超声剪切波弹性成像技术评估子宫瘢痕情况的价值  

The Value of Ultrasonic Shear Wave Elastography in Evaluating Uterine Scar Condition

作　　者：唐紫露 邓芯茹 董晓静[1] TANG Zilu;DENG Xinru;DONG Xiaojing(Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院妇产科,重庆400010

出　　处：《实用妇产科杂志》2023年第9期681-685,共5页Journal of Practical Obstetrics and Gynecology

基　　金：2023年重庆市妇幼保健科研培育项目(妇幼管理项目)(编号:2023FY201);重庆市南岸区区级公共卫生重点学科建设经费资助;重庆医科大学未来医学青年创新团队(编号:W0122)。

摘　　要：目的:将超声剪切波弹性成像(SWE)技术用于检测子宫下段瘢痕最薄处僵硬度,为剖宫产后子宫瘢痕功能恢复情况的评估提供参考依据。方法:选择2022年1月至12月重庆医科大学附属第二医院就诊的剖宫产术后再次妊娠的孕妇180例为研究对象,分娩前进行SWE检查,根据剖宫产术中判断是否发生先兆子宫破裂分为先兆子宫破裂组(19例)和正常组(161例),根据孕妇是否有瘢痕压痛症状分为瘢痕压痛组(45例)和无瘢痕压痛组(135例)。比较各组子宫瘢痕最薄处弹性值、厚度、瘢痕压痛、分娩结局,同时绘制受试者工作特征(ROC)曲线评价指标对预测发生先兆子宫破裂的可行性及有效性。结果:①先兆子宫破裂组弹性模量平均值大于正常组(42.25±6.02 kPa vs.19.21±7.98 kPa,P<0.05),先兆子宫破裂组中弹性图像评分为3分、4分的比例(31.58%、68.42%)高于正常组(16.15%、0.62%),差异有统计学意义(P<0.05)。两组子宫瘢痕厚度差异无统计学意义(1.34±0.63 mm vs.1.67±0.95 mm,P>0.05)。瘢痕弹性模量平均值预测先兆子宫破裂的最佳截断值为34.27 kPa,灵敏度100.0%,特异度94.4%。②瘢痕压痛组的先兆子宫破裂发生率高于无瘢痕压痛组(22.22%vs.6.67%,P<0.05)。瘢痕压痛组弹性模量平均值大于无瘢痕压痛组(31.16±8.83 kPa vs.18.47±9.06 kPa,P<0.05),瘢痕弹性模量平均值预测瘢痕压痛的最佳截断值为25.93 kPa,灵敏度88.9%,特异度73.3%。结论:SWE技术评估子宫下段瘢痕僵硬度及功能是可行的,瘢痕弹性值相较于瘢痕厚度、瘢痕压痛症状对于瘢痕功能评估性能更好,对于先兆子宫破裂的预测价值更大,对临床瘢痕子宫分娩时机及分娩方式的选择有一定指导意义。Objective:To use ultrasonic shear wave elastography(SWE)technology to detect the stiffness of the thinnest scar in the lower segment of uterus,and to provide a reference basis for the evaluation of the functional recovery of uterine scar after cesarean section.Methods:A total of 180 pregnant women with pregnancy after cesarean section in the Secord Affiliated Hospital of Chongqing Medical University from January 2022 to December 2022 were selected.SWE examination was performed before delivery.The pregnant women were divided into threatened uterine rupture group(19 cases)and normal group(161 cases)according to whether there was threatened uterine rupture during cesarean section.And the pregnant women were divided into scar tenderness group(45 cases)and non-scar tenderness group(135 cases)according to whether they had symptoms of scar tenderness.Then compare the elasticity,thickness,scar tenderness and delivery outcome at the thinnest part of uterine scar in each group,and draw the receiver operating characteristic(ROC)curve to evaluate the feasibility and effectiveness of indicators for threatened uterine rupture.Results:①The mean elastic modulus of the threatened uterine rupture group was higher than that of the normal group(42.25±6.02 kPa vs.19.21±7.98 kPa,P<0.05).The proportion of subjects with elastic image score of 3 and 4 in the threatened uterine rupture group(31.58%and 68.42%)was higher than that in the normal group(16.15%and 0.62%),the difference was statistically significant(P<0.05).There was no statistically significant difference in uterine scar thickness between the two groups(1.34±0.63 mm vs.1.67±0.95 mm,P>0.05).The optimal cut-off value of mean elastic modulus to predict threatened uterine rupture was 34.27 kPa,with a sensitivity of 100.0%and specificity of 94.4%.②The incidence of threatened uterine rupture in the scar tenderness group was higher than that in the non-scar tenderness group(22.22%vs.6.67%,P<0.05).The mean elastic modulus in the scar tenderness group was higher than that in the

关 键 词：超声剪切波弹性成像 剖宫产后再次妊娠 瘢痕弹性 子宫瘢痕 

分 类 号：R714.22[医药卫生—妇产科学]