李　静　张　蕾　公　真　马小平　万贵平

南京中医药大学附属中西医结合医院妇科超声室，江苏南京210028

经阴道彩色多普勒超声在剖宫产瘢痕部位妊娠中的应用

李静张蕾公真马小平万贵平▲

南京中医药大学附属中西医结合医院妇科超声室，江苏南京210028

目的探讨经阴道彩色多普勒超声用于剖宫产瘢痕部位妊娠的临床价值。方法收集我院2013年12月2日～2016年7月6日经手术和病理学诊断为剖宫产瘢痕部位妊娠的19例患者的临床资料，对其进行回顾性分析。结果19例剖宫产瘢痕部位妊娠患者中18例经阴道彩色多普勒超声确诊，准确率为94.7%，漏诊1例由磁共振确诊。不同类型的剖宫产瘢痕部位妊娠有各自的声像图特点。超声确诊18例中孕囊表面型5例、孕囊植入型8例、包块残留型3例和包块侵蚀型2例。结论经阴道彩色多普勒超声不仅是诊断剖宫产瘢痕部位妊娠的主要方法，而且在其治疗方面具有指导性作用。

彩色多普勒超声曰子宫曰剖宫产瘢痕部位妊娠

［Abstract］Objective To investigate the clinical value of transvaginal color Doppler ultrasound in the application of cesarean scar pregnancy.Methods The clinical data of 19 patients with cesarean scar pregnancy confirmed by operation and pathological diagnosis from December 2nd，2013 to July 6th，2016 in our hospital were collected and retrospective analysis were made.Results 18 out of 19 patients with cesarean scar pregnancy were definitely diagnosed by the transvaginal color Doppler，with the accuracy rate of 94.7%and one case was missed and diagnosed by magnetic resonance.Different ultrasonographic characteristics were demonstrated in the different types of cesarean scar pregnancy. 5 cases were at the surface of the gestational sac；8 cases were type of the gestational sac implanted；3 cases were type of masses residual and 2 cases were type of masses erosion.Conclusion Transvaginal color Doppler ultrasound is not only the primary measure to diagnose the cesarean scar pregnancy，but also plays an instructive role in the treatment.

［Key words］Color Doppler ultrasound；Uterus；Cesarean scar pregnancy

剖宫产瘢痕部位妊娠（cesarean scar pregnancy，CSP）指胚胎着床在子宫下段剖宫产切口瘢痕处，是一种特殊类型的异位妊娠［1］，是剖宫产远期并发症之一。CSP与异位妊娠总数比为1/1800～1/2216，已经超过宫颈妊娠［2］。如果早期不及时干预，妊娠物可种植于子宫瘢痕凹陷处，并且不断向子宫肌层发展，与其发生粘连、植入、穿透，甚至引起子宫破裂，发生难以控制的大出血，严重影响妊娠妇女的身心健康［3］。2013年WHO调查资料表明，我国剖宫产率已达55%，居世界第一位。……