经阴道与经腹部彩超诊断剖宫产后瘢痕妊娠的效能比较

Comparison of efficacy of transvaginal and transabdominal color Doppler ultrasound in diagnosis of cesarean scar pregnancy

目的:比较经阴道与经腹部彩色多普勒超声(彩超)诊断剖宫产后瘢痕妊娠(CSP)的效能。方法:选取2019年1月至2022年6月在该院就诊的76例疑似CSP患者进行前瞻性研究,所有患者依次接受经腹部、经阴道彩超检查,以术后病理检查结果为金标准,评估经阴道、经腹部彩超对CSP的诊断效能,并比较两种超声与病理检查对3种类型CSP的诊断符合率。结果:76疑似CSP患者中,金标准诊断检出CSP 65例(85.53%),其中Ⅰ型36例、Ⅱ型16例、Ⅲ型13例;非CSP 11例,其中难免流产6例、子宫峡部妊娠3例、宫颈妊娠2例。经阴道彩超诊断CSP的灵敏度、准确度分别为95.38%、92.11%,高于经腹部彩超的76.92%、72.37%,漏诊率为4.62%,低于经腹部彩超的23.08%,差异均有统计学意义(P<0.05);两种超声诊断CSP的特异度、误诊率比较,差异均无统计学意义(P>0.05)。经阴道彩超诊断CSP类型的结果与病理检查结果的一致性(Kappa=0.921)高于经腹部彩超(Kappa=0.614)。结论:经阴道彩超诊断CSP的灵敏度、准确度均高于经腹部彩超,漏诊率低于经腹部彩超,且更有利于区分不同类型CSP。临床针对疑似CSP患者,可优先采取经阴道彩超诊断。

Objective:To compare efficacy of transvaginal and transabdominal color Doppler ultrasound in diagnosis of cesarean scar pregnancy(CSP).Methods:A prospective study was conducted on 76 patients with suspected CSP who were visited in the hospital from January 2019 to June 2022.All patients were diagnosed by transvaginal and transabdominal color Doppler ultrasound.Using the postoperative pathological examination as the gold standard,the diagnostic efficacy of transvaginal color Doppler ultrasound and transabdominal color Doppler ultrasound were evaluated.The diagnostic coincidence rates of the two kinds of ultrasound and pathological examination for three types of CSP were compared.Results:Among the 76 suspected CSP patients,65 cases(85.53%)of CSP were detected by gold standard diagnosis,including 36 cases of type I,16 cases of type II and 13 cases of type III;there were 11 cases of non-CSP,including 6 cases of inevitable abortion,3 cases of uterine isthmus pregnancy and 2 cases of cervical pregnancy.The sensitivity and the accuracy of transvaginal color Doppler ultrasound in the diagnosis of CSP were 95.38%and 92.11%,which were higher than 76.92%and 72.37%of transabdominal color Doppler ultrasound,the missed diagnosis rate was 4.62%,which was lower than 23.08%of transabdominal color Doppler ultrasound,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the specificity and the misdiagnosis rate between the two types of ultrasound(P>0.05).The consistency of transvaginal color Doppler ultrasound and pathological examination in the diagnosis of CSP type(Kappa=0.921)was higher than that of transabdominal color Doppler ultrasound(Kappa=0.614).Conclusions:The sensitivity and the accuracy of transvaginal color Doppler ultrasound in the diagnosis of CSP are higher than those of transabdominal color Doppler ultrasound,the missed diagnosis rate is lower than that of transabdominal color Doppler ultrasound,and it is more conducive to distinguish different types of CSP.Clinically,for patients with suspected CSP,transvaginal color Doppler ultrasound diagnosis can be given priority.