三维超声定量分析对子宫瘢痕妊娠术中大出血风险的评估价值

Value of Three-dimensional Ultrasound Quantitative Analysis in Risk Assessment of Intraoperative Massive Hemorrhage of Uterine Scar Pregnancy

目的:研究三维超声定量分析对瘢痕子宫妊娠术中大出血风险的评估价值。方法:研究对象选取2019年1月-2020年1月于滕州市中心人民医院接受手术治疗的162例子宫瘢痕患者,按照术中是否发生大出血分为观察组(n=40,出血量≥400 ml)与对照组(n=122,出血量<400 ml),收集两组术前三维超声检查资料,并比较两组超声定量参数[病灶最大径线、残余层肌厚度、血管化指数(VI)、阻力指数(RI)、血流指数(FI)、血管血流指数(VFI)],采用多因素Logistic回归分析术中大出血发生的影响因素,采用ROC曲线评估各定量参数对预测术中大出血的价值。结果:观察组病灶最大径线、VI、VFI均高于对照组,残余层肌厚度、RI均低于对照组,差异均有统计学意义(P<0.05);Logistic分析结果显示病灶最大径线(OR=4.150,95%CI:1.097,15.103)、残余层肌厚度(OR=0.486,95%CI:0.353,0.938)、VI(OR=11.382,95%CI:5.056,25.622)、RI(OR=0.355,95%CI:0.237,0.915)、VFI(OR=4.591,95%CI:1.389,15.174)均是子宫瘢痕妊娠术中大出血的影响因素(P<0.05);病灶最大径线、残余层肌厚度、VI、RI、VFI的ROC曲线下面积(AUC)分别为0.718、0.685、0.806、0.776、0.852。结论:三维超声定量分析中病灶最大径线、残余层肌厚度、VI、RI、VFI均是瘢痕妊娠术中大出血的影响因素,均具有一定的评估价值,对指导临床治疗有着较大意义。

Objective:To study the value of three-dimensional ultrasound quantitative analysis in risk assessment of intraoperative massive hemorrhage of uterine scar pregnancy.Method:A total of 162 patients with uterine scar who underwent surgical treatment in Tengzhou Central People’s Hospital from January 2019 to January 2020 were divided into the observation group(n=40,bleeding volume≥400 ml)and the control group(n=122,bleeding volume<400 ml)according to whether major bleeding occurred during operation,and the ultrasonic quantitative parameters[the maximum diameter of the lesion,the thickness of the residual layer,the vascularization index(VI),the resistance index(RI),the blood flow index(FI),and the vascular blood flow index(VFI)]of two groups were compared,the influencing factors of intraoperative massive hemorrhage were retrospectively analyzed by multivariate Logistic,and the value of each quantitative parameter in predicting intraoperative massive hemorrhage was evaluated by ROC curve.Result:The maximum diameter of lesions,VI and VFI in the observation group were significantly higher than those in the control group,and the thickness of residual layer and RI were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Logistic analysis results showed the maximum diameter of lesion(OR=4.150,95%CI:1.097,15.103),thickness of residual layer(OR=0.486,95%CI:0.353,0.938),VI(OR=11.382,95%CI:5.056,25.622),RI(OR=0.355,95%CI:0.237,0.915),VFI(OR=4.591,95%CI:1.389,15.174)were all the influencing factors of massive bleeding during uterine scar pregnancy(P<0.05).The area under the ROC curve(AUC)of the maximum diameter line,residual layer muscle thickness,VI,RI and VFI were 0.718,0.685,0.806,0.776 and 0.852 respectively.Conclusion:In the quantitative analysis of three-dimensional ultrasound,the maximum diameter of lesion,the thickness of residual layer muscle,VI,RI and VFI are all influential factors of intraoperative massive hemorrhage of uterine scar pregnancy,which have certain evaluation value and great significance in guiding clinical treatment.