超声在妇产科急腹症临床诊断中的应用价值以及存在问题的meta分析

Application value of ultrasound in clinical diagnosis of obstetric and gynecological acute abdomen and meta analysis of existing problems

目的通过Meta分析探讨超声技术应用于妇产科急腹症诊断的价值及其存在的问题。方法对CKNI(中国期刊全文数据库)、万方数据库、维普数据库、Cochrane图书馆、PubMed数据库、Medline数据库进行电子检索,收集应用超声技术诊断妇产科急腹症的文献,排除与本次收集无关的文献,采用文献质量标准对其质量进行评价,应用Stata11.0软件对其进行疗效评价。结果符合本次纳入标准的文献共13篇,参与本次研究的对象共1231例。Meta分析结果显示,本次纳入的文献异质性较好,灵敏度为0.89,其可信区间为(0.82,0.94),特异度为0.79,其可信区间为(0.69,0.87);总阳性似然比为4.26,其可信区间为(2.71,7.14),总阴性似然比为0.12,其可信区间为(0.04,0.23);受试者工作特征曲线下面积为0.93,其可信区间为(0.81,0.95);纳入的文献稳定性较好,无发表偏倚(P>0.05)。结论超声技术应用于诊断妇产科急腹症具有较好的灵敏度,临床应用价值较高,但其特异度一般,诊断时应结合患者病史,以降低误诊率。

Objective To explore the value and existing problems of ultrasonography in the diagnosis of acute abdomen in obstetrics and gynecology through meta analysis. Methods CKNI (Chinese journal full-text database), Wanfang Database, Weipu Database, the Cochrane Library, PubMed Database, and Medline database were electronicly retrieved;the literatures applying ultrasound in the diagnosis of gynecological acute abdomen were collected, and the irrelevant literatures were ruled out. The qualities were evaluated by the quality standards. Stata11.0 software was used to evaluate the curative effect. Results A total of 13 literatures met the inclusion criteria of this study, and a total of 1 231 subjects participated in this study. Meta analysis results showed that the included literatures had good heterogeneity, with a sensitivity of 0.89, a confidence interval of (0.82, 0.94), a specificity of 0.79, and a confidence interval of (0.69, 0.87). The total positive likelihood ratio was 4.26, with a confidence interval of (2.71, 7.14);and the total negative likelihood ratio was 0.12, with a confidence interval of (0.04, 0.23). The area under the subjects' working characteristic curve was 0.93, and its confidence interval was (0.81, 0.95). The included literatures showed good stability and no publication bias (P > 0.05). Conclusion Ultrasonography has a good sensitivity and high application value in the diagnosis of acute abdomen in obstetrics and gynecology, but its specificity is general. When the patients' symptoms are not obvious, it should be combined with the history of diagnosis to reduce the misdiagnosis rate.