经腹和经阴道超声对剖宫产术后瘢痕妊娠的诊断价值比较

Comparison of the diagnostic value between transabdominal ultrasonography and transvaginal ultrasonography in scar pregnancy after cesarean

目的:比较经腹部超声和经阴道超声检查在剖宫产术后瘢痕妊娠(CSP)诊断中的应用价值。方法:选取疑似CSP病人70例作为研究对象,均行经腹部和经阴道超声检查,经术后病理检查证实,比较2种诊断方法的准确性。结果:70例中共58例(82.86%)经病理检查诊断为CSP,其中孕囊型36例(62.07%),不均质包块型18例(31.03%),混合型4例(6.90%)。经腹部超声+经阴道超声和经阴道超声检查对CSP的诊断率均高于经腹部超声(P<0.05),而经腹部超声+经阴道超声与经阴道超声诊断率差异无统计学意义(P>0.05)。经腹部+经阴道超声对CSP诊断的敏感性、特异性均明显高于经腹部超声(P<0.01),但与经阴道超声差异均无统计学意义(P>0.05);经阴道超声敏感性、特异性亦均高于经腹部超声(P<0.01和P<0.05)。结论:在CSP的临床诊断中,经阴道超声检查能有效弥补经腹超声检查的不足,清晰显示瘢痕妊娠的范围、位置、血供、子宫肌层厚度等,提高瘢痕妊娠的诊断准确性。

Objective： To compare the application value between transabdominal ultrasonography and transvaginal ultrasonography in the diagnosis of scar pregnancy（ CSP） after cesarean. Methods： Seventy patients suspected with CSP were detected using transabdominal and transvaginal ultrasound before operation,and diagonised with pathology after operation. The diagnostic accuracy between two groups was compared. Results： Among 70 patients,the CSP in 58 cases（ 82. 86%） were diagnosed by pathological examination,which included 36 cases of gestational sac type（ 62. 07%）,18 cases of heterogeneous masses（ 31. 03%） and 4 cases of mixed type（ 6. 90%）. The diagnostic rate of CSP in transabdominal combined with transvaginal ultrasonography and transvaginal ultrasonography was significantly higher than that in transabdominal ultrasonography（ P 〈0. 05）,The difference of the diagnostic rate of CSP between transabdominal combined with transvaginal ultrasonography and transvaginal ultrasonography was not statistically significant（ P 〉0. 05）. The sensitivity and specificity of the transabdominal combined with transvaginal ultrasonography in the diagnosis of CSP in were significantly higher than those in transabdominal ultrasonography（ P 〈0. 01）,but there was no statistical significance between transvaginal ultrasonography and transabdominal combined with transvaginal ultrasonography（ P 〉0. 05）. The sensitivity and specificity of transvaginal ultrasonography in the diagnosis of CSP were higher than those in transabdominal ultrasonography（ P〈 0. 01 and P 〈0. 05）. Conclusions： In the clinical diagnosis of scar pregnancy after cesarean section,the transvaginal ultrasonography can effectively compensate the lack of transabdominal ultrasonography,which can clearly show the range,location,blood supply and myometrial thickness of scar pregnancy,and improve the diagnostic accuracy of scar pregnancy.