彩超对剖宫产瘢痕妊娠的诊断及治疗疗效观察

发布时间：2018-02-08 17:35

本文关键词： 彩超妊娠瘢痕诊断超声检查剖宫产术妊娠异位高强度聚焦超声消融治疗结果　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分彩超早期诊断剖宫产瘢痕妊娠价值分析目的：评估彩超在剖宫产瘢痕妊娠早期诊断中的价值分析。方法：对66例经临床或病理证实为剖宫产瘢痕妊娠病例进行分析，观察、总结其超声声像图特点。结果：66例剖宫产瘢痕妊娠病例，按其超声声像图分为胚囊型（39例）及包块型（27例），超声检查正确诊断为瘢痕妊娠者55例，诊断符合率为83.3%（55/66）。其中胚囊型诊断符合率92.3%（36/39），误诊率7.7%（3/39）；包块型诊断率70.4%（19/27），误诊率29.6%（8/27）。结论：1.彩超是早期诊断剖宫产瘢痕妊娠的有效方法。 2.剖宫产瘢痕妊娠误诊率高，以包块型显著。第二部分高强度聚焦超声治疗剖宫产瘢痕妊娠彩超疗效观察目的：探讨彩超观察高强度聚焦超声（HIFU)治疗剖宫产术后瘢痕妊娠疗效的价值。方法：经临床或超声诊断且接受HIFU治疗的子宫瘢痕妊娠患者30例，分析其HIFU治疗前、治疗后1周、4周的超声声像图，，并将其周边血流阻力指数（RI）及血人绒毛膜促性腺激素（-HCG）值进行统计分析。结果：1）二维超声表现：27例患者治疗后病灶逐渐缩小至消失。其中16例胚囊型治疗后孕囊塌陷、变形、胚芽未见长大，10例卵黄囊回声稍增强、壁增厚；11例包块型治疗后包块回声先稍增高，而后中央区回声减低，最终表现为稍高回声3例治疗后仍见心管搏动。 2）彩色多普勒超声表现：与治疗前相比，治疗后病灶周边血流明显减少或消失，治疗后1周、4周血流RI均高于治疗前，治疗后4周RI高于治疗后1周（P均0.05）；但-HCG在治疗前后差异均无统计学意义(P均0.05)。结论：1.彩超对剖宫产术后瘢痕妊娠的HIFU治疗疗效观察及随访具有临床价值。 2.彩超对临床治疗方案的选择有指导意义。
[Abstract]:Part I value of early diagnosis of Cesarean scar pregnancy by Color Doppler Ultrasonography. Objective: to evaluate the value of color Doppler ultrasound in the early diagnosis of cesarean scar pregnancy. Methods: 66 cases of pregnancy with cesarean scar confirmed by clinic or pathology were analyzed, and the ultrasonographic features were summarized. Results among 66 cases of cesarean scar pregnancy, 39 cases were divided into embryo sac type (n = 39) and mass type (n = 27). 55 cases were correctly diagnosed as scar pregnancy by ultrasonic examination. The diagnostic coincidence rate was 83.3% / 66%. The diagnostic coincidence rate of embryo sac type was 92.3% (36 / 39), misdiagnosis rate was 7.7% (39 / 39), mass diagnosis rate was 70.4% (19 / 27), misdiagnosis rate was 29.6% / 27%. Conclusion 1. Color Doppler ultrasound is an effective method for early diagnosis of cesarean scar pregnancy. 2. The misdiagnosis rate of cesarean scar pregnancy is high, especially in the lump type. The second part: the effect of high intensity focused ultrasound in the treatment of cicatricial pregnancy by cesarean section. Objective: to evaluate the effect of high intensity focused ultrasound (HIFU) on scar pregnancy after cesarean section. Methods: thirty cases of pregnancy with uterine scar diagnosed by clinical or ultrasonic diagnosis and treated with HIFU were analyzed. The sonograms of 30 pregnant women with uterine scar were analyzed before and after HIFU treatment for 1 week and 4 weeks after treatment. The peripheral blood flow resistance index (RI) and human chorionic gonadotropin (HCG) were analyzed statistically. Results (1) the lesions of 27 cases were gradually reduced to disappear after treatment, 16 cases of embryo sac collapsed and deformed, and 10 cases of yolk sac were slightly enhanced in embryo bud. In 11 cases of wall thickening, the echo of the mass increased slightly after treatment, then decreased in the central region. Finally, cardiac tube pulsation was seen in 3 cases with slightly hyperechoic echo. 2) Color Doppler ultrasound: compared with before treatment, the peripheral blood flow of the lesion decreased or disappeared significantly after treatment, and the RI of the lesion was significantly higher at 1 week and 4 weeks after treatment than that before treatment. The RI at 4 weeks after treatment was higher than that at 1 week after treatment (P < 0.05), but there was no significant difference between the two groups before and after treatment (P < 0.05). Conclusion 1. Color Doppler ultrasound has clinical value in the treatment of scar pregnancy after cesarean section by HIFU. 2. Color Doppler ultrasound has guiding significance to the choice of clinical treatment scheme.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.22

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