停经时间短、妊娠囊占据宫腔、妊娠囊过小及只贴着瘢痕表面、混合包块型者、血供多少以及结合临床不紧密是误诊的重要原因。     

Ⅱ型剖宫产瘢痕妊娠手术方法的临床分析

目的:比较分析Ⅱ型剖宫产瘢痕妊娠(CSP)经阴道及开腹两种手术治疗方法的临床疗效。方法:回顾分析2013年7月至2016年3月青岛大学附属医院妇科收治的60例Ⅱ型CSP患者的临床资料,患者均行经阴道彩色多普勒超声检查。按手术方式不同分为:经阴道前穹窿切开剖宫产瘢痕妊娠病灶切除+子宫修补术(经阴组)37例,经腹剖宫产瘢痕妊娠病灶切除+子宫修补术(经腹组)23例。比较两组的手术时间、术中出血量、血β-HCG降至正常时间、住院费用及术后住院时间。结果:所有病例均经阴道彩超检查诊断,准确率为100%。经阴组中1例中转开腹手术,其余59例手术均顺利完成。经阴组的术中出血量、手术时间、术后住院时间、住院费用均明显少于经腹组,差异均有统计学意义(P0.05);术后血β-HCG降至正常时间比较,差异无统计学意义(P0.05)。结论:经阴道彩超是CSP早期诊断的主要方法,经阴及开腹手术均可用于治疗Ⅱ型CSP,经阴道病灶切除术优于开腹手术,具有手术时间短、创伤小、术中出血少、术后恢复快等优点,值得推广。     

剖宫产后瘢痕处妊娠经阴道超声图像分析的临床意义

目的:探讨剖宫产后瘢痕处妊娠超声图像特点及其对临床处理的指导意义.方法:回顾性分析经阴道超声检查诊断为瘢痕处妊娠的40例患者的超声图像及其对应的临床处理资料.结果:①40例患者经二维阴道超声检查均明确诊断,超声图像表现为孕囊型6例、空泡型9例、团块型25例;CDFI表现为血流信号丰富15例、有血流信号20例、无血流信号5例,其中血流信号丰富患者的CDFI频谱多为高速低阻,占87%(阻力指数RI＜0.5).②根据团块或孕囊与肌层的关系分为4级.其中0级5例,均选择保守治疗全部成功;1级18例,行保守治疗成功17例,1例行子宫病灶切除术加子宫修补术;2级13例,11例行保守治疗成功,1例行子宫切除术,1例行子宫修补术;3级4例,3例行子宫切除术,1例行子宫修补术.结论:掌握阴道超声检查剖宫产后瘢痕处妊娠声像图特点,为正确诊断瘢痕处妊娠提供了依据.根据声像图中孕囊或团块与肌层的关系进行分级,并结合彩色血流检查结果,有利于指导选择合适的临床处理方案.     

不同途径彩色多普勒超声诊断剖宫产瘢痕妊娠44例比较分析

目的:探讨3种不同途径的彩色多普勒超声诊断方法对剖宫产瘢痕妊娠(CSP)诊断的准确性。方法:选择2009年1月至2013年12月,泰山医学院附属医院以及泰安市中心医院共收治经临床以及术后病理证实的CSP患者44例,根据彩色多普勒超声的不同途径分为经腹组(13例)、经阴道组(17例)、经腹联合经阴道组(14例),比较3组的诊断准确率和误诊率,以及误诊导致的误治情况。结果:1经腹组诊断准确8例(61.5%),误诊5例(38.5%);经阴道组诊断准确13例(76.5%),误诊4例(23.5%),经腹联合经阴道组诊断准确13例(92.9%),误诊1例(7.1%)。210例误诊患者中,经腹组误诊为稽留流产的3例患者以及经阴道组误诊为稽留流产的1例患者口服戊酸雌二醇后行负压吸引术时发生大出血,其中3例术后给予纱条填塞宫腔压迫方止血,另1例因出血难以控制中转开腹行局部病灶切除术加子宫修补术。经腹组误诊为宫颈妊娠的2例患者,经阴道组误诊为宫颈妊娠的3例患者以及经腹部联合阴道组误诊为宫颈妊娠的1例患者均行子宫动脉栓塞术并动脉内注射甲氨蝶呤,然后行负压吸引术,方治疗成功。结论:经腹联合经阴道彩色多普勒超声检查较经腹及经阴道彩色多普勒超声检查的诊断准确率高,而误诊率最低,推荐临床上选择经腹联合经阴道彩色多普勒超声检查作为诊断CSP检查方法。     

