子宫瘢痕妊娠患者阴道超声影像学特征及其诊治价值分析

发布时间：2018-04-09 11:44

本文选题：异位妊娠　切入点：子宫瘢痕妊娠　出处：《山东医药》2017年34期

【摘要】：目的分析子宫瘢痕妊娠(CSP)患者阴道超声影像学特征及其诊治价值。方法收集30例CSP患者临床资料,治疗前后均行阴道超声检查,根据患者实际情况进行治疗。结果 30例患者均在阴道超声下见到妊娠囊,28例初诊为CSP,2例由于妊娠囊较小、血流不丰富而误诊,初诊符合率为93.33%。其中,妊娠囊为孕囊型21例、混合回声型9例,多普勒模式下表现为富血流型28例、少血流型2例。21例孕囊型均表现为子宫增大、子宫前壁切口瘢痕处见妊娠囊,5例孕囊内有原始心管搏动及胎芽迹象,19例妊娠囊周边与瘢痕处可见丰富血流信号、2例血流信号不明显。19例富血流孕囊型CSP、9例混合包块型CSP行宫腔镜下局部病灶切除术+甲氨蝶呤治疗,2例少血流孕囊型CSP给予甲氨蝶呤联合米非司酮治疗,均成功终止CSP,未发生大出血及切除子宫。结论 CSP患者阴道超声影像学下主要表现子宫前壁切口瘢痕处孕囊或混合回声包块,有丰富血流信号;根据影像学表现不同采取个体化治疗措施,患者预后良好。
[Abstract]:Objective to analyze the imaging features and diagnostic value of vaginal ultrasound in patients with CSP (uterine scar pregnancy).Methods the clinical data of 30 patients with CSP were collected. Vaginal ultrasound was performed before and after treatment.Results all the 30 cases were diagnosed as CSP in 28 cases under vaginal ultrasound, 2 cases were misdiagnosed because of the small pregnancy sac and the blood flow was not abundant, the coincidence rate of the first diagnosis was 93.33 3.There were 21 cases of pregnancy sac type, 9 cases of mixed echo type, 28 cases of rich blood flow type in Doppler mode, and 2 cases of low blood flow type. 21 cases of pregnancy sac type showed uterine enlargement.Gestational sac was seen in 5 cases of pregnancy sac in anterior wall incision of uterus. There were signs of primitive cardiac tube pulsation and fetal bud in gestational sac in 5 cases. Abundant blood flow signals were observed in 19 cases around pregnancy sac and 2 cases in scar. 19 cases of CSP with rich blood flow and 9 cases of CSP with rich blood flowTwo cases of CSP with less blood flow were treated with methotrexate combined with mifepristone.CSP was successfully terminated without massive bleeding and hysterectomy.Conclusion the main features of CSP patients are pregnancy sac or mixed echo mass at the scar of anterior wall incision of uterus, which has rich blood flow signal, and the prognosis is good when individualized treatment measures are taken according to the different imaging findings.
【作者单位】：承德医学院附属医院;
【基金】：河北省科技支撑计划项目(20122177)
【分类号】：R445.1;R714.22

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