腹部超声在妇科急腹症鉴别诊断中价值研究

The value of abdominal ultrasound in the differential diagnosis of gynecological acute abdomen

目的探讨腹部超声鉴别诊断妇科急腹症的临床价值。方法采用定群抽样法选取2016年6月至2017年9月某三级医院诊治的282例妇科急腹症患者为研究对象,对患者进行超声检查,根据各疾病诊断标准计算超声诊断该疾病的误诊率及漏诊率。采用受试者工作特征曲线(ROC)评价敏感度及特异度,以约登指数评价诊断效果。结果经确诊,异位妊娠患者200例,卵巢肿,瘤蒂扭转患者29例,子宫内膜异位囊肿患者26例,急性盆腔炎患者27例。腹部超声诊断异位妊娠,误诊率偏高,漏诊率较低,ROC曲线显示,对应诊断曲线均落在绿色标准线的左上方。腹部超声诊断卵巢肿瘤蒂扭转,误诊率、漏诊率均较低,ROC曲线显示,对应诊断曲线均落在绿色标准线的左上方,提示其具有较为优质的诊断价值。腹部超声诊断子宫内膜异位囊肿,误诊率、漏诊率均偏高,ROC曲线显示,对应诊断曲线有部分区间落在绿色标准线以下且曲线下面积未超过0. 5,诊断价值不理想。腹部超声诊断急性盆腔炎,误诊率、漏诊率较低,ROC曲线显示,对应诊断曲线均落在绿色标准线的左上方,提示其具有较为优质的诊断价值。结论腹部超声诊断卵巢肿瘤蒂扭转及急性盆腔炎价值较高,诊断异位妊娠漏诊率较低。

Objective To investigate the clinical value of ultrasonography in the differential diagnosis of gynecological acute abdomen. Methods A retrospective study was performed on 282 cases of patients with acute abdomen who were admitted from July 2016 to September 2017. Patients were performed ultrasonography,the misdiagnosis rate and missed diagnosis rate were calculated according to the diagnostic criteria. The sensitivity and specificity of the subject job characteristic curve（ ROC） were used to evaluate the diagnostic effect with the Jordan index. Results It was confirmed that there were 200 cases of ectopic pregnancy,29 cases of ovarian tumor pedicled torsion,26 cases of endometrial ectopic cyst and 27 cases of acute pelvic inflammatory disease. The misdiagnosis rate was high and the rate of missed diagnosis was low. The ROC curve showed that the corresponding diagnostic curves all fall in the upper left of the green standard line. The misdiagnosis rate and missed diagnosis rate of ovarian tumor pedicles diagnosed by abdominal ultrasound were relatively low. The ROC curve showed that the corresponding diagnostic curve fell on the upper left of the green standard line,indicating that it had relatively high diagnostic value. The misdiagnosis rate and missed diagnosis rate of endometriosis cyst diagnosed by abdominal ultrasonography were all high. The ROC curve showed that part of the corresponding diagnostic curve fell below the green standard line and the area under the curve did not exceed 0. 5,so the diagnostic value was not ideal. In the diagnosis of acute pelvic inflammation by abdominal ultrasound,the misdiagnosis rate and missed diagnosis rate were relatively low. The ROC curve showed that the corresponding diagnostic curve fell on the upper left of the green standard line,indicating that it had relatively high diagnostic value. Conclusion The diagnostic value of abdominal ultrasonography in ovarian tumor pedicled torsion and acute pelvic inflammatory disease is higher,and the rate of missed diagnosis in ectopic pregnancy is lower.