经阴道彩色多普勒超声对宫外孕破裂与卵巢黄体破裂的鉴别诊断价值

目的 分析宫外孕破裂与卵巢黄体破裂的鉴别诊断中经阴道彩色多普勒超声的应用价值。方法 选取40例宫外孕破裂患者（设为宫外孕破裂组）与40例卵巢黄体破裂患者（设为卵巢黄体破裂组）,患者均接受经阴道彩色多普勒超声诊断,对比两组超声检查结果及影像学表现。结果 经阴道彩色多普勒超声检查宫外孕破裂、卵巢黄体破裂准确率分别为85.00%、87.50%,误诊率分别为15.00%、12.50%。两组患者血流信号形态、血流频谱及血流参数比较,差异具有统计学意义（P<0.05）。宫外孕破裂超声声像特征：未见宫内孕囊声像,附件区多为高回声,包块多呈不规则状且边界不清。对血流频谱进行分析,发现以高阻力型最多,信号以点状分布;妊娠囊结构分辨困难。卵巢黄体破裂超声声像：附件区可见囊实性包块,呈不规则状且边界不清。对血流信号进行分析,发现以环状、半环状为主,血流信号充盈且未见过多血流信号;血流频谱以低阻力型最多,超声信号以低回声为主,包块内部偶见强回声。结论 经阴道彩色多普勒超声诊断宫外孕破裂与卵巢黄体破裂的影像学表现差异明显,能够作为鉴别诊断的主要方法。     

经阴道彩色多普勒超声诊断异位妊娠的临床价值

目的 探讨经阴道彩色多普勒超声诊断异位妊娠的价值。方法 选取72例疑似异位妊娠患者为研究对象,术前均接受经阴道彩色多普勒超声与经腹部彩色多普勒超声检查,以手术病理结果为诊断标准,比较两种检查方式的诊断效能及异位妊娠典型声像图特征检出情况。结果 72例疑似异位妊娠患者经手术病理确诊61例,余下9例为其余腹部急症。经阴道彩色多普勒超声检查的诊断准确率、灵敏度、特异度、阳性预测值与阴性预测值为95.83%、96.72%、90.91%、98.33%、83.33%,高于经腹部彩色多普勒超声检查的73.61%、83.61%、18.18%、85.00%、16.67%(P<0.05)。经阴道彩色多普勒超声检查对混合型团块、疑似孕囊影、胚芽胎心、盆腔积液征象检出率分别为80.56%、61.11%、52.78%、88.89%,均明显高于经腹部彩色多普勒超声检查的58.33%、22.22%、30.56%、62.50%(P<0.05)。结论 经阴道彩色多普勒超声检查诊断异位妊娠的诊断效能较经腹部彩色多普勒超声检查更高,且异位妊娠典型声像图特征检出率更高,值得推广。     

体外受精-胚胎移植后宫内妊娠合并子宫切口妊娠1例治疗分析

目的:探讨在宫内合并子宫下段切口瘢痕妊娠(cesarean scar pregnancy,CSP)复合妊娠时治疗CSP同时保存宫内胎儿安全有效的方法。方法:在本中心行体外受精-胚胎移植(IVF-ET)助孕后妊娠患者1例,经反复阴道超声检查确诊宫内合并CSP。在患者充分知情同意的前提下,于移植后35 d行阴道超声引导下经阴道CSP胚胎穿刺减灭术,术后保胎及定期产检。结果:孕37周出现宫缩后急诊剖宫产一活婴,发育正常,术中下段切口处出血多,但宫缩正常,术程共出血1 000 ml,切口缝合后出血止,保留子宫,术后42 d复查子宫复旧好。结论:IVF-ET后出现剖宫产CSP合并宫内妊娠的复合妊娠极为罕见,早期诊断后通过阴道针刺抽吸妊娠胚囊可以达到终止切口瘢痕妊娠的目的,而且对宫内正常的妊娠囊无任何影响,是在保存宫内妊娠的同时治疗CSP切实有效的方法。     

经阴道彩色多普勒超声诊断卵巢妊娠的临床价值

目的探讨经阴道彩色多普勒超声对卵巢妊娠的诊断价值.方法对40例经病理证实的卵巢妊娠的术前经阴道彩色多普勒超声检测结果作回顾性分析.结果卵巢内胚囊型13例,卵巢表面不均质型16例,输卵管部位杂乱低回声型¨例.其中经阴道超声检查确诊29例(73%),误诊11例(27%),9例误诊为输卵管妊娠,2例误诊为妊娠黄体.结论经阴道彩色多普勒超声对诊断卵巢妊娠具有重要作用.     

