CAJ | 학술논문

目的：探讨剖宫产后宫腔内瘢痕处早期妊娠的MRI及经阴道超声表现，通过对比评估两种诊断方法对宫内瘢痕处早孕的诊断价值。方法回顾性分析2010年3月-2014年4月经手术证实为宫内瘢痕处早孕的35例患者的MRI及经阴道超声的影像资料，其中早早孕17例；早孕中期8例，早孕后期10例，对比分析两种方法显示孕囊着床位置、孕囊大小、是否有宫腔及孕囊内出血、胚芽及卵黄囊，胎心搏动等情况。结果 MRI及经阴道超声显示囊性孕囊29例，包块型孕囊6例，29例囊性孕囊中MRI显示位于瘢痕处孕囊12例，位于瘢痕处向宫腔方向延伸17例，而经阴道超声诊断位于瘢痕处孕囊8例，位于瘢痕处向宫腔内延伸21例；MRI诊断孕囊内合并出血8例,经阴道超声诊断囊内出血3例；经阴道超声发现卵黄囊16例，胚芽结构11例，其中见胎心搏动12例，MRI发现胚芽5例，无法区分卵黄囊结构及胚芽结构，无法判断胎心搏动；6例包块型孕囊中MRI诊断包块对子宫肌层浸润6例，经阴道超声无法判断孕囊对子宫肌层的浸润；MRI诊断包块内出血6例，经阴道超声诊断3例；MRI诊断宫腔内积血20例，经阴道超声诊断7例；结论 MRI与经阴道超声在宫内瘢痕处早孕中的诊断中各有优势，联合应用有利于提高对该病的全面认识，便于指导临床。
목적：탐토부궁산후궁강내반흔처조기임신적MRI급경음도초성표현，통과대비평고량충진단방법대궁내반흔처조잉적진단개치。방법회고성분석2010년3월-2014년4월경수술증실위궁내반흔처조잉적35례환자적MRI급경음도초성적영상자료，기중조조잉17례；조잉중기8례，조잉후기10례，대비분석량충방법현시잉낭착상위치、잉낭대소、시부유궁강급잉낭내출혈、배아급란황낭，태심박동등정황。결과 MRI급경음도초성현시낭성잉낭29례，포괴형잉낭6례，29례낭성잉낭중MRI현시위우반흔처잉낭12례，위우반흔처향궁강방향연신17례，이경음도초성진단위우반흔처잉낭8례，위우반흔처향궁강내연신21례；MRI진단잉낭내합병출혈8례,경음도초성진단낭내출혈3례；경음도초성발현란황낭16례，배아결구11례，기중견태심박동12례，MRI발현배아5례，무법구분란황낭결구급배아결구，무법판단태심박동；6례포괴형잉낭중MRI진단포괴대자궁기층침윤6례，경음도초성무법판단잉낭대자궁기층적침윤；MRI진단포괴내출혈6례，경음도초성진단3례；MRI진단궁강내적혈20례，경음도초성진단7례；결론 MRI여경음도초성재궁내반흔처조잉중적진단중각유우세，연합응용유리우제고대해병적전면인식，편우지도림상。
Objective To explore the value of MRI and transvaginal ultrasound in the diagnosis of cesarean scar pregnancy (CSP). Methods 35 cases time from March 2010 to April 2014 were retrospectivly studied, All cases were proved by operation. Among these cases, 17 cases were early-early pregnancy、8 cases were early-middle pregnancy, 10 cases were early-later pregnancy. Compare gestation sac location, size, nature, the myometrium invasion, whether combined with pouch of uterine cavity hemorrhage, and the yolk sac display and survival status, and so on the signs in MR and in transvaginal ultrasound. Results MRI and vaginal ultrasound showed cystic gestation sac in 29 cases, Multilobulated mass in 6cases, MRI showed at the scar pregnancy sac muscle layer in 12 cases, located in the scar extension to uterine direction in 17 cases, Vaginal ultrasound found 8 cases located in the muscle layer of scar and 21 cases in intrauterine. Vaginal ultrasound found 16 cases of yolk sac, embryonic survival 11 cases; MRI display 5 cases, can not distinguish the yolk sac and the germ, also can not judge whether embryos survive;Ultrasound found hemorrhage in multilobulated mass in 3 cases, MRI found in 6 cases, MRI diagnosis of intrauterine hemorrhage in 20 cases, vaginal ultrasound diagnosis of 6 cases. Conclusion vaginal ultrasonography and MRI have great significance in the diagnosis of CSP, Combine use of the two methods is helpfull to clinical.