阴道超声鉴别宫内妊娠及CSP的简便方法探究  

A simple method to identify intrauterine pregnancy and cesarean scar pregnancy by transvaginal ultrasonography

作　　者：杨萌 杨晓惠[1] 王端[1] 董海伟[1] Yang Meng;Yang Xiaohui;Wang Duan;Dong Haiwei(Department of Obstetrics and Gynecology,Tianjin Medical University General Hospital,Tianjin 300052,P.R.China)

机构地区：[1]天津医科大学总医院妇产科,天津300052

出　　处：《中国计划生育和妇产科》2022年第3期79-83,I0002,共6页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的 探究经阴道超声(transvaginal ultrasound, TVS)鉴别宫内妊娠(intrauterine pregnancy, IUP)及剖宫产瘢痕妊娠(cesarean scar pregnancy, CSP)的简便方法。方法 回顾性分析2019年7月~12月天津医科大学总医院IUP及术后病理证实为CSP的TVS存档图像120例,分为IUP组和CSP组,每组各60例。每例图像均进行以下测量:宫颈外口至宫底部距离、子宫的中点轴位置,妊娠囊(gestational sac, GS)最远点至子宫中点轴距离、GS中心至子宫中点轴距离以及GS最近点至子宫中点轴距离。采用Student独立样本t检验对两组的年龄及各项测量值进行比较,并进一步计算敏感性、特异性、阳性似然比及阴性似然比。结果 两组中图像宫颈外口至宫底部距离、子宫中点轴位置比较,差异无统计学意义(P>0.05);GS最远点至子宫中点轴距离、GS中心至子宫中点轴距离、GS最近点至子宫中点轴距离比较,差异有统计学意义(P<0.01)。其中,GS中心至子宫中点轴距离对诊断CSP的特异性、阳性似然比最佳,GS最近点至子宫中点轴距离对诊断CSP的敏感性、阴性似然比最佳。结论 GS最远点、中心及最近点至子宫中点轴距离均可作为TVS鉴别IUP和CSP的简便方法,可单独或联合使用,但同时还应结合孕周及其他临床特征加以综合诊断。Objective To explore the simple method of transvaginal ultrasound(TVS) in differentiating intrauterine pregnancy(IUP) and cesarean scar pregnancy(CSP).Methods From July 2019 to December 2019,120 cases of TVS archived images of IUP and postoperative pathologically confirmed CSP in Tianjin Medical University General Hospital were retrospectively analyzed, and they were divided into IUP group and CSP group, with 60 cases in each group.The following measurements were performed on each image: the distance from the external cervical os to the fundus, the midpoint axis of the uterus, the distance from the farthest point of the gestational sac(GS) to the midpoint axial of the uterus, the distance from the center of the GS to the midpoint axial of the uterus, and the distance from the GS center to the midpoint axial of the uterus.A Student’s independent samples t test was used to compare the age and various measurement values of the IUP and CSP groups, and further calculated the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio.Results There was no significant difference in the distance from the external cervical orifice to the fundus and the axial position of the uterus between the two groups(P>0.05).The distance from the closest point of GS to the midpoint axial of the uterus, the distance from the center of the GS to the midpoint axial of the uterus, and the distance from the GS center to the midpoint axial of the uterus was compared, and the difference was statistically significant(P<0.01).Among them, the axial distance from the center of GS to the midpoint axial of the uterus had the best specificity and positive likelihood ratio for diagnosing CSP,and the distance from the closest point of GS to the midpoint axial of the uterus had the best sensitivity and negative likelihood ratio for diagnosing CSP.Conclusion The axial distance from the farthest point, the center and the nearest point of GS to the midpoint of the uterus can be used as a simple method for TVS to distinguish between

关 键 词：剖宫产瘢痕妊娠 宫内妊娠 鉴别诊断 阴道超声 超声 

分 类 号：R714.22[医药卫生—妇产科学]