朱兆领　王睿丽　刘冰冰　郭玉娟

【摘要】 目的 探讨经阴道超声检查对剖宫产术后子宫切口憩室的诊断价值。方法 对剖宫产术后临床怀疑切口处憩室的50例患者行经阴道超声检查， 检查过程中观察切口处有无憩室， 测量憩室大小及其最薄肌层厚度， 检查后1个月内均进行宫腔镜检查， 以宫腔镜检查发现憩室作为诊断标准。结果 宫腔镜发现憩室45例， 经阴道超声检查发现憩室40例， 与宫腔镜相比， 经阴道超声检查诊断憩室的符合率为90.00%， 灵敏度为88.89%， 特异度为100.00%， 漏诊率为11.11%。经阴道超声检查测量憩室大小为上下径（9.17±2.63）mm、左右径（11.76±5.67）mm、高度（5.62±2.13）mm， 最薄肌层厚度（3.29±1.01）mm。结论 经阴道超声检查能够较好的发现子宫切口处憩室并能够对憩室大小、肌层厚度进行准确测量， 是一种诊断切口处憩室无创、便捷的检查方法。

【关键词】 经阴道超声检查；剖宫产瘢痕憩室；宫腔镜

DOI：10.14163/j.cnki.11-5547/r.2016.26.010

【Abstract】 Objective To investigate diagnostic value of transvaginal ultrasound for cesarean scar diverticulum after cesarean section. Methods Transvaginal ultrasound was taken by 50 patients with suspected scar diverticulum after cesarean section. Scar diverticulum was observed， and diverticulum size and the thinnest muscular thickness were detected. All patients received hysteroscope examination after 1 month， and hysteroscopic outcome was taken as diagnosis standard. Results There were 45 cases with diverticulum detected by hysteroscope and 40 cases by transvaginal ultrasound. Comparing with hysteroscope， transvaginal ultrasound in diagnosing diverticulum showed coincidence rate as 90.00%， sensitivity as 88.89%， specificity as 100.00% and misdiagnosis rate as 11.11%. Transvaginal ultrasound showed vertical diameter of diverticulum as （9.17±2.63） mm， transversal diameter as （11.76±5.67） mm， height as （5.62±2.13） mm and the thinnest muscular thickness as （3.29±1.01） mm. Conclusion As an non-invasive and convenient examination way in diagnosis of scar diverticulum， transvaginal ultrasound can detect cesarean scar diverticulum and measure diverticulum size and muscular thickness with good accuracy.

【Key words】 Transvaginal ultrasound； Cesarean scar diverticulum； Hysteroscope

近些年来， 剖宫产率逐年上升， 已超过足月分娩的1/3[1]， 国内尤为普遍， 剖宫产术后并发症逐渐显现， 而切口憩室是剖宫产术后最常见的远期并发症之一[2]， 一次剖宫产可使60.0%患者出现切口憩室， 16.9%～88.0%切口处憩室的患者会出现明显临床症状[3]， 主要症状表现为月经淋漓不尽， 慢性盆腔疼痛、憩室处妊娠、继发不孕等情况， 严重影响患者的生活质量， 对于憩室处肌层较薄者甚至可能出现再次妊娠时子宫破裂的风险， 随着二胎政策的开放， 孕前准确评估憩室显得尤为重要。目前对憩室的诊断方法不一， 本文旨在探讨经阴道超声检查诊断憩室的临床意义及价值， 报告如下。……