经阴道超声在瘢痕妊娠诊断及瘢痕厚度评估中的应用价值

Application value of transvaginal ultrasound in the diagnosis of cesarean scar pregnancy and evaluation of scar thickness

目的探究经阴道超声在瘢痕妊娠(CSP)诊断及瘢痕厚度评估中的应用价值。方法选取2020年6月至2021年6月于上饶市妇幼保健院就诊的70例疑似CSP患者作为研究对象,均进行经阴道超声和经腹部超声检查诊断其是否为CSP,并评估瘢痕厚度。以病理结果为金标准,采用Kappa一致性分析经阴道超声诊断CSP的价值,分析经阴道超声检查患者分娩方式与瘢痕厚度的关系。结果病理结果显示,70例疑似CSP患者中确诊CSP 61例。经阴道超声检查诊断CSP的灵敏度、准确度、Kappa值均高于经腹超声检查,差异有统计学意义(P<0.05);两种检测方法特异度、阳性预测值、阴性预测值比较差异无统计学意义。Ⅱ、Ⅲ级瘢痕孕妇子宫下段肌层厚度薄于Ⅰ级瘢痕孕妇,且Ⅲ级瘢痕孕妇子宫下段肌层厚度薄于Ⅱ级瘢痕孕妇(P<0.05);Ⅰ~Ⅲ级瘢痕孕妇剖宫产率比较差异无统计学意义。结论经阴道超声对CSP诊断的检出率明显高于经腹部超声,且在瘢痕厚度评估中的应用效果良好。

Objective To explore the application value of transvaginal ultrasound in the diagnosis of cesarean scar pregnancy(CSP)and evalua-tion of scar thickness.Methods A total of 70 patients with suspected CSP who were treated in Shangrao Maternal and Child Health Hospital from June 2020 and June 2021 were selected as the research subjects,transvaginal ultrasound and transabdominal ultrasound were performed to diagnose whether they were CSP,and the scar thickness was evaluated.Taking pathological results as the golden standard,the diagnostic value of transvaginal ultrasound for CSP was analyzed by Kappa consistency test,the relationship between delivery modes and scar thickness were analyzed.Results The pathological results showed that among the 70 patients with suspected CSP,there were 61 cases had CSP.The sensitivity,accuracy and Kappa value of transvaginal ultrasound in the diagnosis of CSP were higher than those of transabdominal ultrasound,and the difference was statistically signifi-cant(P<0.05),but there were no significant differences in diagnostic specificity,positive predictive value and negative predictive value between the two methods.The thickness of the lower uterine segment muscle layer of pregnant women with gradeⅡand gradeⅢscars was thinner than that of pregnant women with gradeⅠscars,and the thickness of the lower uterine segment muscle layer of pregnant women with gradeⅢscars was thinner than that of pregnant women with gradeⅡscars(P<0.05);there was no significant difference in cesarean section rate between pregnant women with gradeⅠ-Ⅲscars.Conclusion The detection rate of CSP by transvaginal ultrasound is significantly higher than that by transabdominal ultra-sound,which has good application effect in the evaluation of scar thickness.