中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2015年
12期
107-111
,共5页
杨仁东%袁秀英%古雯洁%刘小媚%钟智波%孙晓岩
楊仁東%袁秀英%古雯潔%劉小媚%鐘智波%孫曉巖
양인동%원수영%고문길%류소미%종지파%손효암
彩色多普勒超声%剖宫产%子宫瘢痕妊娠
綵色多普勒超聲%剖宮產%子宮瘢痕妊娠
채색다보륵초성%부궁산%자궁반흔임신
Color Doppler ultrasound%Cesarean section%Uterine scar pregnancy
目的：探讨经阴道彩色多普勒超声在剖宫产术后子宫瘢痕妊娠（CSP）诊断和治疗中的临床价值。方法回顾性分析2009年1月~2014年10月广东省东莞市第三人民医院收治的21例CSP患者的超声声像图特征，21例患者均采用经阴道彩色多普勒超声检查，并在阴道超声下进行穿刺注药治疗。总结21例患者的经阴道超声表现，比较穿刺注药治疗前后病灶长径、宽径、子宫前壁下段肌层厚度和病灶周围动脉血流阻力指数（RI）。结果21例CSP患者中单纯孕囊型18例，超声表现子宫前壁下段切口处肌壁间完整的孕囊，11例孕囊内见卵黄囊、胎芽和原始的胎心搏动，3例孕囊内见卵黄囊和胎芽，未见胎心搏动，2例孕囊内仅见卵黄囊，无胎芽和胎心搏动，2例孕囊皱缩、变形。团块型3例，超声表现为子宫前壁下段切口处混合回声团块，与子宫肌层分界不清，切口区域肌层菲薄，彩色多普勒超声显示孕囊或团块周围可见丰富的血流信号，滋养血管来自切口处子宫肌层，3例团块型病灶内部可见血流信号，频谱多普勒呈低速低阻型，RI值为0.32~0.56。穿刺注药治疗后，21例CSP病灶长径和宽径与治疗前比较差异无统计学意义（P>0.05），但子宫前壁下段肌层厚度较治疗前明显增加（P<0.01），病灶及周围肌层回声减低，病灶周围血流信号减少，RI值较前明显增加（P<0.01）。16例单纯孕囊型CSP患者穿刺注药后临床治愈。2例单纯孕囊型CSP患者治疗后症状不缓解，行手术治疗后痊愈。3例团块型病灶治疗后血HCG下降不明显，行超声引导下清宫术治愈。结论经阴道彩色多普勒超声在剖宫产术后瘢痕妊娠的诊断和治疗中具有重要价值。
目的：探討經陰道綵色多普勒超聲在剖宮產術後子宮瘢痕妊娠（CSP）診斷和治療中的臨床價值。方法迴顧性分析2009年1月~2014年10月廣東省東莞市第三人民醫院收治的21例CSP患者的超聲聲像圖特徵，21例患者均採用經陰道綵色多普勒超聲檢查，併在陰道超聲下進行穿刺註藥治療。總結21例患者的經陰道超聲錶現，比較穿刺註藥治療前後病竈長徑、寬徑、子宮前壁下段肌層厚度和病竈週圍動脈血流阻力指數（RI）。結果21例CSP患者中單純孕囊型18例，超聲錶現子宮前壁下段切口處肌壁間完整的孕囊，11例孕囊內見卵黃囊、胎芽和原始的胎心搏動，3例孕囊內見卵黃囊和胎芽，未見胎心搏動，2例孕囊內僅見卵黃囊，無胎芽和胎心搏動，2例孕囊皺縮、變形。糰塊型3例，超聲錶現為子宮前壁下段切口處混閤迴聲糰塊，與子宮肌層分界不清，切口區域肌層菲薄，綵色多普勒超聲顯示孕囊或糰塊週圍可見豐富的血流信號，滋養血管來自切口處子宮肌層，3例糰塊型病竈內部可見血流信號，頻譜多普勒呈低速低阻型，RI值為0.32~0.56。穿刺註藥治療後，21例CSP病竈長徑和寬徑與治療前比較差異無統計學意義（P>0.05），但子宮前壁下段肌層厚度較治療前明顯增加（P<0.01），病竈及週圍肌層迴聲減低，病竈週圍血流信號減少，RI值較前明顯增加（P<0.01）。16例單純孕囊型CSP患者穿刺註藥後臨床治愈。2例單純孕囊型CSP患者治療後癥狀不緩解，行手術治療後痊愈。3例糰塊型病竈治療後血HCG下降不明顯，行超聲引導下清宮術治愈。結論經陰道綵色多普勒超聲在剖宮產術後瘢痕妊娠的診斷和治療中具有重要價值。
목적：탐토경음도채색다보륵초성재부궁산술후자궁반흔임신（CSP）진단화치료중적림상개치。방법회고성분석2009년1월~2014년10월광동성동완시제삼인민의원수치적21례CSP환자적초성성상도특정，21례환자균채용경음도채색다보륵초성검사，병재음도초성하진행천자주약치료。총결21례환자적경음도초성표현，비교천자주약치료전후병조장경、관경、자궁전벽하단기층후도화병조주위동맥혈류조력지수（RI）。결과21례CSP환자중단순잉낭형18례，초성표현자궁전벽하단절구처기벽간완정적잉낭，11례잉낭내견란황낭、태아화원시적태심박동，3례잉낭내견란황낭화태아，미견태심박동，2례잉낭내부견란황낭，무태아화태심박동，2례잉낭추축、변형。단괴형3례，초성표현위자궁전벽하단절구처혼합회성단괴，여자궁기층분계불청，절구구역기층비박，채색다보륵초성현시잉낭혹단괴주위가견봉부적혈류신호，자양혈관래자절구처자궁기층，3례단괴형병조내부가견혈류신호，빈보다보륵정저속저조형，RI치위0.32~0.56。천자주약치료후，21례CSP병조장경화관경여치료전비교차이무통계학의의（P>0.05），단자궁전벽하단기층후도교치료전명현증가（P<0.01），병조급주위기층회성감저，병조주위혈류신호감소，RI치교전명현증가（P<0.01）。16례단순잉낭형CSP환자천자주약후림상치유。2례단순잉낭형CSP환자치료후증상불완해，행수술치료후전유。3례단괴형병조치료후혈HCG하강불명현，행초성인도하청궁술치유。결론경음도채색다보륵초성재부궁산술후반흔임신적진단화치료중구유중요개치。
