经阴道超声联合超声造影检查对剖宫产术后盆腔粘连的评估价值

Evaluation value of transvaginal ultrasound combined with contrast-enhanced ultrasound for pelvic adhesion after cesarean section

目的:探讨经阴道超声联合超声造影检查对剖宫产术后盆腔粘连的评估价值。方法:抽取2017年9月至2020年12月于河南大学第一附属医院接受体检的疑似剖宫产术后盆腔粘连患者173例,均进行腹腔镜检查,其中123例患者确诊为盆腔粘连,50例患者确诊为盆腔粘连0级。同时对所有患者行经阴道超声、超声造影检查。计算对比经阴道超声以及经阴道超声联合超声造影断的灵敏度、特异度、阳性检测值(PPV)、阴性检测值(NPV)和分级准确率。结果:经阴道超声联合超声造影诊断盆腔粘连的灵敏度、特异度、PPV、分级准确度分别为99.19%、96.00%、98.39%、98.27%,高于经阴道超声诊断的92.68%、74.00%、89.76%、87.28%(P<0.05);两种诊断方式的NPV分别为97.96%、80.43%,差异未见统计学意义(P>0.05)。结论:经阴道超声联合超声造影检查和经阴道超声对于剖宫产术后盆腔粘连均具有较高的诊断评估价值,但经阴道超声联合超声造影检查的诊断灵敏度、特异度、分级准确度更高。

Objective To investigate the value of transvaginal ultrasound combined with contrast-enhanced ultrasound in the evaluation of pelvic adhesion after cesarean section.Methods A total of 173 patients with suspected pelvic adhesions after cesarean section who received physical examination in the First Affiliated Hospital of Henan University from September 2017 to December 2020 were enrolled.All patients received laparoscopy,and the results showed that 123 cases were diagnosed as pelvic adhesions and 50 cases were diagnosed as grade 0 pelvic adhesions.At the same time,all patients were examined by transvaginal ultrasound and contrast-enhanced ultrasound.The sensitivities,specificities,positive detection values(PPV),negative detection values(NPV)and accuracy rates of classification of transvaginal ultrasound and transvaginal ultrasound combined with contrast-enhanced ultrasound were calculated.Results The sensitivity,specificity,PPV and accuracy rate of classification of transvaginal ultrasound combined with contrast-enhanced ultrasound in the diagnosis of pelvic adhesions were 99.19%,96.00%,98.39%,and 98.27%,higher than 92.68%,74.00%,89.76%and 87.28%of transvaginal ultrasound(P<0.05).The NPV of the two diagnostic methods were 97.96%and 80.43%,respectively,and there was no significant difference between them(P>0.05).Conclusions Transvaginal ultrasound combined with contrast-enhanced ultrasound and transvaginal ultrasound have high diagnostic value for pelvic adhesion after cesarean section.However,the diagnostic sensitivity,specificity and grading accuracy of transvaginal ultrasound combined with contrast-enhanced ultrasound are higher.