彩色多普勒超声诊断及治疗子宫瘢痕妊娠

目的 探讨彩色多普勒超声在子宫瘢痕妊娠诊断及治疗中的应用价值.方法 分析34例子宫瘢痕妊娠的声像图特点,比较保守治疗前后声像图及血流阻力指数的变化情况,并参考血β-hCG变化情况评价其治疗效果.结果 根据经腹部及经阴道彩色多普勒超声的声像图特点,将子宫瘢痕妊娠分为三型:①胚囊型16例;②不均质团块型14例;③混合型(不规则孕囊+团块型)4例.治疗前子宫瘢痕妊娠孕囊周围肌层或团块内部血流信号丰富,可探及低阻力指数血流信号,治疗前与治疗后1周血流阻力指数比较差异无统计学意义;治疗后4周孕囊周围肌层或病灶血流明显减少或消失,阻力指数升高,与治疗前比较差异有统计学意义.结论 子宫瘢痕妊娠有特征性彩色多普勒超声表现.彩色多普勒超声对子宫瘢痕妊娠能做出较准确的定位及定性诊断, 在制定治疗方案、疗效评估及随访中有重要指导作用.

Color Doppler ultrasonography in the diagnosis and treatment of uterine scar pregnancy

Objective To investigate the application value of color Doppler ultrasonography in the diagnosis and treatment of uterine scar pregnancy. Methods The sonographic characteristics of 34 patients of uterine scar pregnancy were analyzed. The changes of blood flow and the resistance index (RI) were compared before and after conservative treatment. Meanwhile, the therapeutic effect was evaluated referencing to the changes of β-hCG in blood. Results Uterine scar pregnancies were classfied into three subtypes according to ultrasonic characteristics: Type Ⅰ: embryo sac (n=16 cases);Type Ⅱ: asymmetrical mass (n=14);Type Ⅲ: mixed type (embryo sac+asymmetrical mass, n=4). Peri-myometrium of the gastrula and the mass had abundant blood flow and lower RI before treatment, while rare blood flow and middle RI were found 4 weeks after treatment. There was statistical significance in the change of RI between before and four weeks, after treatment. Conclusion Uterine scar pregnancy has characteristic ultrasonogram. Color Doppler ultrasound may precise diagnose and localize uterine scar pregnancy, playing an important role in guiding the conservative treatment schedule, evaluating the therapeutic effect and following-up of these patients.