摘要
目的探究剖宫产术后子宫瘢痕憩室(previous cesarean scar defect,PCSD)经阴道超声的形态学特征及其形成危险因素。方法回顾性分析我院2014年9月—2017年11月收治的PCSD患者59例作为研究组,另选取同期来我院行剖宫产术后未发生PCSD患者60例作为对照组,术后常规行经阴道超声检查,观察研究组患者超声声像图特征;分析比较两组相关临床资料,探寻PCSD形成的影响因素。结果 59例PCSD长度为10.03～23.17(15.42±4.21) mm,宽度为4.02～13.18(8.73±3.12) mm,深度为4.67～10.88(7.08±2.03) mm,憩室处残余肌层厚度为2.34～7.92 (4.17±1.89) mm;位于子宫前壁下段32例(54.24%); 46例(77.97%)憩室呈三角形或楔形,13例(22.03%)呈椭圆形或其他形状。PCSD声像图表现为剖宫切口肌层明显变薄,形成部分连续或完全不连续的断裂缺损,肌层大部分呈无回声或弱回声的液性暗区,极少部分液性暗区内出现中或高回声,憩室边界较清晰,一端与子宫宫腔相通。logistic回归分析显示:子宫后位、切口邻近宫颈内口、产后感染是PCSD形成的独立危险因素。结论经阴道超声检查可清晰观察PCSD的形态特征,可为临床早期确诊提供影像学依据;子宫后位、切口邻近宫颈内口、产后感染是本病的危险因素,早期及时给予干预可减少或避免严重并发症的发生。
Objective To explore the morphological characteristics of previous cesarean scar defect(PCSD)by transvaginal ultrasonography and to analyse the related risk factors for diverticulum.Methods We retrospectively analyzed clinical data of 59 patients with PCSD admitted to our hospital from October 2014 to November 2017.They were enrolled as the research group.Sixty patients without PCSD who underwent cesarean section in our hospital during the same period were selected as the control group.The transvaginal ultrasonography was performed routinely after surgery to observe the sonographic features of patients in the research group.The clinical data of the two groups were compared to explore the influencing factors of PCSD formation.Results The length of the PCSD of 59 cases was 10.03-23.17(15.42±4.21)mm,with a width of 4.02-13.18(8.73±3.12)mm,and a depth of 4.67-0.88(7.08±2.03)mm,and the residual muscle thickness of the diverticulum was 2.34-7.92(4.17±1.89)mm.There were 32 cases(54.24%)in the lower anterior wall of the uterus.In the meantime,46(77.97%)cases of diverticulum were triangular or wedge-shaped,and 13(22.03%)cases were semicircular or other shapes.The ultrasonographic images of PCSD showed that muscular layer of uterine incision after cesarean section was obviously thinner,forming part of the continuous or completely discontinuous fracture defect.In addition,most parts of muscular layer appeared as a anechoic or hypoechoic fluid dark space,as well as several moderate echo or hyperecho fluid dark space.The diverticulum boundary was clear,and one end was connected with the uterine cavity.Logistic regression analysis revealed that the posterior position of the uterus,the location of the incision near the internal cervix and postpartum infection were independent risk factors of PCSD formation.Conclusion Transvaginal ultrasonography can be used to clearly observe morphological characteristics of PCSD,thereby providing reliable imaging basis for early clinical diagnosis and treatment.The posterior position of the uterus,the location of the incision near the internal cervix,and postpartum infection are risk factors for this disease.Early and timely intervention can reduce or avoid serious complications.
作者
蒲红生
马志刚
王淑霞
PU Hong-sheng;MA Zhi-gang;WANG Shu-xia(Department of Ultrasound, Maternal and Child Health Care Hospital of Wuji County, Wuji, Hebei 052460, China;Department of Gynecology, the Second Central Hospital of Baoding, Baoding, Hebei 072750, China;Department of Ultrasound, Hebei People's Hospital, Shijiazhuang 050051, China)
出处
《临床误诊误治》
2019年第1期66-69,共4页
Clinical Misdiagnosis & Mistherapy
基金
保定市科学技术研究与发展指导计划项目(17ZF248)
关键词
阴道超声
瘢痕憩室
剖宫产术
危险因素
Vaginal ultrasound
Scar diverticulum
Cesarean section
Risk factors
