超声造影定量分析评估聚桂醇硬化治疗瘢痕妊娠预后的价值  

Contrast-enhanced ultrasound time-intensity curve analysis in predicting cesarean outcomes in scar pregnancy patients treat-ed with polylauryl sclerosis

作　　者：赵丽燕 俞琤 朱淼红 王小剑 ZHAO Liyan;YU Cheng;ZHU Miaohong;WANG Xiaojian(Department of Ultrasonography,Hangzhou Women's Hospital,Hangzhou 310008,China)

机构地区：[1]杭州市妇产科医院超声科,310008

出　　处：《浙江医学》2023年第18期1966-1970,共5页Zhejiang Medical Journal

基　　金：杭州市生物医药和健康产业发展扶持科技专项(2023WJC047)。

摘　　要：目的探讨超声造影(CEUS)定量分析参数与聚桂醇硬化治疗瘢痕妊娠手术结果的相关性及临床意义。方法对2020年1月至2022年12月杭州市妇产科医院行聚桂醇硬化治疗的108例剖宫产瘢痕妊娠孕妇进行回顾性研究,对感兴趣区内对比剂灌注全过程进行自动分析,绘制出时间-强度曲线(TIC),分析硬化前后定量参数特征,包括到达时间(AT)、达峰时间(TTP)、峰值强度(PI)、AUC。根据手术结果分为手术成功组和手术失败组,比较两组孕妇参数的差异,以手术结果为状态变量绘制ROC曲线。结果手术成功101例,失败7例。硬化治疗后AT和TTP较治疗前略有增加,硬化治疗后AUC和PI较硬化治疗前明显减小,差异均有统计学意义(均P<0.05);不同手术结果组CEUS定量分析参数比较:AT_(1)、AT_(2)、TTP_(1)、TTP_(2)、PI_(2)差异均无统计学意义(均P>0.05),手术失败组PI_(1)、AUC_(TIC1)、AUC_(TIC2)均明显大于手术成功组,差异均有统计学意义(均P<0.05);ROC曲线分析,硬化治疗前AUC_(TIC)参数的AUC、灵敏度、特异度为0.825、0.714、0.866,硬化治疗后分别为0.837、0.857、0.897。结论聚桂醇注射可明显减少前峡部注射区域周围血供,取得良好的硬化效果。硬化前和硬化后造影定量参数AUC均可作为评估手术疗效预测的重要参考指标。Objective To explore the prediction value of the time-intensity curve(TIC)of contrast-enhanced ultra sonography for cesarean outcomes in scar pregnancy patients treated with polylauryl sclerosis.Methods The clinical data of 108 scar pregnancies patients admitted to Hangzhou Women's Hospital for cesarean surgery from January 2020 to December 2022 were retrospectively analyzed.The whole process of contrast agent perfusion in regions of interest(ROI)was automatically analyzed.The TIC was drawn,and the quantitative parameters PI,AT,TTP,and AUC before and after hardening were analyzed and compared between the surgical success group and the surgical failure group.The value of above parameters for predicting surgical outcomes was evaluated with ROC curve.Results The surgery was successful in 101 cases and failed in 7 cases.The AT and TTP values after sclerotherapy increased slightly,but AUC and PI values were significantly lower after sclerotherapy than those before sclerotherapy(P<0.05).There were no significant differences in AT_(1),AT_(2),TTP_(1),TTP_(2)and PI_(2)between surgical success and failure groups;while the PI1,AUC_(TIC1)and AUC_(TIC2).in surgical failure group were significantly larger than those in the success group(P<0.05).ROC analysis showed that the area under curve(AUC)of TIC before sclerotherapy for predicting surgical outcome was 0.825 with a sensitivity of 0.714 and specificity of 0.866;AUC of TIC after sclerotherapy was 0.837 with a sensitivity of 0.857 and specificity of 0.897.Conclusion Polylauryl sclerosis can significantly reduce the blood supply around the anterior isthmus injection area and achieve good hardening effect.The quantitative parameter AUCTIC of pre-sclerosis and post-sclerosis contrast can be used as an predictor of surgical efficacy.

关 键 词：超声造影 时间-强度曲线 聚桂醇硬化 

分 类 号：R714.22[医药卫生—妇产科学] R445.1[医药卫生—临床医学]