本文關(guān)鍵詞： 彩超 妊娠 瘢痕 診斷 超聲檢查 剖宮產(chǎn)術(shù) 妊娠 異位 高強(qiáng)度聚焦超聲消融 治療結(jié)果　出處：《南昌大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分彩超早期診斷剖宮產(chǎn)瘢痕妊娠價(jià)值分析 目的：評(píng)估彩超在剖宮產(chǎn)瘢痕妊娠早期診斷中的價(jià)值分析。 方法：對(duì)66例經(jīng)臨床或病理證實(shí)為剖宮產(chǎn)瘢痕妊娠病例進(jìn)行分析，觀察、總結(jié)其超聲聲像圖特點(diǎn)。 結(jié)果：66例剖宮產(chǎn)瘢痕妊娠病例，按其超聲聲像圖分為胚囊型（39例）及包塊型（27例），超聲檢查正確診斷為瘢痕妊娠者55例，診斷符合率為83.3%（55/66）。其中胚囊型診斷符合率92.3%（36/39），誤診率7.7%（3/39）；包塊型診斷率70.4%（19/27），誤診率29.6%（8/27）。 結(jié)論：1.彩超是早期診斷剖宮產(chǎn)瘢痕妊娠的有效方法。 2.剖宮產(chǎn)瘢痕妊娠誤診率高，以包塊型顯著。 第二部分高強(qiáng)度聚焦超聲治療剖宮產(chǎn)瘢痕妊娠彩超療效觀察 目的：探討彩超觀察高強(qiáng)度聚焦超聲（HIFU)治療剖宮產(chǎn)術(shù)后瘢痕妊娠療效的價(jià)值。 方法：經(jīng)臨床或超聲診斷且接受HIFU治療的子宮瘢痕妊娠患者30例，分析其HIFU治療前、治療后1周、4周的超聲聲像圖，，并將其周邊血流阻力指數(shù)（RI）及血人絨毛膜促性腺激素（-HCG）值進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：1）二維超聲表現(xiàn)：27例患者治療后病灶逐漸縮小至消失。其中16例胚囊型治療后孕囊塌陷、變形、胚芽未見長大，10例卵黃囊回聲稍增強(qiáng)、壁增厚；11例包塊型治療后包塊回聲先稍增高，而后中央?yún)^(qū)回聲減低，最終表現(xiàn)為稍高回聲3例治療后仍見心管搏動(dòng)。 2）彩色多普勒超聲表現(xiàn)：與治療前相比，治療后病灶周邊血流明顯減少或消失，治療后1周、4周血流RI均高于治療前，治療后4周RI高于治療后1周（P均0.05）；但-HCG在治療前后差異均無統(tǒng)計(jì)學(xué)意義(P均0.05)。 結(jié)論：1.彩超對(duì)剖宮產(chǎn)術(shù)后瘢痕妊娠的HIFU治療療效觀察及隨訪具有臨床價(jià)值。 2.彩超對(duì)臨床治療方案的選擇有指導(dǎo)意義。
[Abstract]:Part I value of early diagnosis of Cesarean scar pregnancy by Color Doppler Ultrasonography. Objective: to evaluate the value of color Doppler ultrasound in the early diagnosis of cesarean scar pregnancy. Methods: 66 cases of pregnancy with cesarean scar confirmed by clinic or pathology were analyzed, and the ultrasonographic features were summarized. Results among 66 cases of cesarean scar pregnancy, 39 cases were divided into embryo sac type (n = 39) and mass type (n = 27). 55 cases were correctly diagnosed as scar pregnancy by ultrasonic examination. The diagnostic coincidence rate was 83.3% / 66%. The diagnostic coincidence rate of embryo sac type was 92.3% (36 / 39), misdiagnosis rate was 7.7% (39 / 39), mass diagnosis rate was 70.4% (19 / 27), misdiagnosis rate was 29.6% / 27%. Conclusion 1. Color Doppler ultrasound is an effective method for early diagnosis of cesarean scar pregnancy. 2. The misdiagnosis rate of cesarean scar pregnancy is high, especially in the lump type. The second part: the effect of high intensity focused ultrasound in the treatment of cicatricial pregnancy by cesarean section. Objective: to evaluate the effect of high intensity focused ultrasound (HIFU) on scar pregnancy after cesarean section. Methods: thirty cases of pregnancy with uterine scar diagnosed by clinical or ultrasonic diagnosis and treated with HIFU were analyzed. The sonograms of 30 pregnant women with uterine scar were analyzed before and after HIFU treatment for 1 week and 4 weeks after treatment. The peripheral blood flow resistance index (RI) and human chorionic gonadotropin (HCG) were analyzed statistically. Results (1) the lesions of 27 cases were gradually reduced to disappear after treatment, 16 cases of embryo sac collapsed and deformed, and 10 cases of yolk sac were slightly enhanced in embryo bud. In 11 cases of wall thickening, the echo of the mass increased slightly after treatment, then decreased in the central region. Finally, cardiac tube pulsation was seen in 3 cases with slightly hyperechoic echo. 2) Color Doppler ultrasound: compared with before treatment, the peripheral blood flow of the lesion decreased or disappeared significantly after treatment, and the RI of the lesion was significantly higher at 1 week and 4 weeks after treatment than that before treatment. The RI at 4 weeks after treatment was higher than that at 1 week after treatment (P < 0.05), but there was no significant difference between the two groups before and after treatment (P < 0.05). Conclusion 1. Color Doppler ultrasound has clinical value in the treatment of scar pregnancy after cesarean section by HIFU. 2. Color Doppler ultrasound has guiding significance to the choice of clinical treatment scheme.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R714.22

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