Objective To investigate the clinical value of transvaginal color Doppler ultrasound in the diagnosis and treatment of cesarean scar pregnancy (CSP). Methods Sonographic characteristics of 21 patients with CSP in the Third People's Hospital of Dongguan City from January 2009 to October 2014 were analyzed retrospectively, 21 cases were examined by transvaginal color Doppler ultrasound, and treated with puncture and injection of medicine under vaginal ultrasonography detection, transvaginal ultrasound manifestations of 21 cases were summarized, the lesion length to di-ameter, wide diameter, anterior uterine wall peripheral arterial resistance thickness and lesions with muscular segment index (resistive index, RI) before and after drug injection for the treatment of puncture were compared. Results 21 cas-es with CSP were divided into the following types pure gestational sac type (18 cases), and complete gestational sac were showed in anterior wall of the lower part of the incision of uterus intramural under ultrasond, yolk sac, embryo bud and original fetal heart beat were seen in gestational sac of 11 cases, yolk sac, embryo bud were seen in gestation-al sac of 3 cases, but no fetal heart beat, yolk sac were only seen in gestational sac of 2 cases but no embryo bud or fetal heart beat, gestational sac shrinkage, deformation were in 2 cases, and 3 cases were the mass type, and mixed e-chogenic mass were showed in the incision of the anterior wall of hypomere of the uterus, and uterine muscular layer boundary was not clear, the incision area muscle layer was humble, ditissimus blood flow signals were showed around the gestational sac or clumps under color Doppler ultrasond, nourishing vessels were from the incision of uterine mus-cular layer, blood flow signals were seen in the mass lesions of 3 cases, spectral Doppler showed a low speed and low resistance, the RI value was 0.32-0.56. Compared with before treatment, the length and width of CSP lesions in 21 pa-tients after the treatment of puncture and injection of medicine, there were no statistical significant differences (P> 0.05), but the muscle layer thickness of anterior wall in the lower part of uterus significantly increased than be-fore treatment (P< 0.01), hypoechoic of the lesions and the surrounding muscle layer reduced and blood flow signals reduced, RI value significantly increased (P < 0.01). 16 patients with simple gestational sac type were healed after clinical cure of puncture and injection. 2 patients with simple gestational sac type did not alleviate the symptoms, and the two cases were cured after operation, blood HCG of mass lesions in 3 cases decreased not obviously after treatment, and the 3 cases were cured after the uterus curettage. Conclusion It has important value of transvaginal color Doppler ultrasound in the diagnosis and treatment of CSP.
