改良超声评分量表诊断胎盘植入性疾病的价值  

Application of Modified Ultrasound Scoring Scale in Diagnosis of Placenta Accreta Spectrum Disorders

作　　者：魏芸[1] 赵青[1] 杨冬[2] 付静静 张爽[1] WEI Yun;ZHAO Qing;YANG Dong;FU Jingjing;ZHANG Shuang(Department of Ultrasound,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院综合超声科,北京100029 [2]首都医科大学附属北京安贞医院妇产科,北京100029

出　　处：《中国医学影像学杂志》2023年第4期385-389,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨改良超声评分量表对胎盘植入性疾病的诊断价值。资料与方法回顾性分析2019年1月—2021年10月首都医科大学附属北京安贞医院因前置或低置胎盘怀疑胎盘植入的55例患者的超声和临床资料,根据各病例超声征象联合病史制订改良超声评分量表,评价其对胎盘植入及不同类型胎盘植入的诊断价值,并与种氏超声评分量表对比,分析两者对不同类型胎盘植入的诊断效能。结果以术中临床诊断为标准,无胎盘植入11例,粘连型24例,植入型14例,穿透型6例,其改良超声评分分别为(3.36±0.67)、(4.50±1.14)、(6.71±1.44)、(10.50±0.55)分,差异有统计学意义(F=66.171,P<0.001)。改良超声评分量表诊断无胎盘植入和粘连型界值为4分(敏感度83.3%、特异度63.6%),粘连型和植入型界值为6分(敏感度85.7%、特异度95.8%),植入型和穿透型界值为9分(敏感度100%、特异度92.9%);诊断粘连型、植入型、穿透型胎盘植入准确度分别为81.8%、92.7%、98.2%,与手术结果高度一致。与种氏超声评分量表诊断粘连型、植入型的敏感度、特异度和准确度(83.3%、78.6%,58.1%、90.2%,69.1%、87.3%)相比,改良超声评分量表提高了粘连型、植入型胎盘植入的诊断效能。结论改良超声评分量表对胎盘植入性疾病及其类型具有较高的诊断价值。Purpose To investigate the diagnostic value of modified ultrasound scoring scale in placenta accreta spectrum disorders.Materials and Methods The ultrasound and clinical data of 55 patients with suspected placental implantation due to placenta previa or low placentation from January 2019 to October 2021 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.According to the ultrasonic signs and medical history of each case,a modified ultrasound scoring scale was developed to evaluate the diagnostic value of placenta implantation and its type.The diagnostic efficiency of its and Chong's ultrasound scoring scale on different types of placental implantation was compared.Results Based on the intraoperative clinical diagnosis,there were 11 cases without placenta implantation,24 cases with adhesion,14 cases with implantation and 6 cases with penetration,and the modified ultrasound score were(3.36±0.67),(4.50±1.14),(6.71±1.44),and(10.50±0.55)points,respectively,and there were statistically significant differences in types of placenta implantation among the four groups(F=66.171,P<0.001).The cut-off value of non-implantation and adhesion was 4 points(with sensitivity 83.3%,specificity 63.6%),adhesion and implantation was 6 points(with sensitivity 85.7%,specificity 95.8%),and implantation and penetration was 9 points(with sensitivity 100%,specificity 92.9%),respectively.The diagnostic accuracy of adhesion,implantation,penetration type was 81.8%,92.7%and 98.2%,respectively,which were highly consistent with the surgical results.The sensitivity,specificity,and accuracy of Chong's ultrasound score were 83.3%,78.6%,58.1%,90.2%,69.1%,87.3%,respectively,compared with Chong’s ultrasound score,it could improve the diagnostic efficiency of implantation and adhesion.Conclusion The modified ultrasound scoring scale has high diagnostic value for placenta accreta spectrum disorders and their types.

关 键 词：侵入性胎盘 超声检查 产前 诊断 鉴别 

分 类 号：R714.462[医药卫生—妇产科学] R445.1[医药卫生—临床医学]