经阴道彩超诊断早期瘢痕妊娠及评价疗效临床价值

王珉鑫++++++孙咏梅

[摘要] 目的 探討经阴道彩超诊断早期瘢痕妊娠及评价疗效临床价值。 方法 选取2016年1月～2017年1月我院瘢痕妊娠患者50例，均行经阴道超声检查。 结果 50 例术后病理检查确诊包块型29例，孕囊型21例。经阴道超声检出孕囊型18例，包块型30例，未检出2例，符合率为92.0%[（28+18）/50]。经阴道超声检查显示，包块型主要表现为形态多样，质地不均，界限不清，内膜形态失常，回声强弱不均。外周回声强，而中央以弱回声为主，部分患者中央可不见回声。峡部局部增大，与包块分界不清晰，和膀胱间肌层变薄，血流信号以低阻性为主。子宫下段切口有血流丰富的回声团块呈杂乱分布，回声紊乱。孕囊型主要表现为子宫下段切口有典型孕囊声像，子宫峡部前壁内出现明显血管搏动或明显的血流迹象。孕囊外周回声高，中央无回声，部分患者的孕囊较大，宫颈形态正常，且未发现妊娠物。结论 经阴道超声可以准确检测瘢痕妊娠，观察妊娠囊位置、大小、形态及血流情况，为瘢痕妊娠的诊断和治疗提供了可靠的参考依据。

[关键词] 经阴道彩超；瘢痕妊娠；包块型；孕囊型

[中图分类号] R445.1；R714.22 [文献标识码] B [文章编号] 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