经阴道三维超声诊断PCSD的价值及宫腹腔镜手术与传统阴式手术治疗的效果比较  

EFFECT OF MERIDIAN HYPERTENSION AND COMPARISON OF LAPAROSCOPIC SURGERY AND VAGINAL SURGERY IN DIAGNOSING PCSD

作　　者：李晓庆 程蔚然 温乔 刘守福[1] LI Xiaoqing;CHENG Weiran;WEN Qiao;LIU Shoufu(Ziyang First People's Hospital,Ziyang 641300,China)

机构地区：[1]四川省资阳市第一人民医院,641300

出　　处：《中国煤炭工业医学杂志》2021年第6期598-602,共5页Chinese Journal of Coal Industry Medicine

基　　金：四川省卫生厅科研基金资助项目(编号:17151)。

摘　　要：目的探讨剖宫产术后子宫瘢痕憩室(PCSD)的经阴道三维超声诊断价值及采用宫腹腔镜手术治疗的临床效果。方法选取资阳市第一人民医院2017年3月—2020年2月经临床初步诊断为PSCD患者400例,所有患者均接受经阴道三维超声诊断,以宫腔镜诊断结果作为判断标准,计算经阴道三维超声诊断PCSD的价值;并按照随机数字表法将确诊PCSD患者分为腔镜组(宫腹腔镜联合手术)和传统阴式手术组(阴式组),对比两种手术方法的临床效果差异。结果以宫腔镜诊断结果作为金标准,经阴道三维超声对PCSD的诊断灵敏度为90.29%、特异度为83.61%、漏诊率为9.71%、误诊率为16.39%、ROC曲线下面积AUC值为0.869;经阴道三维超声诊断轻型PSCD患者与宫腔镜诊断结果的符合率为86.96%,经阴道三维超声诊断重型PSCD患者与宫腔镜诊断结果的符合率为94.87%;腔镜组与阴式组的手术时间、住院时间比较,差异均无统计学意义(P>0.05);腔镜组的术中出血量、术后阴道出血量、术后肛门排气时间均低于阴式组,差异有统计学意义(P<0.05);腔镜组的住院总费用高于阴式组,差异有统计学意义(P<0.05);腔镜组的显效率20.86%、有效率59.71%、无效率19.42%,阴式组的显效率15.83%、有效率58.27%、无效率25.90%,二组差异均无统计学意义(P>0.05)。结论经阴道三维超声诊断PCSD具有较高的灵敏度与特异度,与宫腔镜诊断结果具有较高的符合率;对于PCSD患者采用宫腹腔镜联合手术治疗较传统阴式手术具有手术创伤更小的优势。Objective To explore the value of transvaginal three-dimensional ultrasound diagnosis of uterine scar diverticulum(PCSD) after cesarean section and the clinical effect of laparoscopic surgery.Methods We selected four hundred patients of Ziyang First People′s Hospital were PSCD from March 2017 to February 2020.All patients received transvaginal three-dimensional ultrasound diagnosis.Hysteroscopy was used as the criterion to calculate the value of transvaginal three-dimensional ultrasound diagnosis of PCSD;and the diagnosis was confirmed according to a random number table PCSD patients were divided into endoscopic group(hysteroscopy combined surgery) and traditional vaginal surgery(vaginal group).The clinical effect of the two surgical methods was compared.Results With hysteroscopy as the gold standard, the diagnostic sensitivity of transvaginal three-dimensional ultrasound for PCSD was 90.29%,the specificity was 83.61%,the missed diagnosis rate was 9.71%,the misdiagnosis rate was 16.39%,and the area under the ROC curve AUC value was 0.869;The coincidence rate of transvaginal three-dimensional ultrasound diagnosis of patients with light PSCD and hysteroscopy was less than 86.96%,and the coincidence rate of transvaginal three-dimensional ultrasound diagnosis of patients with severe PSCD and hysteroscopy was less than 94.87%;the difference between the endoscopic group and the vaginal group There was no statistically significant difference in operationtime and hospital stay(P>0.05);the intraoperative blood loss, postoperative vaginal bleeding, and postoperative anal exhaust time in the endoscopic group were lower than those in the vaginal group, and the difference was statistically significant Clinical significance(P<0.05);the total hospitalization cost of the endoscopy group is higher than that of the vaginal group, and the difference is statistically significant(P<0.05);the effective rate of the endoscopy group is 20.86%,the effective rate is 59.71%,and the inefficiency is 19.42% In the negative group, the effecti

关 键 词：剖宫产 子宫瘢痕憩室 经阴道三维超声 宫腹腔镜 

分 类 号：R71[医药卫生—妇产科学]