【摘要】 目的 探讨经腹部及经阴道超声在剖宫产瘢痕处妊娠诊断及其介入治疗中的应用价值。方法 应用经腹部及经阴道超声对临床疑诊的剖宫产瘢痕妊娠患者进行超声检查,观察病灶的声像图特征,将超声诊断结果与临床最终诊断结果对比分析,并将经临床和超声检查明确诊断且有穿刺治疗适应证的患者,进行超声引导下妊娠囊内甲氨蝶呤(MTX)注射及(或)实时监视下的清宫治疗。结果 48例患者临床最终结果确诊为剖宫产瘢痕妊娠28例,超声检查诊断正确25例,诊断正确率89.3%,漏诊3例,另有2例超声诊断为假阳性。28例确诊患者中有4例行超声引导下妊娠囊内局部MTX注射,1周后超声显示孕囊消失,血供减少;血β-人绒毛膜促性腺激素(β-HCG)下降,行超声引导监视下清宫治疗痊愈,20例患者经药物流产、全身用药、子宫动脉栓塞后再行超声引导监视下清宫治愈;另4例超声及临床确诊的患者行手术治疗。结论 经腹部与经阴道超声对剖宫产瘢痕妊娠诊断具有重要的临床应用价值,超声引导下的妊娠囊内药物注射及实时监视下的清宫为剖宫产后瘢痕妊娠提供了更为安全的治疗方法。更多还原

【Abstract】 Objective To investigate the application value of transabdominal and transvaginal ultrasound in the clinical diagnosis and interventional treatment of cesarean scar pregnancy.Methods Transabdominal and transvaginal ultrasonography was adopted in the ultrasound examination in patients with clinically suspected cesarean scar pregnancy,and the sonographic characteristics of lesions were observed.The results of ultrasonic diagnosis and final clinical diagnosis were contrastively analyzed.Patients who were confirmed by clinical and ultrasound diagnoses and indicative of puncture treatment underwent methotrexate(MTX) injection into the gestational sac under ultrasound guidance and/or under real-time monitoring of uterine curettage.Results Of the 48 patients,28 cases were eventually confirmed as having cesarean scar pregnancy by final clinical diagnosis,while ultrasound diagnosis was correct in 25 cases,with an accuracy percentage of 89.3% and missed diagnosis in 3 cases.Moreover,false positive results in ultrasonography were observed in 2cases.4 of the 28 cases who was confirmed as cesarean scar pregnancy underwent ultrasound guided local MTX injection into the gestational sac.One week later,ultrasonography revealed disappearance of the gestational sac,reduced blood supply and reduced blood β human chorionic gonadotropin(β-HCG),and recovered following ultrasound guided uterine curettage.20 cases who underwent drug abortion,systemic medication,uterine artery embolization prior to ultrasound guided curettage were cured,while the other 4 cases who were confirmed by ultrasound and clinical diagnosis were scheduled for surgery.Conclusion Transabdominal and transvaginal ultrasonography have important application value for the clinical diagnosis of cesarean scar pregnancy,and the ultrasound guided drug injection into the gestational sac and realtime monitoring of uterine curettage provide a safer therapy for cesarean scar pregnancy.更多还原