本文選題：超聲 + 疤痕子宮　； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：目的： 本研究旨在通過對剖宮產(chǎn)術(shù)后再次妊娠的病例,在中晚孕期進(jìn)行經(jīng)腹部及經(jīng)會陰超聲掃查,觀察子宮下段的厚度、連續(xù)性等情況,分析其超聲圖像特征,評估不同超聲掃查方式對觀察子宮下段的價值、各自優(yōu)勢,超聲測量子宮肌層厚度的可行性,為評價剖宮產(chǎn)術(shù)后再次妊娠病例的子宮疤痕情況提供影像學(xué)依據(jù)。 材料與方法： 選擇剖宮產(chǎn)術(shù)后再次妊娠的249例孕婦作為研究組,77例未產(chǎn)妊娠孕婦為未產(chǎn)對照組,另39例經(jīng)陰道分娩后再次妊娠孕婦作為經(jīng)產(chǎn)對照組。所有受檢者均在適度充盈膀胱后接受經(jīng)腹部及經(jīng)會陰超聲檢查。觀察內(nèi)容包括：盡可能大范圍地掃查子宮前壁肌層情況,并對同范圍的肌層進(jìn)行彩色血流顯示掃查,嘗試確定前次剖宮產(chǎn)疤痕位置,并在最薄處測量肌肉層厚度,測量3次以上取最小值,記錄觀察及測量結(jié)果,對各組不同孕周得結(jié)果以及各組間的結(jié)果進(jìn)行比較分析。對于研究組還進(jìn)行了產(chǎn)時情況的隨訪記錄,與產(chǎn)前超聲檢查及測量情況進(jìn)行比較分析。 結(jié)果： 1.超聲掃查可以獲得較理想的聲像圖,能顯示子宮前壁下段的三層結(jié)構(gòu)(從內(nèi)到外)：羊膜、絨毛膜與子宮壁之間的強回聲層,子宮肌層的低回聲層,子宮與膀胱壁分界強回聲層。 2.總計509次檢查中444次(87.2%)經(jīng)腹掃查時獲得的圖像較經(jīng)會陰掃查更理想。比較經(jīng)腹部及經(jīng)會陰測量結(jié)果均較理想的196例測量結(jié)果,兩種測量結(jié)果相關(guān)性良好(r=0.943),經(jīng)陰道測量結(jié)果大于經(jīng)腹(p=0.000)。 3.對于研究組病例,43次檢查(11.7%)能大致辨認(rèn)疤痕位置,表現(xiàn)為局部肌層明顯較周邊薄、各層結(jié)構(gòu)邊界不清或回聲增強增厚等情況,余324次檢查未能辨認(rèn)疤痕位置,僅能在盡可能大范圍掃查后測量最薄處肌層厚度。 4.隨著孕周的增大,剖宮產(chǎn)組、初產(chǎn)婦組和經(jīng)產(chǎn)婦組的子宮下段肌層都逐漸變薄。 5.比較各組病例的子宮下段肌層厚度平均值,相同孕周病例,剖宮產(chǎn)組的子宮下段肌層最薄,其次是初產(chǎn)婦組,而經(jīng)產(chǎn)婦組的子宮下段肌層最厚,組間差異有統(tǒng)計學(xué)意義。 6.研究組病例均以再次剖宮產(chǎn)的方式結(jié)束妊娠,術(shù)中見子宮下段無明顯薄弱部分144例,局部較薄但未能透過子宮下段看到宮腔內(nèi)容物87例,子宮先兆破裂即無明顯肌層但漿膜層完整,可透過子宮下段看到宮腔內(nèi)容物5例,術(shù)后診斷子宮破裂病例0例。 7.總計509次檢查中CDFI血流顯像有明顯血流信號136次(26.7%)。 結(jié)論： 1.應(yīng)用超聲掃查的方式觀察子宮下段前壁肌層的情況是可行的,在孕母充盈膀胱后經(jīng)腹掃查可以獲得較滿意聲像圖,但仍有小部分病例必須結(jié)合經(jīng)會陰掃查。 2.隨著孕周增大,子宮下段厚度逐漸變薄。相同孕周病例,剖宮產(chǎn)組的子宮下段肌層最薄,其次是初產(chǎn)婦組,而經(jīng)產(chǎn)婦組的子宮下段肌層最厚。 3.超聲測量的子宮下段肌層厚度與再次剖宮產(chǎn)術(shù)中所見的子宮下段肌層厚度符合率高。選取1mm作為診斷閾值,提示子宮下段肌層缺陷,警惕子宮發(fā)生破裂的可能。 4.超聲掃查及超聲對子宮下段的測量可以客觀的反應(yīng)子宮下段的情況,但因課題內(nèi)容所限不能得出子宮下段超聲表現(xiàn)正常則預(yù)測陰道試產(chǎn)的安全性的結(jié)論。
[Abstract]:Objective:
The purpose of this study was to observe the thickness and continuity of the lower uterine segment in the middle and late pregnancy by scanning the abdominal and transperineal ultrasound in the middle and late pregnancy, and to evaluate the value of different ultrasonic scanning methods on the observation of the subsection of the uterus, the advantages of ultrasound and the ultrasonic measurement of the thickness of the uterine myometrium. It is feasible to provide imaging evidence for the evaluation of uterine scar after cesarean section.
Materials and methods:
249 pregnant women who were pregnant after cesarean section were selected as the study group, and 77 cases of non pregnancy pregnant women were not produced in the control group. The other 39 cases of the second pregnancy after vaginal delivery were used as the control group. All the subjects received the abdominal and transperineal ultrasound examination after the proper filling of the bladder. The contents included as large scope as possible. The situation of the myometrium of the anterior wall of the uterus was examined and the color flow of the myometrium in the same range was scanned. The position of the scar in the anterior cesarean section was determined and the thickness of the muscle layer was measured at the thinnest place. The minimum value was measured over 3 times. The results of observation and measurement were recorded and the results of each group were compared and analyzed. The group also conducted a follow-up record of birth time, and compared with prenatal ultrasound examination and measurement.
Result錛，

本文編號：1815002