文章摘要

经阴道三维超声联合超声造影对瘢痕妊娠的诊断价值

作者: 1卓娜, 1汪娟
1 大冶市中医院超声科,湖北 大冶 435100
通讯: 汪娟 Email: 2928310043@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.09.013

摘要

目的:探讨经阴道三维超声(three-dimensional transvaginal ultrasound,3D-TVS)联合超声造影(contrast-enhanced ultrasonography,CEUS)对瘢痕妊娠(cesarean scars pregnancy,CSP)的诊断价值。方法:回顾性分析大冶市中医院2017年2月至2018年5月收治的120例经二维超声诊断疑似为CSP患者的临床资料,所有患者先后通过3D-TVS与CEUS诊断,并经术后病理结果证实,与术后病理结果进行对比,以阐述联合诊断价值。结果:经手术病理结果诊断CSP共89例,非CSP共31例,其中单独3D-TVS诊断CSP共84例,有14例CSP妊娠漏诊,9例非CSP患者误诊为CSP;3D-TVS联合CEUS检测诊断CSP共87例,有4例CSP妊娠漏诊,2例非CSP患者误诊为CSP;3D-TVS联合CEUS对CSP的诊断准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为95.00%,95.50%,93.55%,97.70%,87.88%,高于单独3D-TVS检测80.83%,84.27%,70.97%,89.29%,61.11%(P<0.05);对89例经病理证实为CSP的患者进行分型,病理结果包括I型22例,II型51例,III型16例,3D-TVS联合CEUS对CSP患者的分型符合率93.26%高于3D-TVS的79.76%(P<0.05)。结论:3D-TVS联合CEUS诊断CSP准确度较高,较单独的3D-TVS检测,可明显提高部分切口及部分宫腔内孕囊型CSP诊断效能。
关键词: 瘢痕妊娠;经阴道三维超声;超声造影;联合诊断

Diagnostic value of three-dimensional transvaginal ultrasound combined with contrast-enhanced ultrasonography in cesarean scar pregnancy

Authors: 1ZHUO Na, 1WANG Juan
1 Department of Ultrasonography, Daye Hospital of Traditional Chinese Medicine, Daye Hubei 435100, China

CorrespondingAuthor: WANG Juan Email: 2928310043@qq.com

Abstract

Objective: To explore the diagnostic value of three-dimensional transvaginal ultrasound (3D-TVS) combined with contrast-enhanced ultrasonography (CEUS) for cesarean scar pregnancy (CSP). Methods: A retrospective analysis was performed on the clinical data of 120 patients with suspected CSP by two-dimensional diagnosis who were admitted to the hospital from February 2017 to May 2018. All underwent 3D-TVS and CEUS in turn, and then they were confirmed by postoperative pathological results. The above results were compared with postoperative pathological results. The combination diagnostic value was explained. Results: Among the 120 patients, surgical pathology results showed that there were 89 cases with CSP and 31 cases without CSP. 3D-TVS diagnosis showed that there were 84 cases with CSP. There were 14 CSP cases missing the diagnosis and 9 non-CSP cases misdiagnosed as CSP. The detection of 3D-TVS combined with CEUS showed that there were 87 cases with CSP. There were 4 CSP cases missing the diagnosis and 2 non-CSP cases misdiagnosed as CSP. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 3D-TVS combined with CEUS for CSP were 95.00%, 95.50%, 93.55%, 97.70% and 87.88%, which were higher than those of 3D-TVS alone (80.83%, 84.27%, 70.97%, 89.29%, 61.11%) (P<0.05). The typing was conducted on the 89 patients who were confirmed with CSP by pathology, pathological results showed that there were 22 cases, 51 cases and 16 cases with type I, II and III, respectively. The typing coincidence rate of 3D-TVS combined with CEUS for CSP patients was higher than that of 3D-TVS (93.26% vs 79.76%) (P<0.05). Conclusion: The accuracy of 3D-TVS combined with CEUS is relatively higher for diagnosis of CSP. Compared with simple 3D-TVS detection, the former can significantly improve diagnosis accuracy of gestational sac type CSP at partial incision sites and in uterine cavity.
Keywords: cesarean scar pregnancy; three-dimensional transvaginal ultrasound; contrast-enhanced ultrasound; combination diagnosis