超声对切口妊娠的诊断价值及误诊病例分析.docVIP

精品论文 参考文献 超声对切口妊娠的诊断价值及误诊病例分析 湖南省长沙市妇幼保健院超声科 湖南长沙 410007 【摘 要】目的 探讨超声对剖宫产术切口处妊娠（切口妊娠）的诊断价值，以及如何提高超声诊断切口妊娠的准确率。方法 选取2016年1月至2016年6月，在我科诊断为切口妊娠，并在我院治疗或密切随访的病例资料进行回顾性分析。结果 42例诊断为切口妊娠的患者中，41例临床反馈符合切口妊娠，符合率97.6%，其中，妊娠物位于切口（剖腹产切口疤痕）11例（活胎10例、胚胎停育1例）；妊娠物下缘达切口处30例（活胎28例，胚胎停育2例）；孕囊下缘距离切口3mm 1例。另有1例孕60+天的低位妊娠误诊为切口妊娠。 结论 超声诊断较早期的切口妊娠有较高的准确率，但对于初次超声检查孕囊已经较大几乎充满宫腔的病例，诊断会相对困难。为提高诊断符合率，我们在检查中除了要关注孕囊位置，切口处疤痕厚度，还要着重观察孕囊与子宫切口之间是否有明确的血流滋养关系，及孕囊主要的血供来自子宫的哪个壁，来综合判断是否为切口妊娠。 【关键词】切口妊娠；孕囊位置；疤痕厚度；血流滋养关系 ［Abstract］Objective To investigate the value of ultrasound in the diagnosis of incision pregnancy，and how to improve the accuracy rate. Method we made a retrospective analysis of incision pregnancy cases，those cases were diagnosed and treated or closely observed in our hospital during the period from January 2016 to June 2016. Results In 42 cases of patients diagnosed as incision pregnancy，41 cases were clinically feedback to meet the incision pregnancy，the rate was 97.6%。Among these cases，the pregnancy of 11 cases were located in the incision：1 cases of live births and 10 cases of embryo stop；The lower edge of the pregnancy in 30 cases were located in the edge of incision(28 cases of live birth，2 cases of embryo stop）；1 case，the distance between the lower margin of the gestational sac and the incision was 3 mm. Another case of low pregnancy was misdiagnosed as incision pregnancy. Conclusion The accurate rate of ultrasound diagnosis of early incision pregnancy is very high，however，the diagnosis of those cases（The gestational sac has been large and even filled the whole uterine cavity in the initial ultrasound examination）will be relatively difficult. In order to improve the accordance rate，we should pay attention to the location of the gestational sac，and the thickness of the scar in the incision，especially，we should focus on whether there was clear blood supply relationship between the gestational sac and uterine incision，and the main blood supply of the gestational sac was from witch