经阴道彩色多普勒超声对剖宫产切口瘢痕妊娠的临床价值

目的探讨剖宫产切口瘢痕妊娠的声像图特征,评价经阴道彩色多普勒超声对剖宫产切口瘢痕妊娠的临床诊断价值。方法对30例在中山大学附属东华医院住院治疗的剖宫产切口瘢痕妊娠者的超声特征进行回顾性分析,观察妊娠囊位置、子宫切口部位回声、瘢痕处肌层厚度、妊娠囊与子宫切口关系以及血流分布。结果 30例剖宫产切口瘢痕妊娠者超声诊断正确18例,误诊2例,诊断符合率为93.3%。所有孕妇在宫腔正常位置未见妊娠囊,在子宫下段切口部位可见妊娠囊或混合性团块,妊娠囊或团块与膀胱之间的子宫肌层明显变薄。根据声像图特征,将子宫下段瘢痕妊娠分为妊娠囊完全嵌于瘢痕型（13例）、妊娠囊部分向宫腔内生长型（6例）及瘢痕处混合性团块型（11例）。彩色多普勒血流图（CDFI）观察瘢痕处妊娠囊或混合性团块周边可见丰富的血流信号,PW显示平均RI值〈0.5。结论经阴道彩色多普勒超声能对剖宫产切口瘢痕妊娠提供较准确的定位和定性诊断,有重要的临床价值。

Clinical value of transvaginal color doppler ultrasound on cesarean setion scar pregnancy

Objective To investigate the ultrasonic features of cesarean setion scar pregnancy,and to evaluate the clinical diagnostic value of transvaginal color doppler ultrasound on the cesarean section scar pregnancy.Methods The ultrasonic features of 30 patients with cesarean setion scar pregnancy in Donghua hospital were retrospectively analyzed.The location of the gestational sac,the echo of uterine incision site,the thickness of myometrium beside the scars,the relationship between gestational sac and uterine incision,and the blood flow distribution were observed.Results In 30 cases of cesarean section scar pregnancy,18 cases were accurately diagnosed,2 cases were misdiagnosed,the diagnosis coincidence rate was 93.3%.No gestational sac was seen in normal position in the uterine cavity,but a gestational sac or mixed mass attached to the cicatrix,with a very thin myometrium between the gestationgal sac and bladder walls was found.According to the sonographic features,there were three types： gestational sac was completely embedded in the scar type（13 cases）,gestational sac partly grew to uterine cavity type（6 cases） and mixed mass in the incision site type（11 cases）.Color doppler flow imaging showed in the scar abundant vasculature was found around the gestational sac or mixed mass.Pulsed wave doppler showed the average RI value was less than 0.5.Conclusion Transvaginal color doppler ultrasound may give a precise diagnosis to cesarean section scar pregnancy.It has an importment clinical value.