超声对剖宫产后子宫瘢痕憩室与异常子宫出血的相关性分析

The correlation analysis of abnormal uterine bleeding and previous cesarean scar defect of ultrasonic

目的探讨经阴道三维超声检查剖宫产后子宫切口憩室的声像图特征及三维容积测定与异常子宫出血的关系。方法回顾性分析48例剖宫产后子宫瘢痕憩室(PCSD)的声像图特征,其中正常组22例,异常子宫出血组26例,比较两组子宫瘢痕憩室的长度、高度、深度、残存肌厚度、三维容积以及憩室比率〔深度/(深度+残存肌层厚度)〕。结果正常组与出血组PCSD的长度、宽度、残存肌层厚度及子宫位置、剖宫产次数单项指标之间差异无统计学意义(P>0.05),深度、容积以及憩室比单项指标之间的差异有统计学意义(P<0.05)。根据ROC曲线分析,憩室容积的敏感性较高,而憩室深度及憩室比率的特异性较高。结论PCSD的深度、容积以及憩室比率是预测子宫憩室出血关键指标。憩室深度与憩室比结合憩室容积与深度联合诊断,能够提高预测PCSD出血的准确度,给予临床一定的指导意义。

Objective To investigate the correlation between the ultrasonic characteristics of previous cesarean scar defect by transvaginal three-dimensional ultrasonography with the three-dimensional volume measurement and abnormal uterine bleeding.Methods The ultrasono-graphic characteristics of 48 cases who were diagnosed as previous cesarean scar defect(PCSD)were retrospectively analyzed,including 22 cases in the normal group and 26 cases in the abnormal bleeding group.The length,height,depth,residual muscle thickness,three-dimensional volume and niche ratio of PCSD in the two groups were compared.Results There were no statistically significant differences in the length,width,residual muscle-thickness of PCSD and uterine position,cesarean section number between the normal group and the abnormal bleeding group(P>0.05),but there were statistically significant differences in the depth,volume and niche ratio of PCSD between the normal group and the abnormal bleeding group(P<0.05).According to ROC curve analysis,the sensitivity of diverticulum volume was higher,while,the specificity of depth and niche ratio was higher.Conclusion The depth,volume and niche ratio of PCSD are key indicators for predicting uterine niche bleeding.The niche ratio combined with the volume and depth of the PCSD can improve the accuracy of predicting PCSD bleeding,which can provide certain clinical guidance.