超声对早孕流产后妊娠物残留合并子宫动静脉瘘的诊断价值及大出血的预测价值分析  

Diagnostic Value of Ultrasound for Residual Pregnancy Products Combined with Uterine Arteriovenous Fistula after Early Pregnancy Miscarriage and Predictive Value for Major Bleeding

作　　者：刘林玲 何庆兰 邓红英 罗红 LIU Linling;HE Qinglan;DENG Hongying;et al(Department of Ultrasound,The People's Hospital of Jianyang City,Jianyang Sichuan 641400,China)

机构地区：[1]四川省简阳市人民医院超声科,四川简阳641400 [2]四川大学华西第二医院超声科、出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《实用妇产科杂志》2025年第3期246-251,共6页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨超声检查对早孕流产后妊娠物残留合并子宫动静脉瘘(UAVF)的诊断价值和大出血的预测价值。方法:选择2013年7月至2021年9月在四川大学华西第二医院超声诊断为早孕流产后妊娠物残留合并UAVF的患者90例,其中37例行数字减影血管造影(DSA)检查。收集患者的临床资料(主要症状、入院前有无自发大出血、治疗方式、有无术中大出血等)和超声资料(病灶大小、有无血管池、有无扩张血管等),采用单因素和多因素Logistic回归分析相关性,并绘制诊断UAVF及预测术中大出血的受试者工作特征(ROC)曲线,计算曲线下面积(AUC)。结果:①37例超声诊断妊娠物残留合并UAVF患者行DSA检查后,确诊UAVF者14例(37.8%)。单因素和多因素Logistic回归分析显示,扩张血管内径增大是早孕流产后妊娠物残留合并UAVF的独立危险因素(OR 37.099,P=0.027)。ROC曲线分析发现,扩张血管内径对诊断UAVF的AUC为0.78,敏感度为64%,特异度为91%,最佳临界值为0.85 cm。②在90例患者中,44例发生自发大出血(48.9%)。单因素和多因素Logistic回归分析显示,有血管池或扩张血管是自发大出血的独立危险因素(OR 5.163,P=0.004)。③在70例行手术治疗患者中,7例发生了术中大出血(11.7%),单因素和多因素Logistic回归分析显示,病灶最大径增大是术中大出血的独立危险因素(OR 7.278,P=0.007)。ROC曲线分析发现,病灶最大径对预测术中大出血风险的AUC为0.92,敏感度为100%,特异度为82%,最佳临界值为3.95 cm。结论:超声检查参数扩张血管内径对早孕妊娠物残留合并UAVF有较高的诊断价值。有血管池或扩张血管及病灶大的患者,自发及术中大出血的风险较高,临床可参考预测模型评估出血风险。Objective:To explore the diagnostic value of ultrasound for retained products of conceptions complicated with uterine arteriovenous fistula(UAVF)after early pregnancy miscarriage and the predictive value for massive bleeding by constructing a risk model for bleeding.Methods:A total of 90 patients who were diagnosed by ultrasound in West China Second Hospital of Sichuan University as having retained products of conceptions complicated with UAVF after early pregnancy miscarriage from July 2013 to September 2021 were selected,among which 37 cases underwent digital subtraction angiography(DSA).Clinical and ultrasound data were collected and statistical analysis was conducted on the ultrasound parameters of whether DSA examination was accompanied by UAVF and whether there was major bleeding(spontaneous and intraoperative).We performed multivariate Logistic regression analysis on parameters with statistical differences,plotted receiver operating characteristic(ROC)curve for predicting major bleeding(spontaneous and intraoperative),and calculated the area under the curve(AUC).Results:①After DSA examination,14 out of 37 patients(37.8%)were diagnosed with UAVF based on ultrasound diagnosis of pregnancy residue combined with UAVF.Univariate and multivariate Logistic analyses showed that the expanding inner diameter of blood vessels was an independent risk factor for residual pregnancy products combined with UAVF after early pregnancy miscarriage(OR 37.099,P=0.027).ROC curve analysis revealed that dilated vessel diameter had an AUC of 0.78,sensitivity of 64%,specificity of 91%,and an optimal cut-off value of 0.85 cm for the diagnosis of UAVF.②Out of 90 patients,44(48.9%)experienced spontaneous massive bleeding.Univariate and multivariate Logistic analyses showed that the presence of vascular pools or dilated vessels was an independent risk factor for spontaneous massive bleeding(OR 5.163,P=0.004).③Among 70 patients undergoing surgical treatment,7 experienced intraoperative bleeding(11.7%).Univariate and multivariate L

关 键 词：超声检查 早孕 妊娠物残留 子宫动静脉瘘 大出血 

分 类 号：R714.21[医药卫生—妇产科学]