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目的总结子宫切口瘢痕妊娠合并出血的彩超、DSA影像学诊断,并探讨其介入和临床联合治疗价值。方法选择收集该院近3年经病理证实的子宫切口瘢痕妊娠合并出血的80例患者资料,术前B超确诊后行介入诊断性造影及双侧子宫动脉栓塞术,并在24~48h内行超声引导下清宫术。结果彩超表现为子宫前壁下段肌层内不均质混合回声,内见囊状及迂曲管状无回声,边界不清,向宫外突出,其前方与膀胱之间肌层变薄。彩色多普勒血流显像示包块内部及周边血流信号非常丰富。DSA表现为不同程度的子宫动脉增粗,子宫常大或稍大,不同程度的峡部增宽,其内均可见不均质染色,有造影剂渗出。80例介入双侧子宫动脉栓塞术联合清宫术均成功。但首次术后出现23例宫腔残留及2例感染的并发症,占31.3%。结论彩超是子宫切口瘢痕妊娠首选、可靠的诊断方法。DSA不仅能明确出血及部位,而且同时行介入双侧子宫动脉栓塞术能较好的治疗出血、起到杀灭胚胎细胞的作用。并联合清宫术彻底治愈疾病,保留子宫。但首次治疗仍有一定的并发症,需要二次处理。
Objective To summarize the color Doppler ultrasound, DSA imaging diagnosis of uterine incision scar pregnancy complicated with bleeding, and discuss the value of its intervention and clinical combination therapy. Methods Eighty patients with histologically proved uterine incision scar pregnancy were collected from the hospital in the past 3 years. Preoperative diagnosis of B-ultrasonography was performed with diagnostic angiography and bilateral uterine arterial embolization. Ultrasound was performed within 24-48 hours Guidance under the curettage. The results of color Doppler ultrasound showed that the lower anterior wall of the uterine anterior mixed heterogeneous muscular echo, see cystic and tortuous tubular anechoic, the boundary is unclear, prominent to the outside of the uterus, the front and the bladder between the thinning. Color Doppler flow imaging showed the internal and peripheral blood flow signals are very rich. DSA showed varying degrees of uterine artery thickening, the uterus often larger or larger, varying degrees of isthmus widening, which can be seen within the uneven staining, with contrast agent exudation. 80 cases of bilateral uterine artery embolization combined with curettage were successful. However, after the first postoperative complications of 23 cases of uterine cavity and 2 cases of infection, accounting for 31.3%. Conclusion Color Doppler ultrasound is the first choice of reliable and reliable method for uterine incision scar pregnancy. DSA can not only identify the site of bleeding and bleeding, but at the same time involved in bilateral uterine artery embolization can better hemorrhage, play a role in killing embryonic cells. And combined curettage cure the disease completely, keep uterus. But the first treatment is still some complications, the need for secondary treatment.