Pitfalls in Ultrasound Diagnosis of Cesarean Scar Pregnancy

Cesarean scar pregnancy (CSP) is a rare kind of ectopic pregnancy implanted in the previous cesarean scar and has an increasing incidence over the past 30 years. As the suspicion is low, the diagnosis may be delayed or misinterpreted in ultrasound, leading to treatment strategies that might end up in uterine rupture or hysterectomy. The objective here is to review the ultrasound findings in CSP with varied presentations. Transabdominal and transvaginal sonography combined with color Doppler is a reliable tool for the diagnosis of CSP. When the gestational sac is seen in lower part of the uterine cavity, differentiation between threatened miscarriage, cervical pregnancy and CSP could be difficult. Not all cases of CSP present with typical ultrasound findings and a high index of suspicion is needed for diagnosis in these cases. An attempted curettage or MTP pill taken in an undiagnosed CSP often alters the typical findings. The possibility of CSP should also be considered in cases presenting with abnormal uterine bleeding and have a prior history of cesarean section. With lack of awareness about this condition, the diagnosis can often be missed either with MRI or in ultrasound. Correct interpretation and timely diagnosis save the mother from life-threatening complications and also preserves future fertility.     

彩色多普勒超声诊断胎盘植入的价值

目的：评价彩色多普勒超声诊断胎盘植入的价值。方法：回顾性分析2012年1月-2013年10月在天津市中心妇产科医院超声诊断胎盘低置状态或低置胎盘或前置胎盘的住院患者93例,其中超声检查疑似胎盘植入者24例。经腹部超声及阴道超声着重扫查胎盘的位置及其厚度、胎盘内回声、胎盘附着处子宫肌层厚度及其与子宫肌层的关系、与子宫相邻的膀胱壁情况、胎盘附着处血流情况。结果：24例经彩色多普勒超声检查疑似胎盘植入,经手术病理确诊为胎盘植入20例,其中粘连性胎盘4例,植入性胎盘14例,穿透性胎盘2例。超声误诊5例,漏诊1例。彩色多普勒超声检查的敏感度为95.00%,特异度为93.15%,阳性预测值为79.17%,阴性预测值为98.55%。结论：彩色多普勒超声为产前检查胎盘植入的较好方法。     

Transvaginal Methotrexate Injection for the Treatment of Cesarean Scar Pregnancy: Efficacy and Subsequent Fecundity

Study ObjectiveTo investigate the efficacy of local methotrexate (MTX) injections under transvaginal ultrasound guidance for treatment of cesarean scar pregnancy (CSP) and to assess fecundity after treatment.DesignRetrospective review (Canadian Task Force classification II-3).SettingUniversity hospital.PatientsEight women with CSP.InterventionTransvaginal MTX injection.Measurements and Main ResultsWe retrospectively reviewed 8 CSP cases treated with local MTX injection under transvaginal ultrasonographic guidance. In all cases, the serum human chorionic gonadotropin concentration was monitored and the gestational sac was evaluated using ultrasonography after treatment. Magnetic resonance imaging was performed as necessary. Patient clinical characteristics, clinical course after treatment, treatment efficacy, and fecundity after treatment in patients desiring subsequent pregnancies were evaluated. All 8 women were successfully treated without the need for blood transfusions or surgical procedures, although 2 required additional MTX therapy via local injection or systemic administration. The mean (SD) time to human chorionic gonadotropin normalization was 78.5 (37.7) days (range, 42–166 days). Four of 5 patients desiring subsequent pregnancies after the treatment had uneventful parturition, and recurrent CSP was diagnosed in 1 patient.ConclusionsTransvaginal MTX injection was effective and safe as sole treatment of CSP. Although the treatment course tended to be long, this method can be considered the first choice of treatment in patients desiring future pregnancies. However, careful attention should be paid to the possibility of CSP recurrence.     

