Observe on the clinical value of combined multi-channel ultrasound in the diagnosis of cesarean scar pregnancy
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摘要:
目的 观察经腹联合经阴道彩色多普勒超声用于剖宫产子宫瘢痕妊娠(cesarean scars pregnancy, CSP)早期鉴别分型诊断的临床效果。 方法 选择2017年4月—2020年4月于金华中心医院接受产检并实施妊娠物清除术中确诊为CSP的患者110例和110例非CSP患者为研究对象，所有患者均于孕早期进行经腹超声、经阴道超声和经腹联合经阴道超声检查，比较3种超声检查方式对CSP鉴别诊断效能差异，统计3种超声检查方式对不同临床类型CSP的诊断符合率，观察3种超声检查方式对CSP患者滋养层血流显示率差异。 结果 经腹联合经阴道超声检查对CSP的鉴别诊断灵敏度、特异性和准确度(98.18%、96.36%和97.27%)均显著高于经腹超声(79.09%、74.54%和76.82%)和经阴道超声(90.91%、88.18%和89.54%)单独检查水平(均P < .05);经腹联合经阴道超声检查对Ⅱ型CSP和CSP总体分型诊断符合率(95.74%和94.54%)均显著高于经腹超声(59.57%和61.82%)和经阴道超声(82.98%和81.82%)单独检查水平(均P < .05);经腹联合经阴道超声检查对CSP患者滋养层血流显示率(97.27%)均显著高于经腹超声(76.36%)和经阴道超声(89.09%)单独检查水平(均P < .05)。 结论 经腹联合经阴道超声检查可有效提高CSP早期鉴别诊断效能及分型诊断符合率。 Abstract:Objective To observe the clinical effect of transabdominal combined with transvaginal color Doppler ultrasound in the early differential diagnosis of cesarean scar pregnancy (CSP). Methods Total 110 CSP patients and 110 non CSP patients confirmed during pregnancy clearance were selected as the research objects. All patients were examined by transabdominal ultrasound, transvaginal ultrasound and transabdominal combined transvaginal ultrasound in early pregnancy. The difference of the diagnostic efficacy of the three ultrasound methods for CSP was compared, and the diagnostic coincidence rate of the three ultrasound methods for different clinical types of CSP was counted. The difference of trophoblast blood flow display rate of CSP patients was observed by three ultrasonic examination methods. Results The sensitivity, specificity and accuracy of transabdominal combined with transvaginal ultrasound in the differential diagnosis of CSP (98.18%, 96.36% and 97.27%) were significantly higher than those of transabdominal ultrasound (79.09%, 74.54% and 76.82%) and transvaginal ultrasound (90.91%, 88.18% and 89.54%) alone (all P < .05). The diagnostic coincidence rate of type Ⅱ CSP and overall CSP by transabdominal combined with transvaginal ultrasound (95.74% and 94.54%) were significantly higher than that of transabdominal ultrasound (59.57% and 61.82%) and transvaginal ultrasound (82.98% and 81.82%, P < .05). The display rate of trophoblast blood flow in CSP patients by transabdominal combined with transvaginal ultrasound (97.27%) was significantly higher than that by transabdominal ultrasound (76.36%) and transvaginal ultrasound (89.09%) alone (all P < .05). Conclusion The combination of transabdominal and transvaginal ultrasound can effectively improve the early differential diagnosis efficiency and classification diagnosis rate of CSP, which is worthy of clinical application. -
表 1 3种超声检查方式对CSP鉴别诊断结果(例)
组织病理检查 经腹超声检查 经阴道超声检查 经腹联合经阴道超声检查 合计 CSP 非CSP CSP 非CSP CSP 非CSP CSP 87 23 100 10 108 2 110 非CSP 28 82 13 97 4 106 110 合计 115 105 113 107 112 108 220 
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表 2 3种超声检查方式对CSP鉴别诊断效能比较(%)
检查方式 诊断效能指标 灵敏度 特异性 准确度 经腹超声检查 79.09(87/110) 74.54(82/110) 76.82(169/220) 经阴道超声检查 90.91(100/110)a 88.18(97/110)a 89.54(197/220)a 经腹联合经阴道超声检查 98.18(108/110)ab 96.36(106/110)ab 97.27(214/220)ab χ2值 21.542 22.695 44.066 P值 ＜0.001 ＜0.001 ＜0.001 注：与经腹超声检查比较，aP < 0.05;与经阴道超声检查比较，bP < 0.05。组间两两比较，校正检验水准为0.0167。
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表 3 不同检查方法对不同类型CSP的鉴别诊断符合率比较(%)
检查方法 Ⅰ型CSP Ⅱ型CSP Ⅲ型CSP 总体符合率 经腹超声检查 64.70(23/34) 59.57(28/47) 62.07(17/29) 61.82(68/110) 经阴道超声检查 79.41(27/34) 82.98(39/47)a 82.76(24/29)a 81.82(90/110)a 经腹联合经阴道超声检查 94.12(32/34)a 95.74(45/47)ab 93.10(27/29)a 94.54(104/110)ab χ2值 7.588 19.361 10.639 36.601 P值 0.023 ＜0.001 0.005 ＜0.001 注：与经腹超声检查比较，aP < 0.05;与经阴道超声检查比较，bP < 0.05。组间两两比较，校正检验水准为0.0167。
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