超声在妊娠期子宫破裂的诊断价值分析

摘要 目的 探讨妊娠期子宫破裂患者的超声图像特征及其临床诊断价值。方法 回顾性分析2014年2月至2021年7月我院产科诊断并收治的子宫破裂患者病例资料，根据手术诊断作为分组标准，将患者分为完全破裂组与不完全破裂组，记录患者孕产史、妇产科相关手术史等临床资料、超声图像特征及母儿预后情况，分析不同类型子宫破裂的发生孕期、发生部位、超声图像特征，超声检出率等。结果 共35例患者纳入研究，完全破裂组人工流产史患者所占比例明显高于不完全破裂组，而剖宫产史患者所占比例在不完全子宫破裂组中明显高于完全破裂组（P＜0.05）。完全性子宫破裂16例，晚孕期9例，中孕期5例，早孕期2例；超声提示完全性子宫破裂13例，诊断符合率81.2%，超声图像表现为子宫肌层及浆膜层断端清楚或模糊，羊膜囊完整或破裂，破口可见血肿低回声；漏诊3例，均为孕晚期患者，破口均位于子宫后壁。不完全性子宫破例19例，早孕2例，晚孕17例，其中17例不完全破裂部位为剖宫产切口瘢痕处；超声提示子宫不完全破裂6例，诊断符合率31.6%，超声图像表现为破口处子宫肌层未显示，仅见浆膜层；漏诊13例。结论 超声检查能够实现大多数孕期完全性子宫破裂的诊断，诊断符合率高，但对于不典型的完全破裂以及不完全破裂，超声医师应当意识到临床症状的不典型性会干扰诊断，应重视病史询问，重视瘢痕子宫患者晚孕期产前子宫下段肌层的常规测量，提高诊断效能。

Diagnostic value of ultrasonography in uterine rupture during pregnancy

ABSTRACT Objective To investigate the ultrasonographic features of uterine rupture during pregnancy and its clinical diagnostic value.??Methods A retrospective analysis was performed about patients diagnosed with of uterine rupture in our hospital from February 2014 to July 2021. All patients were divided into complete rupture group and incomplete rupture group according to surgical findings. Clinical data such as pregnancy history, obstetrics and gynecology related operation history, ultrasonic image characteristics and maternal and infant prognosis were recorded. The time and site of rupture, ultrasonographic image characteristics, diagnostic rate and missed diagnostic rate of different types of uterine rupture were analyzed. Results A total of 35 cases were included in the study. The proportion of patients with induced abortion history in the complete rupture group was significantly higher than that in the incomplete rupture group, while the proportion of patients with cesarean section history in the incomplete rupture group was significantly higher than that in the complete rupture group (P < 0.05). 16 cases were patients with complete uterine rupture including 9 cases in late pregnancy, 5 cases in middle pregnancy, and 2 cases in early pregnancy.??13 cases of complete uterine rupture were diagnosed by ultrasonography, and the diagnostic rate was 81.2%. Ultrasound images showed a clear or unclear break of myometrium and serosal layer with a complete or broken amniotic sac, hypoechoic hematoma around the site of rupture. 3 cases in the late trimester were missed diagnosed as the reason that uterus was broken in the posterior wall of uterus. There were 19 cases of incomplete uterine rupture, 2 cases in early pregnancy and 17 cases in late pregnancy. 6 cases of uterine incomplete rupture were diagnosed by ultrasound with the diagnostic rate of 31.6%. Ultrasonographic imaging indicated that only uterine serosa was found in the site of rupture.??13 cases of late pregnancy cases were missed diagnosed.??Conclusions Most of the complete uterine rupture can be diagnosed by ultrasound through the typical imaging features with a high diagnostic rate. While for complete uterine rupture of atypical images and incomplete uterine rupture,?we should be aware that the atypia of clinical symptoms will interfere with the diagnosis, and pay attention to the medical history. Emphasis on the routine measurement of the lower uterine muscularity before late pregnancy in patients with scar uterus to improve the diagnostic efficiency.