超声造影对剖宫产疤痕妊娠诊断及治疗方式选择的应用价值

杨成梁; 王春艳; 黄恺; 洪雪; 张玮

doi:10.16766/j.cnki.issn.1674-4152.003386

超声造影对剖宫产疤痕妊娠诊断及治疗方式选择的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.003386

杨成梁¹,
王春艳^2, ,,
黄恺²,
洪雪¹,
张玮¹

1.
嘉兴市第二医院超声诊断科，浙江嘉兴 314000
2.
嘉兴市第二医院妇科

基金项目:

浙江省医药卫生科技计划项目 2019KY698

详细信息

通讯作者:
王春艳，E-mail：3304669013@qq.com

中图分类号: R714.2 R445.1
计量
- 文章访问数: 179
- HTML全文浏览量: 154
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2023-02-23
- 网络出版日期: 2024-03-27

The application value of contrast-enhanced ultrasound on diagnosis and treatment of cesarean section pregnancy

1.
Department of Ultrasonography, the Second Hospital of Jiaxing, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的通过分析超声造影(CEUS)在剖宫产疤痕妊娠(CSP)诊断及治疗中的应用效果，以期为临床CSP诊治提供参考。方法回顾性收集2017年1月—2021年1月于嘉兴市第二医院就诊的80例疑似CSP患者的相关资料，术前均接受阴道超声、CEUS检查。以手术病理为金标准，对比阴道超声、CEUS对CSP的诊断效能，观察超声图像表现；对比CSP与非CSP患者超声造影时间-强度曲线(TIC)参数，并分析不同手术方式患者CEUS相关指标差异。结果 80例疑似CSP患者中，手术病理证实CSP 60例(75.00%)。手术病理作为金标准，CEUS诊断敏感度(96.67% vs. 86.67%)、准确度(93.75% vs. 83.75%)均明显高于阴道超声(P＜0.05)。60例CSP患者中，阴道超声显示突向包膜外18例，血流分级丰富型36例，孕囊型病灶46例；CEUS图像显示“面包圈”征55例。CSP患者造影开始增强时间、达峰时间均早于非CSP患者(P＜0.05)，峰值强度、增强速率均更大(P＜0.05)。腹腔镜手术患者CEUS指标孕囊/包块主要血供在疤痕处、绒毛膜/早期胎盘部位完全覆盖疤痕比例均大于超声下吸宫术/宫腔镜(P＜0.05)，疤痕厚度更小(Z=4.615，P < 0.001)。结论 CEUS对CSP诊断典型特征为“面包圈”征，相比阴道超声其诊断效能更大，且CEUS孕囊/包块主要供血部位等特征可能影响CSP治疗方式。
- 剖宫产 /
- 疤痕妊娠 /
- 超声造影 /
- 诊断 /
- 治疗
Abstract: Objective To examine the use of contrast-enhanced ultrasound (CEUS) for diagnosing and treating cesarean section scar pregnancy (CSP) providing a reference for clinical diagnosis and treatment of CSP. Methods The study retrospectively collected data from 80 suspected patients with CSP who were admitted to the Second Hospital of Jiaxing between January 2017 and January 2021. All patients underwent transvaginal ultrasonography and CEUS examination prior to surgery. The study compared the diagnostic efficacy of vaginal ultrasound and CEUS for CSP to surgical pathology, and observed the ultrasonographic manifestations; The parameters of contrast-enhanced ultrasound time-intensity curve (TIC) were compared between CSP and non-CSP patients, and the differences of CEUS related indexes in patients with different surgical methods were analyzed. Results Out of 80 patients suspected of having CSP, 60 cases (75.00%) were confirmed through operation and pathology. CEUS demonstrated significantly higher diagnostic sensitivity (96.67% vs. 86.67%) and accuracy (93.75% vs. 83.75%) compared to transvaginal ultrasound, which was considered the gold standard (P < 0.05). Out of 60 patients with CSP, 18 cases exhibited extravasation, 36 cases showed rich blood grading, and 46 cases showed gestational cystic lesions; The CEUS images revealed a "bagel" sign in 55 cases. The onset and peak times of angiography in patients with cerebral small vessel disease (CSVD) were earlier than those in patients without CSVD (P < 0.05), Additionally, the peak intensity and rate of enhancement were greater in patients with CSVD (P < 0.05). The proportion of the major blood supply to the gestational sac/mass in the scar and the chorionic membrane/early placenta completely covering the scar was found to be higher in laparoscopic surgery than in ultrasound/hysteroscopy (P < 0.05), Additionally, the scar thickness was smaller in laparoscopic surgery (P < 0.05). Conclusion CEUS is typically characterized by the "bagel" sign in the diagnosis of CSP, which has greater diagnostic efficacy than transvaginal ultrasound, Additionally, the characteristics of the main blood supply site of CEUS pregnancy sac/mass may affect the treatment of CSP.
- Caesarean section /
- Scar pregnancy /
- Contrast-enhanced ultrasound /
- Diagnosis /
- Treatment

