經陰道彩超診斷早期瘢痕妊娠及評價療效臨床價值

王珉鑫++++++孫詠梅

[摘要] 目的 探討經陰道彩超診斷早期瘢痕妊娠及評價療效臨床價值。 方法 選取2016年1月～2017年1月我院瘢痕妊娠患者50例，均行經陰道超聲檢查。 結果 50 例術后病理檢查確診包塊型29例，孕囊型21例。經陰道超聲檢出孕囊型18例，包塊型30例，未檢出2例，符合率為92.0%[（28+18）/50]。經陰道超聲檢查顯示，包塊型主要表現為形態多樣，質地不均，界限不清，內膜形態失常，回聲強弱不均。外周回聲強，而中央以弱回聲為主，部分患者中央可不見回聲。峽部局部增大，與包塊分界不清晰，和膀胱間肌層變薄，血流信號以低阻性為主。子宮下段切口有血流豐富的回聲團塊呈雜亂分布，回聲紊亂。孕囊型主要表現為子宮下段切口有典型孕囊聲像，子宮峽部前壁內出現明顯血管搏動或明顯的血流跡象。孕囊外周回聲高，中央無回聲，部分患者的孕囊較大，宮頸形態正常，且未發現妊娠物。結論 經陰道超聲可以準確檢測瘢痕妊娠，觀察妊娠囊位置、大小、形態及血流情況，為瘢痕妊娠的診斷和治療提供了可靠的參考依據。

[關鍵詞] 經陰道彩超；瘢痕妊娠；包塊型；孕囊型

[中圖分類號] R445.1；R714.22 [文獻標識碼] B [文章編號] 1673-9701（2017）31-0098-03

[Abstract] Objective To investigate the diagnosis of early scar pregnancy and efficacy evaluation by transvaginal color ultrasonography. Methods 50 patients with scar pregnancy who were admitted to our hospital from January 2016 to January 2017 were selected， and they were all given transvaginal ultrasonography. Results According to 50 cases of postoperative pathology， 29 cases of massive type and 21 cases of gestational sac were diagnosed. Transvaginal ultrasonography detected 18 cases of gestational sac， 30 cases of massive type， and 2 cases not detected. The coincidence rate was 92.0%[（28+18）/50]. Transvaginal ultrasonography showed that the main manifestations of massive type were various forms， uneven texture， unclear boundaries， endometrial morphology disorders， and uneven echo intensity. The peripheral echo was strong， and the central part was mainly weak echo. There was no echo in some patients in the central part. The isthmus was enlarged locally， with unclear boundaries with the mass， and thinning muscle layer between the bladder. The blood flow signal was dominated by low resistance. In the incision of lower segment of uterus， there was echo mass with rich blood flow， which was distributed in disorder， and the echo was in disorder. The gestational sac type mainly showed typical pregnancy image in the incision of lower segment of uterus. The anterior wall of uterine isthmus showed obvious vascular pulsation or obvious signs of blood flow. The echo of peripheral gestational sac was high， and there was no echo in central part. Some patients were with larger gestational sac， the cervical morphology was normal， and no pregnancy residues were found. Conclusion Transvaginal ultrasonography can accurately detect scar pregnancy. Gestational sac location， size， shape and blood flow conditions are observed， which provides reliable references for the diagnosis and treatment of scar pregnancy.

[Key words] Transvaginal color ultrasonography； Scar pregnancy； Massive type； Gestational sac typeendprint