翟宪皊

[摘要] 目的 探讨彩色多普勒超声诊断子宫瘢痕妊娠（CSP）及临床价值分析。方法 方便选取该组2016年1月—2017年7月收治的10例疑似CSP的患者进行回顾性分析，所有患者均经临床治疗及术后病理证实。结果 10例通过超声检查诊断为CSP患者9例，诊断符合率90%，误诊1例。其中1例行宫腔镜下电切术，由于出血较多转经腹瘢痕妊娠祛除术，其病理为变性坏死的胎盘绒毛；1例在其他医院药物流产失败在该院误诊为不全流产行清宫术，术后大出血，后经保守治疗成功；8例行药物保守治疗成功。根据其声像图特征，分为孕囊型和混合包块型，10例患者中孕囊型7例，混合包块型2例，难免流产1例，全部患者均治愈出院。 结论 超声检查对CSP具有重要诊断价值，值得在临床实践中广泛应用和推广。

[关键词] 彩色多普勒；超声诊断；剖宫产； 瘢痕子宫妊娠

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2018）01（a）-0174-03

Color Doppler Ultrasound in the Diagnosis of Uterine Scar Pregnancy and Its Clinical Value Analysis

ZHAI Xian-ling

B Ultrasonic Room， Chengwu Hospital of Traditional Chinese Medicine， Chengwu， Shandong Province， 274200 China

[Abstract] Objective This paper tries to explore the clinical value of color Doppler ultrasound in the diagnosis of uterine scar pregnancy （CSP）. Methods A retrospective analysis of 10 patients with suspected CSP admitted in this hospital from January 2016 to July 2017 was convenient conducted， all patients were confirmed by clinical treatment and postoperative pathology. Results 10 cases were diagnosed as CSP by ultrasonic examination in 9 cases， the diagnostic accordance rate was 90%， and 1 case was misdiagnosed. In 1 case of hysteroscopic resection， due to bleeding by transabdominal operation dispel scar pregnancy， the placenta pathological degeneration and necrosis； 1 cases in other hospital failed medical abortion in our hospital diagnosed as incomplete abortion curettage， postoperative bleeding， after conservative treatment； 8 cases conservative successful treatment. According to the sonographic features， they were divided into gestational sac type and mixed mass type. In 10 cases， there were 7 cases of gestational sac type， 2 cases of mixed mass type， 1 case of inevitable abortion， all patients were cured and discharged. Conclusion Ultrasonography has important diagnostic value for CSP， and it is worthy of wide application and promotion in clinical practice.

[Key words] Color Doppler； Ultrasound diagnosis； Cesarean section； Scar uterus pregnancy

CSP是指有過剖宫产的妇女，再次妊娠时孕囊在剖宫产术后子宫瘢痕处着床，而引起的一种较难处理的异位妊娠[1]，由于孕囊种植于子宫下段瘢痕部位，其肌层较薄弱收缩力差。如果继续妊娠或者盲目行人工流产则易引起子宫破裂、大出血等严重并发症。近年来，随着剖宫产率升高、二胎政策的开放、超声技术的不断发展、及诊断水平的提高，瘢痕子宫妊娠发生率明显上升，瘢痕妊娠已成为现阶段妇科大夫共同关注的问题，该病早期临床表现不明显，仅凭临床症状及实验室检查，易误诊和漏诊……