经腹联合阴道超声对剖宫产瘢痕妊娠的疗效评估

目的 探讨彩色多普勒超声对剖产瘢痕妊娠疗效的临床意义。方法 收集2019年1月至2021年12月在云南省第一人民医院妇科诊治的82例CSP患者，应用超声对CSP诊疗过程临床价值的回顾性分析。用SPSS19.0对数据进行统计分析，组间比较采用卡方检验进行分析，采用配对t检验进行术前术后比较分析。结果 B超对CSP分型诊断后选择个体化治疗方案结果差异有统计学意义(P <0.05)。病灶面积越大，术后B超的异常概率越高且差异有统计学意义(P=0.002);GSPⅡ型的术后异常比例高于Ⅰ型、Ⅲ型且差异有统计学意义(P=0.027)；手术方式方面宫腔鏡下病灶挖出术的术后异常比例低于B超引导下高危人流术、腹腔镜下病灶挖出术且差异有统计学意义(P=0.002)；剖宫产次数、病灶血供情况与术后B超的结果之间差异没有统计学意义(χ²值和P分别为1.300/0.558、--/0.059)。同时个体化治疗须充分结合CSP的其他相关检验指标。结论 经腹联合阴道彩色多普勒超声对子宫瘢痕妊娠疗效评估过程具有非常重要的临床价值。

Evaluation of Therapeutic Effect of Transabdominal and Transvaginal Ultrasound on Cesarean Scar Pregnancy

  Objective  To investigate the clinical significance of color Doppler ultrasound in the diagnosis and treatment of cesarean scar pregnancy.   Methods  A total of 82 CSP patients diagnosed and treated in the Department of Gynecology of Yunnan First People’s Hospital from January 2019 to December 2021 were collected, and their diagnosis and treatment processes were retrospectively analyzed. A retrospective analysis of the clinical value of ultrasound in the diagnosis and treatment of CSP was carried out. The results of statistical analysis of data by SPSS19.0, Chi square test analysis of inter group comparison and paired T test were used for the comparison and analysis before and after the surgery   Results  There was the statistical significance in selecting individualized treatment plan after the classification diagnosis of CSP by B-ultrasound. The larger the lesion area, the higher the abnormal probability of postoperative B-ultrasonography and the difference was statistically significant （P = 0.002）; The abnormal rate of GSP type II was higher than that of type Ⅰ and type Ⅲ （P = 0.027）; In terms of operation mode, the abnormal rate of hysteroscopic lesion extraction was lower than that of B-ultrasound guided high-risk abortion and laparoscopic lesion extraction, and the difference was statistically significant （P = 0.002）; There was no significant difference between the number of cesarean section, the blood supply of the focus and the results of postoperative ultrasound （and P values were 1.300/0.558, -/0.059, respectively）. At the same time, the individualized treatment should be fully combined with other relevant test indicators of CSP.   Conclusion  Transabdominal combined vaginal color Doppler ultrasound has a very important clinical value in the clinical diagnosis and treatment of uterine scar pregnancy.