超声检查对子宫瘢痕妊娠诊断及治疗方案的指导意义

时彩红; 刘雪戈; 蒙辉雁; 韦月柳

doi:10.16766/j.cnki.issn.1674-4152.001789

超声检查对子宫瘢痕妊娠诊断及治疗方案的指导意义

doi: 10.16766/j.cnki.issn.1674-4152.001789

广西中医药大学附属瑞康医院超声科，广西南宁 530011

基金项目:

广西医药卫生自筹经费科研项目 20200246

详细信息

通讯作者:
时彩红，E-mail：834805899@qq.com

中图分类号: R714.22 R445.1
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- 被引次数: 0
出版历程
- 收稿日期: 2019-06-11
- 网络出版日期: 2022-02-19

Significance of ultrasound examination in the evaluation and treatment of uterine scar pregnancy

Department of Ultrasound, Ruikang Hospital, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi 530011, China

摘要

摘要: 目的探讨不同类型剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy, CSP)患者的超声声像学特征及手术方式和术后恢复情况。方法分析2015年1月—2018年12月广西中医药大学附属瑞康医院诊治的92例CSP患者，比较其一般临床资料、超声图像特点、手术和术后恢复情况，数据采用SPSS 23.0统计学软件进行分析。结果 92例CSP患者超声分型为Ⅰ型的28例，Ⅱ型45例，Ⅲ型19例，不同超声分型的患者年龄、停经时间、距离上次剖宫产时间和治疗前血清β-HCG含量比较差异无统计学意义(均P>0.05)；人工流产次数和剖宫产次数比较差异有统计学意义(均P < 0.05)；子宫前壁下段肌层厚度、绒毛侵入肌层、Alder分级比较差异有统计学意义(均P < 0.05)。不同超声分型的CSP患者超声监视下清宫手术、双侧子宫动脉栓塞术后清宫或手术切除例数、住院时间比较差异有统计学意义(均P < 0.05)；β-HCG降至正常的时间比较差异无统计学意义(P>0.05)。结论不同超声分型CSP患者的一般临床特征、超声声像特征及患者手术方式和术后恢复情况有一定差异，超声检查对CSP分型及手术方式选择有一定指导价值。
- 超声检查 /
- 剖宫产术后子宫瘢痕妊娠 /
- 治疗
Abstract: Objective To explore the ultrasonographic characteristics, surgical methods and postoperative recovery of different types of cesarean scar pregnancy (CSP) patients. Methods Ninety-two cases of CSP diagnosed and treated in our hospital from January 2015 to December 2018 were analysed. The general clinical data, ultrasonographic features, operation and postoperative recovery were compared. The data were analysed by SPSS 23.0 statistical software. Results A total of 92 CSP patients were divided into 28 cases of type Ⅰ, 45 cases of type Ⅱ and 19 cases of type Ⅲ. No significant difference in age, menopause time, distance from the last caesarean section and serum β-HCG content was found before treatment (all P>0.05), but a significant difference in the number of induced abortion and caesarean section was observed (all P < 0.05). Significant differences in the thickness of the anterior inferior segment of the uterus, the percentage of villus invading the myometrium, the percentage of small amount of blood flow and rich blood flow in Alder classification were found (all P < 0.05). Moreover, statistical differences in the ratio of type A operation to type B operation and hospitalisation time were observed (all P < 0.05). However, no significant difference in the time when β-HCG dropped to normal was observed (P>0.05). Conclusion There are some differences in the general clinical, ultrasonic features, surgical methods and postoperative recovery of CSP patients with different ultrasonic classification. Ultrasound examination has certain guiding value for the classification of CSP and the selection of surgical methods.
- Ultrasound examination /
- Caesarean scar pregnancy /
- Treatment

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图 1 Ⅰ型瘢痕妊娠超声图像

注：A为二维图，B为三维图，C为血流图。

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图 2 Ⅱ型瘢痕妊娠超声图像

注：A为二维图，B为三维图，C为血流图。

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图 3 Ⅲ型瘢痕妊娠超声图像

注：A为二维图，B为三维图，C为血流图。

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表 1 不同分型的CSP患者一般临床资料比较(x ±s)

项目	例数	年龄(岁)	停经时间(d)	人工流产史(次)	剖宫产史(次)	距离上次剖宫产时间(年)	血清β-HCG含量(IU/L)
Ⅰ型	28	34.25±6.80	44.90±16.55	1.78±0.67	1.33±0.31	4.39±0.97	8 549.33±223.15
Ⅱ型	45	35.60±6.59	47.20±15.78	2.12±0.75^a	1.51±0.57	4.76±0.97	8 654.50±268.78
Ⅲ型	19	34.22±7.25	49.12±17.53	2.51±0.96^a	1.84±0.56^a	4.50±0.96	8 629.45±279.32
F值		0.462	0.391	5.060	5.845	1.527	1.460
P值		0.632	0.678	0.008	0.004	0.223	0.238
注：与Ⅰ型比较，^aP < 0.05。

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表 2 不同分型的CSP患者超声声像特征比较(例)

项目	例数	子宫前壁下段肌层厚度(x±s，mm)	绒毛侵入肌层(是/否)	Alder分级(少量血流/血流丰富)
Ⅰ型	28	3.24±1.28	8/20	16/12
Ⅱ型	45	2.40±0.77^a	27/18^a	13/32^a
Ⅲ型	19	1.40±0.47^ab	13/6^a	5/14^a
统计量		23.079^c	9.366^d	7.078^d
P值		< 0.001	0.009	0.029
注：与Ⅰ型比较，^aP < 0.05；与Ⅱ型比较，^bP < 0.05;^c为F值，^d为χ²值。

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表 3 不同分型CSP患者手术及术后恢复情况比较(x ±s)

项目	例数	手术方式(超声监视下清宫/双侧子宫动脉栓塞术后清宫或手术切除, 例)	住院时间(d)	β-HCG降至正常的时间(d)
Ⅰ型	28	23/5	4.48±2.16	33.80±9.55
Ⅱ型	45	22/23^a	7.54±2.44^a	35.86±10.33
Ⅲ型	19	4/15^a	8.52±3.73^a	37.23±10.34
统计量		17.646^b	16.141^c	0.704^c
P值		< 0.001	< 0.001	0.497
注：与Ⅰ型比较，^aP < 0.05；^b为χ²值，^c为F值。

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