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目的:分析经腹及经阴道三维超声诊断子宫下段前壁剖宫产术后瘢痕妊娠(CSP)的声像图特征及其对临床治疗的指导价值。方法:2008年1月~2014年9月在该院及深圳宝安区妇幼保健院就诊的CSP患者中选取资料完整的28例进行回顾性分析,利用二维及三维立体成像模式,清晰显示妊娠物(妊娠囊或妊娠包块)与子宫瘢痕分界及空间立体位置关系,观察瘢痕处肌层的厚度、浆膜面的延续情况、妊娠物内部及周边的血流分布、宫腔情况及宫颈情况。结果:28例CSP患者中,在宫内正常部位均未见妊娠囊,在子宫下段切口处可见胚囊或杂乱回声性包块。子宫下段瘢痕处仅见妊娠囊者14例,子宫下段瘢痕处见杂乱回声性包块者4例,妊娠囊部分位于瘢痕处呈“水滴或茄子”状凸向宫腔者7例,妊娠囊部分位于瘢痕处呈“水滴或茄子”状凸向宫颈管者3例。28例CSP患者的子宫下段肌层呈楔形改变,妊娠物与瘢痕肌层大多数分界不清,瘢痕处肌层均较薄或菲薄,血流信号均集中在瘢痕处,大多数血流较丰富。根据妊娠物内部及周边血流分布情况,参照Adler〔1〕进行分级:0级(无)、Ⅰ级(5例)、Ⅱ级(15例)和Ⅲ级(8例)。结论:利用经腹及经阴道三维超声的彩色血流及立体空间结构能更清楚、更形象地显示子宫瘢痕妊娠物与瘢痕之间的关系,及早作出定位定性诊断,给临床治疗和判断治疗效果提供可靠而重要的依据。
OBJECTIVE: To analyze the ultrasonographic features of cesarean scar pregnancy (CSP) by transabdominal and transvaginal three-dimensional ultrasonography in the diagnosis of anterior uterine segment anterior cesarean section and its value in clinical treatment. METHODS: From January 2008 to September 2014, 28 patients with complete CSP in our hospital and in Bao’an District MCH hospital in Shenzhen were retrospectively analyzed. Using 2D and 3D stereoscopic imaging, (Gestational sac or pregnancy mass) and uterine scar demarcation and spatial three-dimensional positional relationship, observing the thickness of myometrial scar, the continuation of the serosal surface, the distribution of blood flow inside and around the pregnancy, uterine conditions and cervical conditions. Results: Among the 28 CSP patients, no gestational sac was found in the normal part of the uterus. Embryo sac or disorganized echogenic mass was seen in the lower uterine incision. In the lower uterine scar, only 14 cases were found with gestational sac, 4 cases with disorganized eyelid mass in the lower uterine scar, 7 cases with gestational sac located in the scar, “water drop or eggplant” Some were located in the scar was “water droplets or eggplant ” convex to the cervical canal in 3 cases. 28 cases of CSP patients with lower uterine myometrium wedge-shaped change, pregnancy and scar myometrial most of the boundaries are unclear, the scar myometrial thin or meager, the blood flow signals are concentrated in the scar, most of the blood flow is more abundant . According to the distribution of blood flow inside and around the pregnancy, the patients were classified according to Adler [1]: grade 0 (no), grade I (n = 5), grade II (n = 15) and grade III (n = 8). Conclusion: The use of transabdominal and transvaginal three-dimensional ultrasound color flow and three-dimensional spatial structure can be more clearly and more vividly show the relationship between uterine scar pregnancy and scars, as early as making a qualitative diagnosis of positioning, to clinical treatment and to determine the treatment effect Provide a reliable and important basis.