实时三维腔内超声诊断剖宫产瘢痕妊娠临床研究  

Application value of real-time three-dimensional intracavitary ultrasound in diagnosis of cesarean scar pregnancy

作　　者：夏东琴 张宏[1] 赵洁[1] 郑瑜[1] XIA Dongqin;ZHANG Hong;ZHAO Jie;ZHENG Yu(Xi’an Central Hospital Affiliated to Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安交通大学附属西安市中心医院,陕西西安710004

出　　处：《陕西医学杂志》2022年第8期966-969,共4页Shaanxi Medical Journal

基　　金：陕西省科学技术研究发展计划项目(2021SF-260)。

摘　　要：目的:探讨实时三维腔内超声在诊断早期剖宫产瘢痕妊娠(CSP)中的应用价值。方法:选取经手术及病理证实的78例CSP患者,术前均行二维、三维腔内超声检查,观察并分析CSP的二维声像图表现和三维成像特征,以手术病理结果为金标准,比较二维、三维腔内超声对CSP的诊断准确率。结果:二维与三维腔内超声在显示妊娠组织与瘢痕关系、滋养血流来源上比较差异有统计学意义(P<0.05),并且经三维腔内超声测量的瘢痕处肌层厚度较二维腔内超声更接近于术后病理测量结果。三维腔内超声诊断CSP的准确率为93.59%(73/78),高于二维腔内超声检查的78.21%(61/78)(χ^(2)=7.620,P<0.05)。在不同类型CSP中,三维腔内超声对CSPⅠ型和CSPⅣ型(包块型)的诊断准确率高于二维腔内超声(P<0.05);二维、三维腔内超声对CSPⅡ型和CSPⅢ型的诊断准确率比较无统计学差异(P>0.05)。结论:实时三维超声腔内超声提供了一种新的显像方式,能更直观、立体地显示妊娠组织与子宫瘢痕的空间位置关系、侵入肌壁的程度及滋养血供来源和分布,客观、精准地测量子宫瘢痕处肌层厚度,对CSP的早期诊断具有较高的准确性和可靠性,尤其是对CSPⅠ型和CSPⅣ型的诊断具有显著优势。Objective:To evaluate the value of real-time three-dimensional(3D)intracavitary ultrasound in the diagnosis of early cesarean scar pregnancy(CSP).Methods:A total of 78 patients with CSP confirmed by surgery and pathology were selected and underwent two-dimensional(2D)and 3D intracavitary ultrasound examination before operation.The 2D sonographic representation and 3D imaging characteristics of CSP were observed and analyzed.The diagnostic accuracy of 2D and 3D intracavitary ultrasound for CSP was compared with the surgical and pathological results as the gold standard.Results:There were statistically significant differences between 2D and 3D intracavitary ultrasound in the relationship between pregnancy tissue and scar and the source of nourishing blood flow(P<0.05),and the thickness of muscle layer at scar measured by 3D intracavitary ultrasound was closer to the results of surgical pathological measurement than that measured by 2D intracavitary ultrasound.The accuracy of 3D intracavitary ultrasound in CSP diagnosis was 93.59%(73/78),which was higher than 78.21%(61/78)of 2D intracavitary ultrasound(P<0.05).Among different types of CSP,the diagnostic accuracy of 3D intracavitary ultrasound was higher than that of 2D intracavitary ultrasound for CSP typeⅠand CSP typeⅣ(all P<0.05).There was no significant difference in the diagnostic accuracy of CSP typeⅡand CSP typeⅢby 2D and 3D intracavitary ultrasound(all P>0.05).Conclusion:Real-time three-dimensional intracavitary ultrasound provides a new way of imaging,which can more intuitively and stereoscopically show the spatial relationship between pregnancy tissue and uterine scar,the degree of invasion of muscle wall,and the source and distribution of nourishing blood supply,objectively and accurately measure the myometrial thickness of uterine scar,and has high accuracy and reliability for early diagnosis of CSP.In particular,there are significant advantages in the diagnosis of CSP typeⅠand CSP typeⅣ(mass type).

关 键 词：剖宫产瘢痕妊娠 诊断 实时三维腔内超声 三维彩色血流成像 分型 应用价值 

分 类 号：R445.1[医药卫生—影像医学与核医学]