多种超声联用诊断瘢痕子宫并前置胎盘植入

Joint Use of Multiple Ultrasonic Examination on Scarred Uterus and Placenta Previa Implantation

目的 探讨二维(2D)、二维彩色多普勒超声(2D-CDFI)及三维能量多普勒超声(3D-CPA)联合应用诊断瘢痕子宫并前置胎盘植入的应用价值。方法 应用二维超声行常规产前检查,对拟诊瘢痕子宫并前置胎盘植入的44例患者用二维彩色多普勒超声显示胎盘与子宫前壁下段瘢痕处肌层的血供情况,然后在可疑胎盘植入处应用三维能量多普勒成像对胎盘内及胎盘后方血流进行三维图像采集,3种方法检查结果与确诊标准进行对比分析。结果 44例可疑瘢痕子宫并前置胎盘植入患者中,二维超声检查,粘连性胎盘、植入性胎盘、穿透性胎盘漏误诊率分别为45.5%、33.3%、33.3%,差异有统计学意义(P<0.05);二维彩色多普勒超声检查,粘连性胎盘、植入性胎盘、穿透性胎盘漏误诊率分别为27.3%、 16.7%、16.7%,差异有统计学意义(P<0.05);三维能量多普勒超声检查,粘连性胎盘及穿透性胎盘误诊率为18.2%,16.7%差异有统计学意义(P<0.05);3种方法联合检查,三型植入性胎盘的漏误诊率均低,差异无统计学意义(P>0.05)。结论 二维、二维彩色多普勒超声和三维能量多普勒超声对瘢痕子宫并前置胎盘植入的检查各有优缺点,3种方法联合应用可明显降低漏诊率和误诊率,为临床提供准确的超声影像依据。

Objective To explore the diagnostic value of the joint use of two dimensional ultrasound (2D), two dimensional color Doppler flow imaging (2D-CDFI)and three-dimensional power Doppler ultrasound (3D-CPA)on scarred uterus with placenta previa implantation. Method 2D was applied for routine prenatal examination. Afterwards, 44 patients diagnosed with suspicious scarred uterus with placenta previa implantation were examined by 2D-CDFI to show the results of blood supply in placenta and muscular layer of scar in the lower part of anterior uterus, followed by a 3D-CPA being applied in suspected placenta implantation to acquire three-dimensional images of placenta and blood flow in the posterior portion of placenta. The diagnosis results and accuracy of these three methods were analyzed and compared. Results Among the 44 patients diagnosed as suspicious scarred uterus and placenta previa implantation, misdiagnosis rate of 2D on adherent placenta, placenta increta, and penetrating placenta were 45.5%, 33.3% and 33.3% respectively(P < 0.05);misdiagnosis rate of 2D-CDFI on adherent placenta, placenta increta, and penetrating placenta were 27.3%, 16.7% and 16.7% respectively (P < 0.05);misdiagnosis rate of 3D-CPA on adherent placenta and penetrating placenta were 18.2% and 16.7%(P < 0.05)The joint use of these three methods indicated a generally low misdiagnosis rate of placenta increta in all three methods, and it had no statistical significance (P > 0.05). Conclusion 2D, 2D-CDFI and 3D-CPA have their own advantages and disadvantages, and the joint use of the three methods can significantly reduce misdiagnosis rate and missed diagnosis rate and provide a more accurate ultrasonic image.