河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (12): 1455-1459.doi: 10.3969/j.issn.1007-3205.2021.12.018

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精准超声分型在剖宫产术后子宫瘢痕妊娠治疗中的应用研究

  

  1. 河北医科大学第三医院妇产科，河北 石家庄 050051
  • 出版日期:2021-12-25 发布日期:2021-12-27
  • 作者简介:李萍（1978-），女，河北辛集人， 河北医科大学第三医院主治医师， 医学硕士，从事妇产科超声诊断研究。
  • 基金资助:
    河北省医学科学研究重点课题计划（ZD20140048）

Application of precise ultrasonic classification in the treatment of cesarean scar pregnancy

  1. Department of Obstetrics and Gynecology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
  • Online:2021-12-25 Published:2021-12-27

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摘要： 目的 探讨剖宫产术后子宫瘢痕妊娠（cesarean scar pregnancy,CSP）超声图像特征与临床诊疗方案的关系。
方法 回顾性分析河北医科大学第三医院收治的38例CSP患者,在超声分型的基础上选择不同诊疗方案。分析其临床数据、诊疗方案及结果。
结果 ①38例CSP患者中，Ⅰ型14例（孕周5.00～9.10周,2例≥8周），Ⅱ型12例（孕周5.60～8.40周），Ⅲ型12例（孕周7.60～9.00周）,分为3组；②采用基于超声分型的手术均成功，所有病例术后1日血清β-人绒毛膜促性腺激素（β-human chorionic gonadotropin,β-HCG）均降至术前的50%以下，38例患者术后3个月超声检查均未发现子宫前壁下段异常回声表现；③术中出血及手术时间：术中出血Ⅰ型中位水平17.50(40.00) mL、Ⅰ型(≥8周)及Ⅱ型20.00(90.00) mL，Ⅲ型100(250.00) mL，手术时间Ⅰ型(10.42±1.44) min、Ⅱ型(11.92±3.84) min，Ⅲ型(96.15±39.43) min，组间比较差异均有统计学意义（P＜0.05）。腹腔镜手术组患者术后β-HCG降至正常、住院时间及术后肌层厚度均优于清宫组，两组比较差异有统计学意义（P＜0.05）。
结论 精准超声分型定位检查为临床诊疗方案选择提供了重要依据，利于根据患者具体情况采用个体化诊疗。腹腔镜CSP妊娠物清除术及子宫瘢痕修补术在保留患者生育功能的同时，具有成功率高、创伤小及住院时间短优点，可作为Ⅲ型及部分Ⅱ型病例治疗的首选。


关键词: 妊娠, 瘢痕, 剖宫产术, 超声检查

Abstract: Objective  To study the relationship between ultrasound image characteristics of cesarean scar pregnancy(CSP) and clinical diagnosis and treatment plan. 
Methods  A retrospective analysis was performed on 38 patients of CSP receiving treatment in the Third Hospital of Hebei Medical University.Different diagnosis and treatment plans were selected on the basis of ultrasonic classification, and its clinical data, diagnosis and treatment plans, and outcomes were analyzed. 
Results  ①All 38 cases were divided into 3 groups, including 14 cases of typeⅠin group one(5.00-9.10 weeks of gestation, 2 cases ≥8 weeks),12 cases of type Ⅱ(5.60-8.40 weeks of gestation) in group two, and 12 cases of type Ⅲ(7.60-9.00 weeks of gestation) in group 3. ②All the patients underwent surgery successfully based on the ultrasonic classification. At one day after surgery,β-human chorionic gonadotropin(β-HCG) levels fell to less than 50% of that before surgery for all the patients. After three months, the sonography of all patients showed no abnormal echo in the lower segment of anterior uterine wall. ③As for duration of operation and blood loss, the median level of blood loss during the procedure was 17.50(40.00) mL of  typeⅠand 20.00(90.00) mL of typeⅠ(more than 8 weeks) and type Ⅱ. The median level of blood loss during the procedure was 100.00(250.00) mL of type Ⅲ. The average of operation duration was(10.42±1.44) min for typeⅠ, (11.92±3.84) min for typeⅡ， and(96.15±39.43) min for  type Ⅲ,suggesting significant differences between groups(P＜0.05).β-HCG fell to normal levels, and the length of hospital stay and the myometrium thickness after operation were better in the laparoscopic surgery group than in curettage group, suggesting significant difference(P＜0.05). 
Conclusion  Preciseultrasonic classification and positioning inspections provide an important basis for the selection of clinical diagnosis and treatment options, which is conducive to individualized diagnosis and treatment according to the specific conditions of patients. Laparoscopic CSP removal of pregnancy products and uterine scar repair have the advantages of high success rate, small trauma and short hospitalization while preserving the patient′s fertility function. They can be the first choice for the treatment of type Ⅲ and some type Ⅱ cases.


Key words: pregnancy, cicatrix, cesarean section, ultrasonography

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