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经阴道彩色多普勒超声对于水囊压迫治疗子宫切口妊娠效果的评估价值
Value of transvaginal color Doppler ultrasound in evaluating the treatment effect of water sac compression to incision pregnancy
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DOI:
作者:
姚丽华,项金莲,陈娟,张姝嫔
yaolihua
作者单位:
上海市第一人民医院宝山分院
Baoshan Branch of Shanghai First People's Hospital
关键词:
彩色多普勒; 阴道超声; 子宫切口妊娠;水囊压迫;化疗
color Doppler ultrasound; transvaginal ultrasound; uterine incision pregnancy; waterbag oppression; chemotherapy
摘要:
目的 探讨经阴道彩色多普勒超声对于水囊压迫治疗子宫切口妊娠效果的评估价值。方法 对40例子宫切口妊娠患者做前瞻性对比研究,将患者随机分为A组和B组各20例,A组在刮宫术前应用Foley球囊注射生理盐水40-60ml压迫CSP孕囊处,下端连接负压吸引球,压迫24小时后超声引导下行刮宫术,B组应用药物治疗(甲氨蝶呤及米非司酮)后超声引导下行刮宫术,分析两组病例的超声声像图特征及治疗后超声图像的变化。结果 1.两组患者均表现为孕囊型。2. 两组病例治疗后胚囊周围血流信号减少,RI增高(p<0.05),两组RI增高值的差异无统计学意义(P>0.05)。3.两组CSP患者刮宫术后声像图均表现为前壁切口处回声增高,部分见混合性包块,并逐渐变小至恢复正常。4.两组患者在术中、术后的出血量及血β-HCG下降到正常水平的时间比较差异有统计学意义(P<0.05)。5.宫腔刮出物组织病理比较,A组为蜕膜组织和胎盘组织绒毛蜕变,伴胚囊绒毛水肿。B组为妊娠期子宫内膜伴绒毛。结论 经阴道彩色多普勒超声对子宫切口妊娠能提供较准确的早期诊断,并对其治疗和随访有重要监测作用。在治疗子宫切口妊娠过程中,刮宫术前应用Foley球囊注水压迫治疗是一种简单易行、疗效显著的方法,值得推广。
Abstract Objective: To discuss value of transvaginal color Doppler ultrasound in evaluating the treatment effect of water sac compression to incision pregnancy. Methods: A prospective and comparative study was done to 40 cases of patients with uterine incision pregnancy, the patients were divided into group A and group B randomly, 20 cases in each group. Group A was treated with waterbag oppression, the Foley balloon injected with 40-60ml saline was oppressed at the CSP gestational sac before curettage , it’s bottom was connected to the negative pressure suction ball, and ultrasound-guided curettage was carried out after 24 hours’ oppression. Group B was treated with drug therapy (MTX and mifepristone) before ultrasound-guided curettage. Ultrasound image features before and after therapy were analyzed. Results: 1.The two groups of patients were all gestational sac type. 2. After treatment the blood flow signal around the embryo sac decreased in both groups, and RI increased (P < 0.05). But the difference of RI increased value for the two groups was not statistically significant (P > 0.05). 3. After curettage, the ultrasound images of two groups all showed increased echo in anterior incision, some cases had mixed masses and could gradually reduced to normal. 4.There was statistical significance between the two groups related to the intraoperative and postoperative blood loss and the time forβ-HCG decreased to normal (P < 0.05). 5. Histopathological findings of intrauterine curettage for two groups: group A showed decidua and placenta chorionic metamorphosis with embryo chorionic edema, group B was found pregnant uterine endometrium with chorion. Conclusions: Transvaginal color Doppler ultrasound can provide relatively accurate early diagnosis of uterine incision pregnancy, and has important monitoring effect on the treatment and follow-up. During the treatment of uterine incision pregnancy, application of Foley balloon oppression before curettage is a method easy to operate and has obvious therapeutic effect which is worthy to be popularized.
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