[磁共振成像在剖宫产瘢痕妊娠中的临床价值]
[Clinical value of MRI in cesarean scar pregnancy].
作者信息
Chong Yiwen, Zhang Kun, Zhou Yan, Han Jinsong, Zhu Fuli, Guo Hongyan, Xiong Guangwu
机构信息
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China. Email:
出版信息
Zhonghua Fu Chan Ke Za Zhi. 2014 Dec;49(12):914-8.
OBJECTIVE
To explore the clinical value of MRI in diagnosing and treating cesarean scar pregnancy (CSP).
METHODS
A retrospective analysis was conducted on the clinical manifestations of 54 patients diagnosed with CSP between January 2009 to January 2013 in Peking University Third Hospital. Based on the patients' MRI image and other clinical datas, we did transvaginal operation on patients with CSP1, and transvaginal combined with abdominal operations on patients with CSP2. The intraoperative blood loss, operation time, postoperative hospital stay, and the length of time required for of serum hCG dropping to normal of the patients were analyzed.
RESULTS
The average age of the 54 patients was (34±5) years and the average duration of gestation was (56±16) days, all patients' vital sign were stable, the hCG level was 23-142 962 U/L before treatment. Twelve patients were diagnosed with CSP1 by MRI, and 5 of them had focus of 1-2 cm in diameter, the 5 patients' serum hCG level was 436-1 159 U/L and 23-32 days after drug administration, their hCG level returned to normal; the other 7 patients had focus of 2.0-4.4 cm in diameter, and their hCG level was 2 218-63 446 U/L, lesion resection was done on the 7 patients by hysteroscope or under B-ultrasound monitor. Forty-two patients were diagnosed with CSP2, and their focus were 1.0-7.1 cm in diameter, and serum hCG level were 23-142 962 U/L. We did bilateral uterine artery occlusion by laparoscope or laparotomy during operation for 22 patients or bilateral uterine artery embolization (UAE) before operation for 20 patients, then we did lesion resections. The blood loss during operation of CSP1 or CSP 2 was 50.1, 267.2 ml; operation time was 30, 128 minutes; postoperative hospital stay was 4.6, 6.7 days; their serum hCG returned to normal 13-30 days after the surgery. All the 54 patients' uterus were and the patients undergoing operations were all cured without the second operation.
CONCLUSION
MRI is an effective method to conduct clinical treatment in CSP.
目的
探讨磁共振成像（MRI）在剖宫产瘢痕妊娠（CSP）诊断及治疗中的临床价值。
方法
回顾性分析2009年1月至2013年1月北京大学第三医院确诊为CSP的54例患者的临床表现。根据患者的MRI图像及其他临床资料，对CSP1患者行阴道手术，对CSP2患者行阴道联合腹部手术。分析患者术中出血量、手术时间、术后住院时间及血清人绒毛膜促性腺激素（hCG）降至正常所需时间。
结果
54例患者平均年龄（34±5）岁，平均孕周（56±16）天，所有患者生命体征平稳，治疗前hCG水平为23～142 962 U/L。12例患者经MRI诊断为CSP1，其中5例病灶直径为1～2 cm，这5例患者血清hCG水平为436～1 159 U/L，给药后23～32天hCG水平恢复正常；另外7例病灶直径为2.0～4.4 cm，hCG水平为2 218～63 446 U/L，对这7例患者行宫腔镜或B超监视下病灶切除术。42例患者诊断为CSP2，病灶直径为1.0～7.1 cm，血清hCG水平为23～142 962 U/L。术中对22例患者行腹腔镜或开腹双侧子宫动脉阻断术，对20例患者术前先行双侧子宫动脉栓塞术（UAE），然后行病灶切除术。CSP1或CSP2患者术中出血量分别为50.1、267.2 ml；手术时间分别为30、128分钟；术后住院时间分别为4.6、6.7天；术后13～30天血清hCG恢复正常。54例患者子宫均保留，手术患者均治愈，无需二次手术。
结论
MRI是CSP临床治疗的有效方法。
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