经腹和阴道超声联合β-HCG测定对剖宫产切口部妊娠的诊断价值

Diagnostic value of transabdominal and transvaginal ultrasonography combined with serumβ-HCG detection in cesarean scar pregnancy

目的探讨经腹和阴道超声联合人绒毛膜促性腺激素β亚单位(β-HCG)检测对剖宫产切口部妊娠(CSP)的诊断价值。方法选取2017年1月至2020年12月就诊于中国人民解放军联勤保障部队第九〇一医院的80例疑似CSP患者为研究对象,根据病理确诊为CSP和非CSP,所有患者均进行经腹部、经阴道超声检查、血清β-HCG检测,对比经腹部、经阴道超声检查及两种超声方法联合血清β-HCG检测对CSP的诊断价值。结果在80例疑似CSP中,经手术或病理组织检查后,确诊CSP患者58例,非CSP22例(输卵管妊娠13例、先兆流产6例、子宫肌瘤3例);经阴道超声在着床位置肌层变薄、周边组织高速低阻信号、血流征象等的检出率明显高于经腹超声检查(P<0.05);CSP患者的β-HCG升高幅度明显低于非CSP患者(P<0.05);与手术和病理检查结果比较,经腹部超声检查、经阴道超声检查、两种超声检查联合血清β-HCG检测三种诊断方法的Kappa值分别为0.77、0.84、0.90(P<0.05),且联合诊断方法的确诊率(98.28%)最高;联合诊断方法的敏感度、特异度、准确度为98.28%、100%%、98.75%,均处于较高水平,且高于单一经腹或经阴道超声检查;联合诊断的ROC曲线下面积为0.850,高于单一经腹或经阴道超声检查。结论经腹部、经阴道超声检查与血清β-HCG检测的联合诊断CSP的方法与手术和病理组织结果具有良好一致性,有较高的诊断准确性,可减少CSP的误诊及漏诊率情况。

Objective To investigate the diagnostic value of transabdominal and transvaginal ultrasonography combined with serum human chorionic gonadotrophin-β(β-HCG)detection in cesarean scar pregnancy(CSP).Methods A total of 80 suspected CSP patients from January 2017 to December 2020 in the 901th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army were selected as the research objects.CSP and non-CSP were confirmed by pathology.All patients were examined by transabdominal and transvaginal ultrasound and serumβ-HCG detection.The diagnostic values of transabdominal ultrasound,transvaginal ultrasound and two ultrasound methods combined withβ-HCG detection in CSP were compared.Results Among the 80 suspected CSP patients,58 patients were diagnosed as CSP and 22 patients were diagnosed as non-CSP(13 cases of tubal pregnancy,6 cases of threatened abortion and 3 cases of hysteromyoma)after surgery or pathological examination.The detection rates of transvaginal ultrasound were significantly higher than those of transabdominal ultrasound in muscle thinning,peripheral tissue high-speed low resistance signal,blood flow signs and other signs at the implantation site(P<0.05).The increase ofβ-HCG in CSP patients was significantly lower than that in non-CSP patients(P<0.05).Compared with the results of surgery and pathology,the Kappa values of transabdominal ultrasound,transvaginal ultrasound and two kinds of ultrasound combined with serumβ-HCG were 0.77,0.84 and 0.90,respectively(P<0.05).The diagnostic rate of the combined diagnostic method was the highest(98.28%).The sensitivity,specificity and accuracy of the combined diagnostic method were 98.28%,100%and 98.75%,which were all at a high level and higher than those of single transabdominal or transvaginal ultrasound examination.The area under the ROC curve of combined diagnosis was 0.850,which was higher than that of single transabdominal or transvaginal ultrasound.Conclusion The combination of transabdominal and transvaginal ultrasonography and serumβ-HCG detection in the diagnosis of CSP has a good consistency with the results of surgery and pathological tissue,and has a high diagnostic accuracy,which can reduce the misdiagnosis and missed diagnosis rate of CSP.