经阴道彩色多普勒超声对切口妊娠的诊断效能及超声分型的临床价值分析

The diagnostic efficacy of transvaginal color Doppler ultrasound for incision pregnancy and the clinical value for ultrasonic typing

目的分析经阴道彩色多普勒超声对切口妊娠的诊断效能及其对切口妊娠分型的临床价值。方法选取2017年2月~2019年2月娄底市中心医院375例临床疑似切口妊娠的病例作为研究对象,对患者进行彩色多普勒超声检查,重点观察孕囊或异常回声与子宫前壁下段切口的关系及周边和内部血流情况,诊断是否为切口妊娠,对阳性者进行超声分型,并追踪患者的临床处理及预后。结果375例患者中,150例为切口妊娠,225例为非切口妊娠,147例经超声诊断并经病理证实为切口妊娠,其中绒毛型85例(57.823%),混合型39例(26.531%),孕囊型17例(11.565%),发育不良型6例(4.082%),漏诊3例;经宫腔镜治疗143例,4例行开腹手术患者超声分型均为孕囊型,继续妊娠3例均为绒毛型(Ia型)。经阴道彩色多普勒超声诊断切口妊娠敏感度为98.000%,特异度为97.778%,误诊率为2.273%,漏诊率为2.000%。结论经阴道彩色多普勒超声对切口妊娠的诊断效能高,对切口妊娠分型具有一定的临床价值。

Objective To analyze the diagnostic efficacy of transvaginal color Doppler ultrasound for incision pregnancy and its clinical value for the typing of incision pregnancy.Methods From February 2017 to February 2019,a total of 375 cases of clinically suspected incision pregnancy in Loudi Central Hospital were selected as the subjects of research.The patients were examined by color Doppler ultrasound,which focused on observing the relationship between gestational sac or abnormal echo and the incision in the lower anterior wall of uterus,as well as the peripheral and internal blood flow,diagnosing whether it was incision pregnancy,performing ultrasonic typing on those with positive results,and tracking and analyzing the clinical treatment and prognosis of the patients.Results Among the 375 patients,150 cases were incision pregnancy,225 cases were non-incision pregnancy,and 147 cases were diagnosed with incision pregnancy by ultrasound,which were pathologically confirmed,including 85 cases of villous type(57.823%),39 cases of mixed type(26.531%),17 cases of gestational sac type(11.565%)and 6 cases of dysplasia type(4.082%),with 3 cases of missed diagnosis.There were 143 cases treated by hysteroscopy,4 cases undergoing laparotomy were classified into gestational sac type by ultrasonic typing,and 3 cases of continued pregnancy were classified into villous(Ia)type.According to transvaginal color Doppler ultrasonography,the sensitivity of incision pregnancy was 98.000%,the specificity was 97.778%,the misdiagnosis rate was 2.273%and the missed diagnosis rate was 2.000%.Conclusion Transvaginal color Doppler ultrasound has high diagnostic efficiency for incision pregnancy and it has a certain clinical value for the typing of incision pregnancy.