Uterine rupture of cesarean scar related to spontaneous abortion in the first trimester

We report the case of a 31-year-old Japanese female diagnosed by transvaginal ultrasonography to have a spontaneous uterine rupture in the first trimester. Her condition was complicated by diabetes mellitus type 1. Her previous pregnancy had resulted in an emergency cesarean section by transverse incision of the lower uterine segment with single-layer suture at 37(+4) weeks of gestation. Transvaginal ultrasonography displayed both a gestational sac located in the anterior lower uterine segment and a defect in the uterine wall located at the site of the previous cesarean delivery scar. Pelvic magnetic resonance imaging showed that the uterine muscle layer was discontinuous and the gestational sac was almost outside the uterine cavity, accompanied by mild hemorrhaging within the endometrial cavity. The defect in the lower uterine wall was round in shape and was 3 cm in diameter. Since uterine ruptures can occur during all gestational periods, it is important to pay attention to the uterine wall where any cesarean incision was previously made.     

剖宫产术后子宫瘢痕妊娠的诊治决策

目的：探讨剖宫产术后子宫瘢痕妊娠（cesaren scar pregnancy,CSP）的诊治决策。方法：选择解放军总医院2007年1月-2012年8月因CSP住院治疗的患者51例,统计患者剖宫产指征、次数、术后恢复情况及发病时间。针对患者具体病情采用清官、子宫动脉栓塞、宫腹腔镜诊治、经阴道病灶切除及子宫切除等方式治疗。结果：所有病例均经超声诊断。患病距上次剖宫产时间5-147个月,平均（60．5±9．5）个月。妊娠2-6次,除10例（19．61％）为临产后剖宫产外,41例（80．39％）为未临产选择性子宫下段横切口剖宫产。48例患者经保守治疗成功：其中8例超声监测下单纯清官、19例子宫动脉栓塞后清宫、8例在腹腔镜或宫、腹腔镜联合监测下清官、11例行宫颈局部注射或深部肌内注射甲氨蝶呤、2例经阴道行子宫前壁修补术,另3例切除子宫（其中1例死亡）。结论：CSP属高危妊娠,早期诊断、谨慎处理至关重要。超声是诊断CSP的有效方法。     

经阴道超声结合VCI-C平面及3D-Glassbody成像模式在诊断异位妊娠中的应用

目的:探讨容积对比成像技术(VCI-C平面)、三维玻璃体模式(3D-Glassbody)及经阴道彩色多普勒超声诊断异位妊娠(EP)的特征性依据,以提高EP诊断的准确性。方法:对188例疑似早期EP的患者,进行二维经阴道(必要时结合经腹)彩超及VCI-C平面+Glassbody模式,观察包块滋养动脉血流分布及频谱。结果:188例中及时确诊183例。①附件区的妊娠囊内可见胎芽和(或)卵黄囊,17例(9.0%)有胎心搏动。②Donut征(输卵管环),其中98例有Donut征,占52.1%。③附件区内可探及混合性包块,有时伴有少量积液,共60例,占31.9%。④另有8例仅表现为盆腔积液,占4.3%。诊断符合率97.3%。误诊5例,均为宫内妊娠合并卵巢黄体破裂,误诊率为2.7%。结论:经阴道超声结合彩色多普勒(CDFI)/能量多普勒(CDE),能准确迅速地取得EP的诊断证据,VCI-C平面超声成像结合3D-Glassbody成像模式,信息量大,提高了对比分辨率与信噪比,可较二维超声提供更详尽的信息。     

剖宫产瘢痕妊娠经阴道手术治疗

经阴道手术是治疗剖宫产瘢痕妊娠安全、有效的治疗方法之一,适用于孕＜10周、妊娠包块最大径线＜6cm的患者,其术前无需预处理。经阴道手术治疗剖宫产瘢痕妊娠对未来妊娠的影响、失败的相关因素及与其他一线治疗方法之间的比较,还需要多中心、大样本的临床研究进行总结。     

子宫腺瘤样瘤的超声诊断价值——附84例病例分析

目的:探讨超声检查对子宫腺瘤样瘤的诊断价值。方法:回顾性分析84例经手术切除物病理免疫组织化学诊断为子宫腺瘤样瘤患者的超声声像图特点,分析其彩色多普勒血流信号特点。结果:84例子宫腺瘤样瘤超声均显示实性回声,其中显示低回声78例(92.9%),中等回声3例(3.6%),高回声3例(3.6%)。病灶位于肌壁间64例(76.2%),浆膜下13例(15.5%),黏膜下2例(2.4%),5例具体位置不详(6.0%)。肿瘤直径0.5~6.0 cm,以1~3 cm多见,占65.5%(55/84)。彩色多普勒显示病灶内少许或无彩色血流信号。结论:超声检查对子宫腺瘤样瘤的诊断有重要参考价值。