部分型切口妊娠的早期超声诊断

摘要

目的 探讨早期注重细节特点及近期追踪观察在部分型切口妊娠诊断、鉴别诊断中的作用.方法 对我院2010年1月至2015年8月66例经超声诊断为部分型切口妊娠的门诊及入院患者作回顾性分析.结果 我院初次超声正确诊断51例,有11例初次误诊为宫内孕经复查后诊断为部分型切口妊娠,另有4例首次误诊为部分型切口妊娠后确诊为宫内孕.回顾分析62例未经处理的部分型切口妊娠的超声图像特点发现:空囊型27例,有卵黄囊无胚芽的22例,有胚芽及有/无胎心搏动的13例.62例均位于子宫下段接近切口处,肌层厚度2.8~6.4 mm,平均4.5 mm.孕囊受牵拉形态改变40例,无明显变形20例,宫腔线偏移37例,偏移不明显的23例,有2例因图像质量欠佳孕囊变形、宫腔线偏移的情况不明确;切口附近有血流的59例,复诊均有血流增多.结论 妊娠囊的细节特点即着床部位、着床处子宫壁的厚度,孕囊变形及偏移宫腔线的情况,卵黄囊及胚芽的位置,孕囊周边的血流及其变化情况对早期诊断部分型切口妊娠很有帮助.%Objective To investigate of effect of early attention to microscopic characteristics and follow-up observation in the diagnosis and differential diagnosis of pregnancy with partial incision. Methods The clinical data of 66 cases of pregnancy with partial incision who diagnosed by ultrasound in our hospital from January 2010 to August 2015 were retrospectively analyzed. Results A total of 51 of the 66 were diagnosed definitely by ultrasonic results for the first time, and 15 cases were misdiagnosed (11 cases of cesarean scar pregnancy [CSP] were misdiagnosed as early intrauterine pregnancies, 4 cases of early intrauterine pregnancies were misdiagnosed as CSP by ultrasonic results for the first time). The ultrasound image characteristics of 62 cases of pregnancy with partial incision showed that, there were 27 cases of empty pregnant sac, 22 cases of yolk sac in pregnant sac, and 13 cases of embryon in pregnant sac. Sixty-two cases were located in the lower part of the uterus near the incision, and the thickness of muscle layer was from 2.8 mm to 6.4 mm, with an average of 4.5 mm. Forty cases had gestational sac deformation, and 20 cases did not show obvious ges-tational sac deformation. Thirty-seven cases had the lower part of gestational sac deviated from the uterine cavity, while 23 cases showed no obvious deviation. Because of the poor image quality, 2 cases were not clear in gestational sac defor-mation and deviation. Star-like or short rod blood signals appeared in 59 cases. All cases showed more blood signals in reexamination. Conclusion Microscopic characteristics (the location of the gestational sacs in the uterus, thickness of myometrium at the incision, gestational sac deformation and deviation, location of yolk sac and embryo, blood signals) were helpful to the early ultrasound diagnosis of pregnancy with partial incision.