41例宫颈癌患者彩超检查漏诊分析

Analysis of Missed Diagnosis of Color Doppler Ultrasonography in 41 Cases of Cervical Cancer

目的:分析宫颈癌患者彩超检查漏诊影响因素。方法:2016年6月—2017年12月医院共明确诊断宫颈癌254例,其中漏诊41例纳入漏诊组,其余213例纳入确诊组,进行因素分析。结果:漏诊组患者年龄、病灶大小、病程、慢性宫颈炎病史低于确诊组(P<0.05)。漏诊组多产(分娩生产次数≥2次)、多孕(怀孕次数≥2次)病史、CINⅡ及CINⅢ、60岁以上、p16/ki-67检测阳性、宫颈息肉比重低于确诊组,漏诊组慢性宫颈炎急性期、重度宫颈糜烂宫颈息肉比重高于确诊组,差异有统计学意义(P<0.05)。漏诊组宫颈息肉、高回声、淋巴结阳性率、子宫不规则增大、不规则血流信号率、医师检查时副主任及以上职称比重低于确诊组,差异有统计学意义(P<0.05)。多因素分析,病灶大小、宫颈息肉、重度宫颈糜烂、医师检查时副主任及以上职称成为独立影响因素(P<0.05)。结论:宫颈癌患者彩超检查漏诊影响因素较多,病灶过小、宫颈本身病变掩盖等导致的不典型及医师经验不足是导致漏诊的主要原因。

Objective： To analyze the influencing factors of missed diagnosis of color Doppler ultrasound in cervical cancer patients. Methods： From June 2016 to December 2017,254 cases of cervical cancer were clearly diagnosed in the hospital, of which 41 cases were included in the missed diagnosis group, and the other 213 cases were included in the diagnosis group,and the factors were analyzed. Results： The age,lesion size, course of disease,and chronic cervicitis in the missed diagnosis group were lower than those in the confirmed group （ P 〈0.05）.The misdiagnosis group was more productive （more than 2 times of labor production）,multiple pregnancy （more than 2 times of pregnancy）,CIN Ⅱ and CIN Ⅲ,60 years old, p16/ki-67 positive, and the proportion of were lower than that of the confirmed group.The specific weight of acute stage of chronic cervicitis and severe cervical erosion were higher than those of the confirmed group（ P 〈0.05）.The cervical polyps,high echo, positive rate of lymph node, irregular enlargement of uterus, irregular blood flow rate, and the proportion of deputy director and above title in the examination were lower than those of the confirmed group （ P 〈0.05）. Multivariate analysis showed that the size of the lesion,cervical polyp, severe cervical erosion, and the deputy director and above title were independent factors （ P 〈0.05）. Conclusion： There are many factors influencing the missed diagnosis of cervical cancer patients with color Doppler ultrasound examination, the minor lesions and the mask of the cervical lesions are untypical,and the lack of doctors’experience is the main cause of missed diagnosis.