HTML全文

表 1 阴道超声对CSP的诊断效能

Table 1. Diagnostic efficacy of vaginal ultrasound for CSP

阴道超声	手术病理		合计
阴道超声	CSP	非CSP	合计
CSP	52	5	57
非CSP	8	15	23
合计	60	20	80

下载: 导出CSV

表 2 CEUS对CSP的诊断效能

Table 2. Diagnostic efficiency of CEUS for CSP

CEUS	手术病理		合计
CEUS	CSP	非CSP	合计
CSP	58	3	61
非CSP	2	17	19
合计	60	20	80

下载: 导出CSV

表 3 CSP患者与非CSP患者TIC参数比较(x±s)

Table 3. Comparison of TIC parameters between CSP patients and non-CSP patients (x±s)

组别	例数	开始增强时间(s)	达峰时间(s)	峰值强度(dB)	增强速率(dB/s)
CSP	60	11.43±2.00	16.70±3.06	27.93±3.28	6.20±2.81
非CSP	20	15.40±1.85	23.10±3.14	18.74±2.96	2.72±0.95
t值		7.827	8.049	11.105	5.416
P值		＜0.001	＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 4 不同治疗方式CSP患者CEUS图像特征比较

Table 4. Comparison of CEUS image features in CSP patients with different treatment modalities

治疗方式	例数	孕囊/包块主要血供在疤痕处[例(%)]	绒毛膜/早期胎盘部位完全覆盖疤痕[例(%)]	疤痕厚度[ M(P₂₅, P₇₅)，mm]
腹腔镜手术	15	10(66.67)	14(93.33)	0.0(0.0, 1.8)
超声下吸宫术/宫腔镜	43	10(23.26)	21(48.84)	2.5(1.2，3.2)
统计量		9.276^a	9.201^a	4.615^b
P值		0.002	0.002	＜0.001
注：^a为χ²值，^b为Z值。经阴道疤痕妊娠病灶清除术样本量太少，未纳入分析。

下载: 导出CSV

参考文献(19)

