超声影像特征、定量参数对剖宫产术后子宫瘢痕妊娠与分型的诊断价值

Diagnostic Value of Ultrasound Imaging Features and Quantitative Parameters in Cesarean Scar Pregnancy and Classification

目的:探讨超声影像特征、定量参数诊断剖宫产术后子宫瘢痕妊娠(CSP)与分型的临床价值。方法:选取2021年1月-2022年4月上海市东方医院吉安医院收治的80例CSP患者作为观察组,另选取同期正常妊娠妇女80例作为对照组。比较两组及不同子宫瘢痕妊娠分型患者的超声影像特征、定量参数[瘢痕肌层(CSM)厚度、最小矢状肌厚度、子宫下段前壁血流阻力指数(RI)]。分析定量参数对剖宫产术后子宫瘢痕妊娠与分型的诊断价值。结果:观察组CSM厚度、最小矢状肌厚度、RI均低于对照组(P<0.05)。Ⅲ型CSP患者CSM厚度、最小矢状肌厚度、RI<Ⅱ型CSP患者<Ⅰ型CSP患者(P<0.05)。经ROC曲线分析显示,CSM厚度、最小矢状肌厚度、RI单独诊断CSP的AUC分别为0.787、0.760、0.799,联合诊断的AUC为0.907,大于单一指标诊断;单独诊断CSPⅠ型与Ⅱ型的AUC分别为0.723、0.705、0.807,联合诊断CSPⅠ型与Ⅱ型的AUC为0.902,大于单一指标诊断;单独诊断CSPⅢ型的AUC分别为0.842、0.786、0.730,联合诊断CSPⅢ型的AUC为0.897,大于单一指标诊断。结论:超声影像特征、定量参数可有效对CSP患者及其不同分型进行诊断,对临床制订相应干预措施具有良好的指导意义。

Objective:To explore the clinical value of ultrasound imaging features and quantitative parameters in the diagnosis and classification of cesarean scar pregnancy(CSP).Method:A total of 80 patients with CSP in Shanghai Oriental Hospital Ji’an Hospital from January 2021 to April 2022 were selected as the observation group,and another 80 women with normal pregnancy in the same period were selected as the control group.The ultrasound imaging features,quantitative parameters[scar muscular layer(CSM)thickness,minimum sagittal muscle thickness,blood flow resistance index(RI)in the anterior wall of the lower uterine segment]were compared between the two groups and patients with different types of uterine scar pregnancy.The diagnostic value of quantitative parameters in the classification of cesarean scar pregnancy was analyzed.Result:The CSM thickness,minimal sagittal muscle thickness and RI in the observation group were lower than those in the control group(P<0.05).CSM thickness,minimal sagittal muscle thickness and RI in CSP patients with typeⅢwere less than those in CSP patients with typeⅡand less than those in CSP patients with typeⅠ(P<0.05).ROC curve analysis showed that the AUC of CSM thickness,minimum sagittal muscle thickness and RI in the diagnosis of CSP were 0.787,0.760,and 0.799,respectively,and the AUC of combined diagnosis was 0.907,which was greater than that of single index diagnosis.The AUC of CSM thickness,minimum sagittal muscle thickness and RI in the diagnosis of CSP typeⅠand typeⅡwere 0.723,0.705 and 0.807,respectively,the AUC of combined diagnosis of CSP typeⅠand typeⅡwas 0.902,which was greater than that of single diagnosis.The AUC of CSM thickness,minimum sagittal muscle thickness and RI in the diagnosis of CSP typeⅢwas 0.842,0.786 and 0.730,respectively,and the AUC of combined diagnosis of CSP typeⅢwas 0.897,which was greater than that of single diagnosis.Conclusion:Ultrasound imaging features and quantitative parameters can effectively diagnose CSP patients and their different subtypes,and have clear guidance significance for clinical formulation of corresponding treatment plans.