超声检测剖宫产瘢痕妊娠部位血流参数及预测清宫术中出血价值

The characteristics of blood flow parameters of caesarean scar pregnancy site detected by ultrasound and its value for predicting the bleeding during curettage

目的:探讨超声检测剖宫产瘢痕妊娠部位血流参数特点及对清宫术中出血量的预测价值。方法:回顾性收集2017年1月—2019年12月本院收治的确诊CSP患者98例为观察组、同期剖宫产术后正常妊娠孕妇90例为对照组临床资料,均采用超声检测胚胎种植处滋养动脉阻力指数(RI)、搏动指数(PI)、收缩期峰值/舒张末期流速(S/D),孕囊区域内血管指数(VI)、血流指数(FI)及血管血流指数(VFI)。结果:RI、PI、S/D值观察组均小于对照组(P<0.05),但观察组中CSPI型与CSPII+Ⅲ型者间无差异(P>0.05);CSPII+Ⅲ型患者VI、FI、VFI值高于CSPI型患者及对照组(P<0.05),而CSPI型患者与对照组VI、FI、VFI值无差异(P>0.05);观察组中,血β-HCG≥40000U/L患者的RI值小于血β-HCG<40000U/L患者(P<0.05),PI、S/D值无差异(P>0.05),血β-HCG≥40000U/L患者的VI、FI、VFI值大于血β-HCG<40000U/L患者(P<0.05)。观察组CSP患者RI、VI、FI、VFI值与血β-HCG值无相关性(P>0.05);行超声监视下清宫术中出血量≥100ml与<100ml的患者RI、PI、S/D值无差异(P>0.05),VI、FI、VFI值出血量≥100ml者大于<100ml者(P<0.05)。β-HCG+VFI值对清宫术中出血量≥100ml预测效能最佳,敏感性82.4%、特异性78.3%。结论:CSP患者胚胎种植处血流呈低阻状态,三维能量血流参数对诊断CSP和预测清宫术中出血量有参考价值。

Objective:To explore the characteristics of blood flow parameters of caesarean scar pregnancy(CSP)site detected by ultrasound,and to study its value for predicting the bleeding during curettage.Methods:98 women with CSP from January 2017 to December 2019 were selected in observation group retrospectively,and 90 women with normal pregnancy after cesarean section were selected in control group.The trophoblast artery resistance index(RI),pulse index(PI),systolic peak/end-diastolic flow rate(S/D),vascular index(VI),blood flow index(FI),and blood flow index(VFI)of the embryo implantation site of the women in the two groups were detected by ultrasound.Results:The RI,PI,and S/D values of the women in the observation group were significant lower than those of the women in the control group(P<0.05),but which had no statistical significant different between the women with type I CSP and the women with type II+III CSP(P>0.05).The VI,FI,and VFI values of the women with type II and III CSP were significant higher than those of the women with type I CSP or the women in the control group(P<0.05),but which had no statistical significant different between the women with type I CSP and the women with type II and III CSP(P>0.05).In the observation group,the serum RI value of the women withβ-HCG level≥40000U/L was significant lower than that of the women withβ-HCG level<40000U/L(P<0.05),but the values of VI,FI,and VFI of the women withβ-HCG level≥40000U/L were significant higher than those of the women withβ-HCG level<40000U/L(P<0.05),there were no significant different in PI and S/D values between the women withβ-HCG level≥40000U/L and the women withβ-HCG level<40000U/L(P>0.05).In the observation group,the RI value,VI value,FI value,or VFI value had no correlation with the serumβ-HCG level(P>0.05).There were no significant different in RI,PI,and S/D values between the women with bleeding loss≥100ml during curettage and the women with bleeding loss<100ml during curettage(P>0.05).β-HCG level combined with VFI value had the best efficiency for predicting blood loss≥100ml during curettage,which’s sensitivity and specificity were 82.4%and 78.3%.Conclusion:The blood flow of embryo implantation site of the women with CSP is the status of low resistance.Three dimensional energy blood flow parameters by ultrasound has certain reference value for the predicting bleeding loss during curettage.