摘要
目的比较静脉超声造影检查与病理学检查在剖宫产瘢痕部位妊娠(CSP)中的诊断价值。方法选取常德市第一人民医院2018年5月—2020年1月收治的CSP患者94例,依据随机数字表法分为超声组与病理组,各47例。病理组行病理学检查,超声组行静脉超声造影检查。比较2组灵敏度、特异度与诊断率,不同类型CSP诊断符合率,并分析静脉超声造影检查声像图。结果超声组灵敏度、特异度、诊断率高于病理组(P<0.05)。经宫腔镜检查47例CSP患者中单纯孕囊型23例,不均质包块型14例,其他10例。超声组单纯孕囊型诊断率、不均质包块型诊断率高于病理组(P<0.05)。47例患者子宫前壁瘢痕处存在妊娠附着,与正常子宫相比,此处为早增强,高增强,慢消退,呈现快进慢出模式,以下是不同类型的声像图表现:单纯孕囊型:子宫下段瘢痕孕囊附着处呈现团块状或半环状,先增强,其中22例患者子宫瘢痕处肌层变薄,1例肌层显示不清晰。均质包块型:子宫下段瘢痕孕囊附着处呈现团块状或半环状,先增强,随后,病灶周围呈现不均匀性增强,其中10例子宫瘢痕处肌层变薄,4例肌层显示不清。其他CSP患者:瘢痕处肌层显示不清,造影均显示此处肌层与妊娠物同步早增强。结论静脉超声造影应用于CSP中诊断效果良好,其特异度和敏感度比病理学检查均要高,同时静脉超声造影也能显示明显的声像图特征,从而判断妊娠物与肌层的关系,以帮助临床更好地治疗。
Objective To compare the diagnostic value of contrast-enhanced ultrasound and pathology in cesarean scar pregnancy(CSP).Methods A total of 94 cases of patients with CSP were selected from May 2018 to January 2020 in Changde First People’s Hospital,which were selected and randomly divided into ultrasound group and pathological group,according to random number table,47 cases in each group.Pathological examination was performed in the pathological group,and intravenous contrast-enhanced ultrasound was performed in the ultrasound group.The sensitivity,specificity and diagnostic rate of the two groups were compared,and the diagnostic coincidence rate of different types of CSP was analyzed.Results The sensitivity,specificity and diagnostic rate of ultrasound group were higher than those of pathological group(P<0.05).Among the 47 CSP patients examined by hysteroscopy,there were 23 cases of simple gestational sac type,14 cases of heterogeneous mass type and 10 cases of others.The diagnosis rate of simple gestational sac type and heterogeneous mass type in ultrasound group was higher than that in pathology group(P<0.05).Compared with the normal uterus,there were early enhancement,high enhancement,slow regression,fast in and slow out patterns.The following are different types of sonographic manifestations:simple gestational sac type:the lower uterine scar gestational sac attachment presented mass or semi ring,enhanced first,22 cases of patients with uterine scar myometrium thinning,1 case of myometrium showing blurring.Homogeneous mass type:the attachment of the gestational sac in the lower uterine scar presented a mass or semi ring,first enhanced,and then showed inhomogeneous enhancement around the lesion.In 10 cases,the myometrium in the uterine scar became thinner,and in 4 cases,the myometrium was not clearly displayed.In other CSP patients,the myometrium of the scar was not clearly displayed,and the angiography showed that the myometrium and the pregnancy were enhanced early.Conclusion Intravenous contrastenhanced ultrasound in the diagnosis of CSP has a good effect,and its specificity and sensitivity are higher than pathological examination.At the same time,intravenous contrast-enhanced ultrasound can also show obvious sonographic features,so as to judge the relationship between pregnancy and muscle layer,so as to help clinical better treatment.
作者
李春香
LI Chunxiang(Department of Ultrasound,Changde First People’s Hospital,Changde 415001,China)
出处
《临床合理用药杂志》
2021年第9期165-167,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
剖宫产术
瘢痕
静脉超声造影
病理检查
诊断价值
Cesarean section
Cicatrix
Intravenous contrast-enhanced ultrasound
Pathological examination
Diagnostic value
