经腹部与经阴道超声检查诊断孕妇宫颈机能不全的临床价值

Clinical value of transabdominal and transvaginal ultrasonography in diagnosis of cervical incompetence of pregnant women

目的探讨经腹部与经阴道超声检查诊断孕妇宫颈机能不全的临床价值。方法选取2011年4月-2015年3月于北京市通州区妇幼保健院产科门诊就诊的204例疑为宫颈机能不全的患者作为研究对象,将其随机平均分为经阴道超声检查组及经腹部超声检查组。比较两种检查方法诊断宫颈机能不全的检出率及患者宫颈内外口图像满意率,随访两组患者妊娠结局。结果经阴道超声检查检出34例宫颈机能不全患者(33.33%),经腹部超声检查检出13例宫颈机能不全患者(12.75%),两组患者宫颈机能不全检出率比较差异有统计学意义(χ~2=13.731,P<0.05)。两组中,共19例患者选用保守治疗,其中2例患者发生流产,4例患者发生早产,13例患者足月顺利分娩;共28例患者行宫颈环扎术,其中2例患者发生流产,2例患者发生早产,24例患者足月顺利分娩。经阴道超声检查组中,99例患者宫颈内口图像显示满意,满意率为97.06%;经腹部超声检查组中,65例患者宫颈内口图像显示满意,满意率为63.73%,两组患者宫颈内口图像满意率比较差异有统计学意义(χ~2=10.874,P<0.05)。经阴道超声检查组中,97例患者宫颈外口图像显示满意,满意率为95.10%;经腹部超声检查组中,54例患者宫颈外口图像显示满意,满意率为52.94%,两组患者宫颈外口图像满意率比较差异有统计学意义(χ~2=16.780,P<0.05)。结论经阴道超声检查诊断宫颈机能不全的准确率高,临床操作简便,可重复性强,可早期发现宫颈机能不全,为临床诊断及治疗提供可靠依据。

Objective To explore the clinical value of transabdominal and transvaginal ultrasonography in diagnosis of cervical incompetence of pregnant women. Methods A total of 204 patients suspected of cervical incompetence in Department of Obstetric Outpatient in the hospital from April 2011 to March 2015 were selected and randomly divided into transabdominal ultrasonography group and transvaginal ultrasonography group. The detection rates of cervical incompetence by the two methods and the satisfaction rates of images of internal cervical orifice and external cervical orifice were compared,the pregnancy outcomes in the two groups were followed up. Results In transvaginal ultrasonography group,the detection rate of cervical incompetence was 33. 33%（ 34 cases）; in transabdominal ultrasonography group,the detection rate of cervical incompetence was 12. 75%（ 13 cases）,there was statistically significant difference between the two groups（ χ^2=13. 731,P〈0. 05）. In the two groups,19 patients chose expectant treatment,abortion in two patients and premature delivery in four patients were found,13 patients got pregnancy successfully; 28 patients chose cervical cerclage,abortion in two patients and premature delivery in two patients were found,24 patients got pregnancy successfully. In transvaginal ultrasonography group and transabdominal ultrasonography group,the satisfaction rates of images of internal cervical orifice were 97. 06%（ 99 cases） and 63. 73%（ 65 cases）,respectively,there was statistically significant difference between the two groups（ χ^2= 10. 874,P〈0. 05）; the satisfaction rates of images of external cervical orifice were 95. 10%（ 97 cases） and 52. 94%（ 54 cases）,respectively,there was statistically significant difference between the two groups（ χ^2=16. 780,P〈0. 05）. Conclusion The accurate rate of transvaginal ultrasonography in diagnosis of cervical incompetence is high,clinical operation is simple and convenient,and it can detect cervical incompetence early and provide a reliable basis for clinical diagnosis and treatment.