经腹联合经会阴超声诊断凶险型前置胎盘合并胎盘植入的价值  

Value of transabdominal combined with transperineal ultrasound in diagnosis of pernicious placenta previa complicated with placenta implantation

作　　者：李琴[1] 邓学东[1] 王中阳[2] 陆冰[1] 张丽丽[1] 申建秋[2] 卞敏[2] 

机构地区：[1]南京医科大学附属苏州医院苏州市立医院超声中心,江苏苏州215002 [2]江苏省泰州市人民医院超声科,江苏泰州225300

出　　处：《实用临床医药杂志》2016年第11期83-86,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨经腹部与经会阴超声联合应用诊断凶险型前置胎盘（PPP）合并胎盘植入的应用价值。方法对临床诊断为PPP的51例患者行经腹部超声检查及联合经会阴超声检查,做出超声诊断;与产后手术病理及临床随访结果对照,对两种超声检查方法胎盘植入产前检出率进行总结分析。结果 51例患者产后手术病理及临床随访结果证实合并胎盘植入42例（82.4%）,未合并胎盘植入9例（17.6%）。与产后手术病理诊断结果及临床随诊结果对照显示：单纯经腹部超声检查正确诊断PPP合并胎盘植入29例（55.8%）,未合并胎盘植入7例（13.7%）,漏诊13例（25.5%）,误诊2例（3.9%）。经腹部联合经会阴超声检查正确诊断PPP合并胎盘植入40例（78.4%）,未合并胎盘植入7例（13.7%）,漏诊2例（3.9%）,误诊2例（3.9%）。单纯经腹部超声诊断PPP合并胎盘植入的灵敏度、特异度、准确性、阳性预测值、阴性预测值、假阳性率、假阴性率分别为69.1%、77.8%、70.6%、93.5%、35.0%、22.2%、30.9%;经腹部联合经会阴超声检查诊断PPP合并胎盘植入的灵敏度、特异度、准确性、阳性预测值、阴性预测值、假阳性率、假阴性率分别为95.2%、77.8%、92.2%、95.2%、77.8%、22.2%、4.8%。经ROC曲线检验,单纯经腹部超声诊断PPP合并胎盘植入的ROC曲线下面积（AUC）为0.746、95%CI为0.568～0.924;经腹部联合经会阴超声诊断PPP合并胎盘植入的AUC为0.865、95%CI为0.699～1.000。结论联合应用经腹部与经会阴超声检查对诊断PPP合并胎盘植入有较大的应用价值。Objective To evaluate the value of combined application of transabdominal（ TAS） and transperineal（ TPS） ultrasound in diagnosis of pernicious placenta previa（ PPP） complicated with placenta implantation. Method Fifty-one patients diagnosed as PPP were examined by both transabdominal and transperineal ultrasonography. The prenatal detection rate of two ultrasound examination methods were summarized and analyzed. Results Out of 51 PPP patients,42 cases（ 82. 4%） were proved as placenta increta disease and 9 cases were confirmed with no placenta implantation complication. By TAS alone,29 cases were correctly diagnosed with placenta implantation（ 55. 8%） while 7 cases（ 13. 3%） were confirmed without placenta accreta,13 cases were missed diagnosed（ 2 5. 5 %）,2 cases（ 3. 9 %） were mis-diagnosed. By TAS combined TPS method,4 0cases were correctly diagnosed with placenta implantation（ 7 8. 4 %）,7 cases（ 1 3. 3 %） were confirmed without placenta increta,2 cases（ 3. 9%） were mis-diagnosed,2 cases（ 3. 9%,2 /51）were missed diagnosed. The sensitivity,specificity,accuracy,positive predictive value,negative predictive value false positive rate,and false negative rate of TAS in diagnosis of PPP were 69. 1%,77. 8%,70. 6%,93. 5% 35. 0%,22. 2% and 30. 9% respectively,while those of combined use of TAS and TPS were 95. 2 %,77. 8%,92. 2%,95. 2%,77. 8%,22. 2%,and 4. 8% respectively. According to the ROC curve test,by TAS alone,the area under curve（ AUC） was 0. 746,95% CI was 0. 568 ～ 0. 924,while those of combined use of TAS and TPS method were 0. 865 and0. 699 ～ 1. 000 separately. Conclusion The combined application of TAS and TPS method has greater value than the TAS alone method in the clinical diagnosis of PPP complicated with placenta implantation.

关 键 词：超声检查 凶险型前置胎盘 胎盘植入 价值 

分 类 号：R714.2[医药卫生—妇产科学]