阴道彩超、三维断层超声在剖宫产术后子宫瘢痕妊娠诊断中的价值分析  

Analysis of the Value of Vaginal Ultrasound and Three-dimensional Tomographic Ultrasound in the Diagnosis of Uterine Scar Pregnancy after Cesarean Section

作　　者：郭瑞芳[1] GUO Rui-fang(Ultrasound Department,Zhengzhou Maternal and Child Health Care Hospital,Zhengzhou,Henan,450000,China)

机构地区：[1]郑州市妇幼保健院超声科,河南郑州450000

出　　处：《黑龙江医学》2023年第11期1353-1355,共3页Heilongjiang Medical Journal

摘　　要：目的:探讨阴道彩超、三维断层超声在剖宫产术后子宫瘢痕妊娠(CSP)诊断中的应用价值。方法:选择2020年3—12月郑州市妇幼保健院就诊的114例疑似CSP患者作为研究对象,均接受阴道彩超及三维断层超声检查,以手术病理结果为金标准,计算阴道彩超、三维断层超声对CSP的诊断特异度、灵敏度及准确度,并计算阴道彩超、三维断层超声对不同类型CSP的诊断符合率。结果:手术病理诊断结果证实,114例患者中诊断为CSP92例,宫颈妊娠9例,妊娠流产8例,滋养细胞疾病5例。阴道彩超诊断CSP阳性75例,诊断CSP阴性39例;三维断层超声诊断CSP阳性87例,诊断CSP阴性27例。以手术病理诊断结果为金标准,阴道彩超诊断CSP的准确度为64.08%,特异度为45.53%,敏感度为68.51%,阳性预测值为84.06%,阴性预测值为25.63%;三维断层超声诊断CSP的准确度为83.32%,特异度为68.24%,敏感度为87.05%,阳性预测值为92.07%,阴性预测值为55.53%;三维断层超声诊断CSP的准确度、敏感度、阴性预测值显著高于阴道彩超,差异有统计学意义(χ2=9.549、3.080、18.538,P<0.05),两种方法诊断CSP的特异度、阳性预测值比较,差异无统计学意义(χ2=10.514、3.052,P>0.05)。经Kappa一致性检验分析,阴道超声与金标准结果之间的一致性Kappa值为0.108,三维断层超声与金标准结果之间的一致性Kappa值为0.508。三维断层超声对不同类型CSP的诊断符合率显著高于阴道彩超,差异有统计学意义(χ2=11.640、6.258、12.766、9.778,P<0.05)。结论:与阴道彩超相比,三维断层超声在剖宫产术后子宫瘢痕妊娠诊断中的价值更优,可有效提高定位准确性及诊断符合率,有利于指导临床诊断、后续妊娠及分娩,减少不良妊娠结局的发生。Objective:To investigate the value of vaginal ultrasound and three-dimensional tomographic ultrasound in the diagnosis of uterine scar pregnancy(CSP)after cesarean section.Methods:114 patients with suspected CSP attending the hospital from March to December 2020 were selected for the study and all received vaginal ultrasound and 3D tomographic ultrasound.The diagnostic specificity,sensitivity and accuracy of vaginal ultrasound and 3D tomography ultrasound for CSP were calculated using the surgical pathology results as the gold standard,and the diagnostic compliance rate of vaginal ultrasound and 3D tomography ultrasound for different types of CSP was also calculated.Results:Diagnostic surgical pathology confirmed the diagnosis of CSP in 92 of 114 patients,cervical pregnancy in 9,pregnancy abortion in 8,and trophoblastic disease in 5.Vaginal ultrasound diagnosed 75 cases of positive CSP and 39 cases of negative CSP,and 3D tomographic ultrasound diagnosed 87 cases of positive CSP and 27 cases of negative CSP.Using the surgical pathology findings as the gold standard,the accuracy of vaginal ultrasound for the diagnosis of CSP was 64.08%,specificity was 45.53%,sensitivity was 68.51%,positive predictive value was 84.06%,and negative predictive value was 25.63%.The accuracy of 3D tomographic ultrasound for the diagnosis of CSP was 83.32%,specificity was 68.24%,sensitivity was 87.05%,positive predictive value was 92.07%,and negative predictive value was 55.53%.The accuracy,sensitivity,and negative predictive value of 3D tomographic ultrasound for the diagnosis of CSP were significantly higher than those of vaginal ultrasound,with statistically significant differences(χ2=9.549,3.080,18.538,P<0.05).The differences in the specificity and positive predictive value of the two methods for the diagnosis of CSP were not statistically significant(χ2=10.514,3.052,P>0.05).The Kappa concordance test analysis showed that the concordance Kappa value between vaginal ultrasound and gold standard results was 0.108,and the concordance

关 键 词：剖宫产术 子宫瘢痕妊娠 阴道彩超 三维断层超声 诊断价值 

分 类 号：R445[医药卫生—影像医学与核医学]