剖宫产术后不同时间子宫瘢痕憩室超声参数对不规则阴道流血的预测价值

Predictive value of ultrasonic parameters of cesarean scar diverticulum at different time points after cesarean section for their irregular vaginal bleeding

目的:分析剖宫产术后不同时期子宫瘢痕憩室(CSD)超声参数预测不规则阴道流血价值.方法:选择2017年1月—2019年6月于本院产科门诊产后康复检查时发现的CSD产妇为研究对象,分别于产后42d、产后6个月和12个月行经阴道超声检查,产后12个月仍存在CSD患者随访,按照随访期间是否出现不规则阴道流血分为有临床症状组与无临床症状组.比较两组术后不同时期CSD超声参数并与不规则阴道流血关系及预测价值.结果:有症状组与无症状组比较,产后42d时憩室宽度、憩室深度、宽度/深度、残留子宫肌层厚度、残留肌层厚度比等均无差异(P>0.05);产后6个月,有症状组憩室深度及宽度/深度≤1比例高于无症状组,残留子宫肌层厚度、残留肌层厚度比小于无症状组(P<0.05),憩室宽度有症状组与无症状组无差异(P>0.05),憩室宽度/深度≤1是不规则阴道流血的独立影响因素(P<0.05);产后12个月,有症状组憩室深度及宽度/深度≤1比例高于无症状组,残留子宫肌层厚度、残留肌层厚度比小于无症状组(P<0.05),憩室宽度有症状组与无症状组无差异(P>0.05),憩室宽度/深度≤1、残留肌层厚度比<0.65是不规则阴道流血的独立影响因素(P<0.05).产后12个月宽度与深度比<1、产后12个月残留肌层厚度比对不规则阴道流血具有预测价值,曲线下面积分别为0.822、0.701,敏感度分别为58.7%、64.4%,特异性分别为80.4%、65.9%.结论:CSD超声参数与术后不规则阴道流血症状有关,术后12个月CSD超声参数对不规则阴道流血预测价值较高.

Objective: To analyze the predictive value of ultrasonic parameters of cesarean scar diverticulum(CSD)of patients at different time points for their irregular vaginal bleeding after cesarean section. Methods: From January 2017 to June 2019,the puerpera with CSD during postpartum rehabilitation examination were selected as the study subjects. Transvaginal ultrasonography was performed on these puerpera in the postpartum 42 th day, in the postpartum 6 th month, and in the postpartum 12 th month, respectively. These puerpera with CSD in the postpartum 12 th month were divided into group A(the puerpera with clinically symptoms) and group B(the puerpera without clinically symptoms) according to whether irregular vaginal bleeding occurred during the followed up period. The ultrasonic parameters values of the puerpera at different postoperative time point of CSD were compared between the two groups. The correlation of the ultrasonic parameters values of the puerperal and their irregular vaginal bleeding was analyzed, and the value of the ultrasonic parameters of the puerpera for predicting the irregular vaginal bleeding was also analyzed. Results: There were no significant differences in the values of the diverticulum width and depth, and the ratio of width to depth of the diverticulum, and the value of the residual uterine muscle thickness and the ratio of the residual muscle thickness in the postpartum 42 th day of the puerpera between group A and group B(P>0.05). The value of diverticulum depth and the proportion of ratio of width to depth of the diverticulum≤1of the puerpera in group A in the postpartum 6th month were significantly higher than those of the puerpera in group B,and the values of the residual uterine muscle thickness and the residual muscle thickness ratio of the puerpera in group A in the postpartum 6th month were significantly lower than those of the puerpera in group B(P<0.05).There was no significant difference in the diverticulum width of the puerpera between group A and group B(P>0.05).The ratio of width to depth diverticulum ≤1and the ratio of the residual muscle thickness<0.65of the puerpera were the independent influencing factors of their irregular vaginal bleeding occurrence(P<0.05).The ratio of width to depth diverticulum ≤1and the ratio of the residual muscle thickness of the puerpera in the postpartum 12th month had predictive value for irregular vaginal bleeding,and the area under the curve(AUC)of which were 0.822and 0.701,the sensitivity of which were 58.7%and 64.4%,and the specificity of which were 80.4% and 65.9%.Conclusion:The parameters of CSD by ultrasound of the puerpera are related to their symptoms of postpartum irregular vaginal bleeding,and the parameters of CSD by ultrasound in the postpartum 12th month have higher predictive value for postpartum irregular vaginal bleeding.