子宫超声造影对产后宫内残留性病变的诊断价值  

Diagnosis of Contrast-Enhanced Ultrasound in Detecting Retained Products of Conception

作　　者：贺琰[1] 王小燕[1] 陈海燕[1] 裴华洁[1] 肖艳菊[1] 卢燕凌 HE Yan;WANG Xiaoyan;CHEN Haiyan;PEIHuajie;XIAO Yanju;LU Yanling(Department of Ultrasound,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院超声科,广西南宁530021

出　　处：《中国医学影像学杂志》2021年第9期924-927,929,共5页Chinese Journal of Medical Imaging

基　　金：广西医药卫生自筹经费科研课题项目(Z20170327)。

摘　　要：目的探讨子宫超声造影对产后宫内残留性病变(RPOC)的诊断价值。资料与方法回顾性分析行常规超声及子宫超声造影检查考虑存在RPOC的患者42例,以术中所见及病理检查结果为对照,分析RPOC的常规超声及超声造影特征,评估超声造影的诊断符合率。结果超声造影清晰显示宫内残留物与子宫内膜及肌壁内的血管灌注情况,观察造影剂灌注的时间变化,诊断宫内胎盘残留28例,胎盘植入11例,宫内积血3例,2例胎盘粘连植入误诊为胎盘残留,诊断符合率为95%,与病理结果一致性较好(Kappa=0.905,P<0.05),两种检查结果高度一致。常规超声的诊断符合率仅为73.8%。结论子宫超声造影对RPOC有特异性的表现,能有效区分产后宫内胎盘残留、胎盘植入及宫内积血,可为临床后续诊疗提供更多有价值的信息。Purpose To explore the diagnostic value of contrast-enhanced ultrasound(CEUS)in detecting retained products of conception(RPOC).Materials and Methods Forty-two patients diagnosed as RPOC by conventional US and CEUS were retrospectively enrolled and analyzed.The results of operation and pathology were compared,and the imaging features of conventional US and CEUS were further analyzed,evaluating the diagnostic accuracy of CEUS.Results The blood perfusion statue and the time course of the contrast agent perfusion in endometrium and the uterine wall of RPOC were clearly displayed by CEUS.There were 28 cases diagnosed with residual placenta,11 cases with placenta accrete,and 3 cases with intrauterine blood clots,and 2 patients with placenta accrete were misdiagnosed as residual placental.The accuracy rate of diagnosis was 95%.The consistency check was with the good performance(Kappa=0.905,P<0.05),showing the highly consistent results.The accuracy rate of diagnosis was 73.8%by conventional US.Conclusion Image features of RPOC could be presented as specific patterns via CEUS,effectively distinguishing residual placental from placenta accrete and intrauterine blood clots and providing valuable information in clinical practice.

关 键 词：产后宫内残留性病变 胎盘残留 胎盘植入 超声检查 造影剂 宫内积血 病理学 临床 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.46[医药卫生—诊断学]