经阴道彩超对产后胎盘植入和胎盘残留的临床诊断价值

Clinical diagnostic value of transvaginal color doppler ultrasound in postpartum placenta increta and placental remnants

目的探讨经阴道彩超对产后胎盘植入和胎盘残留的临床诊断价值。方法选取2016年7月~2017年8月间本院收治诊断结果为胎盘残留患者68例,采用随机数字表法分为观察组和对照组各34例,观察组行经阴道彩超检查,对照组行经腹部超声检查。结果经阴道彩超检查阳性诊断率为34例(94.12%),显著高于经腹部超声检查26例(76.47%),差异有统计学意义(P <0.05)。48例植入组患者中40例诊断正确,8例误诊为胎盘植入。20例非植入组患者中15例诊断正确,5例误诊为植入性胎盘残留。其鉴别胎盘残留是否伴有植入的诊断敏感度、特异度及准确性分别为67.7%、85.9%和79.7%。宫腔内病灶的内部回声是否均匀、与子宫肌层分界是否清楚及Adler血流分级指标中,子宫肌层与病灶的界限是否清楚,对比差异有统计学意义(P <0.05)。结论经阴道彩超声检查诊断率更高,且清晰的显示出病灶及血管灌注情况、子宫肌层与病灶的界限,在临床诊断胎盘残留有无植入上具有重要意义,值得临床推广使用。

Objective To explore the clinical diagnostic value of transvaginal color Doppler ultrasound in postpartum placenta increta and placental remnants. Methods 68 patients who were diagnosed with placental remnants in our hospital from July 2016 to August 2017 were selected.According to random number table method,they were divided into observation group and control group,with 34 cases in each group.The observation group was examined by transvaginal color Doppler ultrasound while the control group was examined by transabdominal ultrasound. Results The positive diagnostic rate of transvaginal color Doppler ultrasound was 94.12% in 34 cases,which was significantly higher than that in 26 cases(76.47%) by transabdominal ultrasound.The comparative difference was statistically significant(P < 0.05).In 48 patients with placenta increta,40 cases were diagnosed correctly and 8 cases were misdiagnosed as placenta increta.Among the 20 patients in the non-placenta increta group,15 cases were correctly diagnosed and 5 cases were misdiagnosed as implantable placental remnants.The diagnostic sensitivity,specificity and accuracy of identifying whether placental remnant was associated with placenta increta were 67.7%,85.9% and 79.7%,respectively.Whether the internal echo of the intrauterine lesion was uniform,whether the boundary with myometrium was clear,and whether the boundary between myometrium and the lesion was clear in the Adler blood flow grading index in two groups had differences and the differences were statistically significant(P < 0.05).Conclusion The diagnostic rate of transvaginal color Doppler ultrasound is higher.It can clearly show the lesion and vascular perfusion and the boundaries between the myometrium and the lesion.It is of great significance in the clinical diagnosis of whether placental remnant is combined with placenta increta or not,which is worthy of clinical promotion.