超微血流成像在清宫术后胎盘残留及绒毛膜疾病鉴别诊断中的应用  

Clinical value of superbmicro-vascular imaging in differential diagnosis of placental residual and chorionic disease after uterine surgery

作　　者：万贝贝[1] 郑瑜[1] 杨勇锋[2] 鞠雪涛[1] 赵琳辉[1] 吴媛 赵洁[1] WAN Bei-bei;ZHENG Yu;YANG Yong-feng;JU Xue-tao;ZHAO Lin-hui;WU Yuan;ZHAO Jie(B-Ultrasound Room,Xi'an Central Hospital,Xi'an 710003,Shaanxi,CHINA;Functional Department,Xi'an North Hospital,Xi'an 710003,Shaanxi,CHINA)

机构地区：[1]西安市中心医院B超室,陕西西安710003 [2]西安市北方医院功能科,陕西西安710003

出　　处：《海南医学》2019年第15期1996-1998,共3页Hainan Medical Journal

基　　金：陕西省社会发展科技攻关项目(编号:2016SF-095);陕西省西安市科技计划项目[编号:SF1514(2)]

摘　　要：目的探讨超微血流成像在清宫术后胎盘残留及绒毛膜疾病中的鉴别诊断价值。方法选取2016年6月至2018年6月到西安市中心医院进行治疗的清宫术后患者110例作为研究对象,运用超微血流成像,并与清宫术后病理诊断结果作对比,观察其诊断宫腔残留物诊断的准确性。结果清宫术后病理检测结果中,95例患者病理组织为绒毛,其中35例患者为变性绒毛膜组织,29例为坏死绒毛膜组织,31例为机化绒毛组织,另外15例为血块;彩色多普勒血流成像(CDFI)检查显示,异常团块血流分级为3~4级的患者62例,占比56.36%(62/110),运用超微血流成像技术(SMI)检测宫内异常团块的血流分级为3~4级者82例,占74.55%(82/110);73例患者运用CDFI检测出滋养细胞血流信号,占76.84%(73/95);SMI诊断的特异度为83.33%,敏感性为91.49%,准确性为89.83%,其中阳性预测值和阴性预测值分别为95.56%和71.43%;此外,CDFI的检测结果为特异度66.67%,灵敏度68.09%、准确性67.80%、阳性预测值88.89%以及阴性预测值34.78%。SMI的检测效能优于CDFI,差异有统计学意义(P<0.05)。结论超微血流成像能够较好的显示宫腔异常回声团块的血流信号,可以显示更微小的血管,对清宫术后宫腔残留物的诊断更为准确。Objective To investigate the value of superbmicro-vascular imaging in the differential diagnosis of placental residual and chorionic diseases after hysterectomy. Methods A total of 110 patients treated in Xi'an Central Hospital from June 2016 to June 2018 were selected. The superbmicro-vascular imaging data were compared with the pathological diagnosis results to observe the accuracy of superbmicro-vascular imaging in the diagnosis of uterine cavity residues. Results Postoperative pathological examination results showed that the pathological tissues of 95 patients were villus, including 35 patients with degenerated chorionic tissue, 29 patients with necrotic chorionic tissue, 31 patients with organized villus tissue, and 15 patients with blood clots. CDFI examination showed that 62 patients (56.36%, 62/110) had grade 3-4 blood flow in intrauterine abnormal clumps, while ultrasound flow imaging (SMI) showed that 82 patients (74.55%) had grade 3-4 blood flow in abnormal clumps. The blood flow signal of trophoblast cells in 73 patients was detected by CDFI, accounting for 76.84%. The sensitivity, specificity, and accuracy, positive predictive value, and negative predictive value of SMI were 91.49%, 83.33%, 89.83%, 95.56%, and 71.43%, and those of CDFI were 68.09%, 66.67%, 67.80%, 88.89%, and 34.78%. SMI was better than CDFI (P<0.05). Conclusion Superbmicro-vascular imaging can better display the blood flow signal of abnormal echo mass in uterine cavity, and can show smaller blood vessels, which is more accurate for the diagnosis of uterine cavity residues after uterine clearance.

关 键 词：超微血流成像 宫腔残留物 清宫术 绒毛膜疾病 鉴别诊断 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]