[1]	HANÁČEK J, HEŘMAN H, KŘEPELKA P, et al. Cesarean scar pregnancy[J]. Ceska Gynekol, 2022, 87(3): 193-197. doi: 10.48095/cccg2022193
[2]	王超, 姚颖, 李蓉, 等. 剖宫产瘢痕妊娠的流行病学研究: 现状与展望[J]. 中国妇产科临床杂志, 2021, 22(4): 444-445. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC202104037.htm WANG C, YAO Y, LI R, et al. Epidemiologic study of cicatricial pregnancy in cesarean section: current situation and prospect[J]. Chinese Journal of Clinical Obstetrics and Gynecology, 2019, 22(4): 444-445. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC202104037.htm
[3]	TIMOR-TRITSCH I E. Cesarean scar pregnancy: a therapeutic dilemma[J]. Ultrasound Obstet Gynecol, 2021, 57(1): 32-33. doi: 10.1002/uog.23549
[4]	沈翠, 刘昕. 超声造影在剖宫产瘢痕妊娠诊断中的价值[J]. 中国数字医学, 2019, 14(2): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-YISZ201902027.htm SHEN C, LIU X. The value of contrast-enhanced ultrasound in the diagnosis of cesarean scar pregnancy[J]. China Digital Medicine, 2019, 14(2): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-YISZ201902027.htm
[5]	LI H Y, LIU X X, XIE L J, et al. Diagnostic accuracy and cut-off of contrast-enhanced ultrasound in caesarean scar pregnancy[J]. Eur J Obstet Gynecol Reprod Biol, 2020, 246: 117-122. doi: 10.1016/j.ejogrb.2020.01.036
[6]	石辛景, 康志平, 刘亚静, 等. 经阴道超声和经腹部超声测量瘢痕妊娠的瘢痕厚度与实际厚度的相关性分析[J]. 影像科学与光化学, 2020, 38(1): 101-108. https://www.cnki.com.cn/Article/CJFDTOTAL-GKGH202001015.htm SHI X J, KANG Z P, LIU Y J, et al. Correlation between the thickness of scar and the actual thickness of scar pregnancy measured by transvaginal ultrasound and transabdominal ultrasound[J]. Imaging Science and Photochemistry, 2020, 38(1): 101-108. https://www.cnki.com.cn/Article/CJFDTOTAL-GKGH202001015.htm
[7]	吴建峰, 吴敏, 王春艳, 等. 剖宫产术后疤痕妊娠CT影像特征及其与超声对比分析[J]. 中国妇幼健康研究, 2021, 32(11): 1682-1686. doi: 10.3969/j.issn.1673-5293.2021.11.025 WU J F, WU M, WANG C Y, et al. Comparison and analysis of CT imaging characteristics and ultrasound of cesarean scar pregnancy[J]. Chinese Journal of Woman and Child Health Research, 2021, 32(11): 1682-1686. doi: 10.3969/j.issn.1673-5293.2021.11.025
[8]	何雯, 郭芳, 黄丽蓉. 应用阴道超声、MRI检查在剖宫产术后瘢痕妊娠的诊断价值分析[J]. 中国CT和MRI杂志, 2022, 20(7): 132-133, 153. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR202207043.htm HE W, GUO F, HUANG L R. Diagnostic value of vaginal ultrasound and mri in scar pregnancy after cesarean section[J]. Chinese Journal of CT and MRI, 2022, 20(7): 132-133, 153. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR202207043.htm
[9]	贾红靖, 梁宝权, 邓学东, 等. 经阴道超声及超声造影对瘢痕妊娠临床诊治价值的研究[J]. 中国临床医学影像杂志, 2022, 33(7): 515-518, 522. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX202207013.htm JIA H J, LIANG B Q, DENG X D, et al. Study on the clinical value of TVS and CEUS in the diagnosis and treatment of cesarean scar pregnancy[J]. Journal of China Clinic Medical Imaging, 2022, 33(7): 515-518, 522. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX202207013.htm
[10]	朱莉, 李丽雅, 吕国荣. 超声造影在瘢痕妊娠诊疗中的应用[J]. 中国超声医学杂志, 2019, 35(9): 837-839. doi: 10.3969/j.issn.1002-0101.2019.09.021 ZHU L, LI L Y, LYU G R. The application of contrast-enhanced ultrasound in the diagnosis of cesarean scar pregnancy[J]. Chinese Journal of Ultrasound in Medicine, 2019, 35(9): 837-839. doi: 10.3969/j.issn.1002-0101.2019.09.021
[11]	刘冬梅, 刘勇, 顾小宁, 等. 超声造影评价子宫剖宫产瘢痕妊娠的诊断价值[J]. 中国超声医学杂志, 2019, 35(11): 1019-1022. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY201911017.htm LIU D M, LIU Y, GU X N, et al. The diagnostic value of contrast-enhanced ultrasound in cesarean scar pregnancy[J]. Chinese Journal of Ultrasound in Medicine, 2019, 35(11): 1019-1022. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY201911017.htm
[12]	王静欣, 罗红, 杨太珠, 等. 超声造影在子宫瘢痕妊娠疑难病例中的应用价值[J]. 西部医学, 2020, 32(4): 555-558. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU202004023.htm WANG J X, LUO H, YANG T Z, et al. The diagnostic values of contrast enhanced ultrasound on difficult cases of cesarean scar pregnancy[J]. Medical Journal of West China, 2019, 32(4): 555-558. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU202004023.htm
[13]	卓娜, 汪娟. 经阴道三维超声联合超声造影对瘢痕妊娠的诊断价值[J]. 临床与病理杂志, 2020, 40(9): 2302-2306. https://www.cnki.com.cn/Article/CJFDTOTAL-WYSB202009013.htm ZHUO N, WANG J. Diagnostic value of three-dimensional transvaginal ultrasound combined with contrast-enhanced ultrasonography in cesarean scar pregnancy[J]. Journal of Clinical and Pathological Research, 2020, 40(9): 2302-2306. https://www.cnki.com.cn/Article/CJFDTOTAL-WYSB202009013.htm
[14]	JUNG E M, WEBER M A, WIESINGER I. Contrast-enhanced ultrasound perfusion imaging of organs[J]. Radiologe, 2021, 61(Suppl 1): 19-28.
[15]	董黎淑, 沈翔. 垂体后叶素联合宫腔镜下负压清宫术治疗Ⅱ型剖宫产子宫瘢痕妊娠临床观察[J]. 中华全科医学, 2020, 18(4): 601-604. doi: 10.16766/j.cnki.issn.1674-4152.001308 DONG L S, SHEN X. Observation on the clinical efficacy of pituitrin combined with hysteroscopic negative pressure hysteroscopy in the treatment of type Ⅱ cesarean scar pregnancy[J]. Chinese Journal of General Practice, 2020, 18(4): 601-604. doi: 10.16766/j.cnki.issn.1674-4152.001308
[16]	Society for Maternal-Fetal Medicine (SMFM). Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: cesarean scar pregnancy[J]. Am J Obstet Gynecol, 2020, 222(5): B2-B14.
[17]	熊光武. 剖宫产瘢痕妊娠治疗方法选择[J]. 中国微创外科杂志, 2021, 21(9): 769-775. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWWK202109001.htm XIONG G W. Selection of treatment methods for caesarean section scar pregnancy[J]. Chinese Journal of Minimally Invasive Surgery, 2021, 21(9): 769-775. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWWK202109001.htm
[18]	ZHANG X L, PANG Y X, MA Y H, et al. A comparison between laparoscopy and hysteroscopy approach in treatment of cesarean scar pregnancy[J]. Medicine (Baltimore), 2020, 99(43): e22845. DOI: 10.1097/MD.0000000000022845.
[19]	肖汀, 黄伟俊, 张四友, 等. 经阴道超声与超声造影联合临床因素评估剖宫产术后瘢痕妊娠治疗方式的研究[J]. 中华超声影像学杂志, 2022, 31(3): 231-235. XIAO T, HUANG W J, ZHANG S Y, et al. Transvaginal ultrasound and contrast-enhanced ultrasound combined with clinical factors to assess the treatment options of cesarean scar pregnancy[J]. Chinese Journal of Ultrasonography, 2022, 31(3): 231-235.