经阴道超声在子宫切口妊娠诊断和治疗中的应用

发布时间：2018-04-01 17:41

  本文选题：子宫切口妊娠　切入点：经阴道超声　出处：《上海交通大学学报(医学版)》2017年10期

【摘要】：目的·探讨剖宫产术后子宫切口妊娠(CSP)经阴道超声检查的表现,并评估经阴道超声结合MRI在CSP诊断和治疗中的价值。方法·回顾性分析上海交通大学附属第一人民医院3年内收治的42例CSP患者的经阴道超声检查表现、MRI结果及临床资料。结果·42例中确诊为CSP共36例,经阴道超声漏诊1例,误诊5例,诊断准确率85.7%;经MRI检查36例,漏诊3例,误诊1例,诊断准确率88.9%。其中孕囊型CSP 30例,混合包块型CSP 6例。根据超声检查提示子宫下段切口处肌层厚度,对孕囊型CSP患者采取不同处理方式:3 mm者采用吸宫术;≤3 mm者进一步结合MRI检查,选择手术切除妊娠物或子宫动脉栓塞+甲氨蝶呤化学治疗+吸宫术。结论·经阴道超声和MRI诊断CSP的准确率均较高。经阴道超声结合MRI可为CSP治疗方案选择提供重要的参考。
[Abstract]:Objective to evaluate the value of transvaginal ultrasound combined with MRI in the diagnosis and treatment of CSP after cesarean section.Methods MRI findings and clinical data of 42 patients with CSP admitted in the first people's Hospital affiliated to Shanghai Jiaotong University within 3 years were retrospectively analyzed.Results among the 42 cases, 36 cases were diagnosed as CSP, 1 case was missed by transvaginal ultrasound, 5 cases were misdiagnosed, the diagnostic accuracy was 85.7%, 36 cases were diagnosed by MRI, 3 cases were missed diagnosis, 1 case was misdiagnosed, and the diagnostic accuracy was 88.9%.There were 30 cases of CSP and 6 cases of mixed mass CSP.According to the results of ultrasound examination, the thickness of myometrium at the incision of the lower uterine segment was indicated, and the patients with gestational sac type CSP were treated with different types of treatment: 3 mm and 鈮，

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