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目的探讨经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠(CSP)的临床价值。方法收集2012年10月至2014年10月沈阳市妇婴医院收治的64例经阴道超声诊断为剖宫产切口瘢痕妊娠患者的影像及临床资料,分析其超声声像图特征及与临床结局的关系。结果超声诊断为CSP的64例患者中59例(92.2%)经病理证实,5例为难免流产。根据超声声像图特征将59例CSP分为2型:孕囊型(41例)和混合回声型(18例)。孕囊型分为3个亚型:I型妊娠囊边缘位于切口处(24例),Ⅱ型妊娠囊陷入切口内(15例),Ⅲ型妊娠囊向膀胱方向凸出(2例)。I型治疗以宫腔镜为主,Ⅱ型、Ⅲ型及混合回声型治疗以腹腔镜为主。结论经阴道彩色多普勒超声为诊断CSP的有效方法,正确的超声分型及对切口瘢痕厚度的准确测量有助于临床医生选择更加适合患者的个体化治疗方案。
Objective To investigate the clinical value of transvaginal color Doppler sonography in the diagnosis of cesarean scar pregnancy (CSP). Methods The images and clinical data of 64 cases of cesarean scar pregnancy diagnosed by transvaginal ultrasound in Shenyang Maternal and Child Hospital from October 2012 to October 2014 were collected and analyzed. The echocardiographic features and clinical features were analyzed relationship. Results Of the 64 patients diagnosed by CSP, 59 (92.2%) were pathologically confirmed and 5 were inevitable abortion. According to the characteristics of ultrasonography, 59 cases of CSP were divided into 2 types: gestational sac type (41 cases) and mixed echo type (18 cases). The gestational sacs were divided into three subtypes: type I gestational sac margins at the incision (24 cases), type II gestational sac incision (15 cases), type III gestational sac protruding to the direction of the bladder (2 cases). Type I treatment is mainly based on hysteroscopy, and type II, type III and mixed echogenic type therapy are mainly laparoscopic. Conclusion Transvaginal color Doppler ultrasonography is an effective method for the diagnosis of CSP. Correct ultrasound typing and accurate measurement of incision scar thickness will help clinicians choose a more personalized treatment plan for patients.