剖宫产后瘢痕妊娠患者应用经阴道彩超联合超声造影技术的早期诊断及分型评估价值探究

Evaluation of the Early Diagnosis Value of the Application of Meridian Color Doppler Ultrasound Combined with Ultrasound in the Secondary Diagnosis of Cracks after Cesarean Section

目的探讨彩色多普勒超声(CDFI)联合超声造影(CEUS)诊断剖宫产后瘢痕妊娠的临床价值。方法选取148例疑似剖宫产后发生瘢痕妊娠的患者作为研究对象,患者就诊时间为2019年4月至2021年10月,所有研究对象均接受CDFI、CEUS检查,以病理学结果作为金标准,计算CDFI、CEUS诊断瘢痕妊娠的临床价值指标;根据瘢痕妊娠分型标准患者分为外生型、内生型,对比两种类型瘢痕妊娠的CDFI血流信号、CEUS分型差异。结果148例疑似剖宫产后发生瘢痕妊娠的患者,年龄范围24~38岁,平均年龄30.8±4.0岁;距离上次剖宫产的时间1.5~5.5年,平均时间2.96±0.88年;经病理学检查:确诊瘢痕妊娠116例(外生型41例、内生型75例),非瘢痕性妊娠32例;CDFI诊断瘢痕妊娠的灵敏度为57.76%、特异度为93.75%、ROC曲线下面积AUC值为0.758;CEUS诊断瘢痕妊娠的灵敏度为81.90%、特异度为87.50%、ROC曲线下面积AUC值为0.847;CDFI联合CEUS诊断瘢痕妊娠的灵敏度为92.24%、特异度为81.25%、ROC曲线下面积AUC值为0.904;外生型瘢痕妊娠病灶Ⅲ级血流患者占比高于内生型患者(P<0.05),外生型瘢痕妊娠病灶Ⅰ级血流患者占比低于内生型患者(P<0.05);外生型瘢痕妊娠与内生型瘢痕妊娠患者CEUS检查的分型分布比较,两组差异无统计学意义(P>0.05)。结论CDFI联合CEUS诊断剖宫产后瘢痕妊娠的价值高于二者单独应用,CDFI血流特征分布在外生型与内生型瘢痕妊娠中存在差异,对于鉴定瘢痕妊娠的分型具有一定的价值。

Objective To explore the clinical value of color Doppler ultrasound(CDFI)combined with contrast-enhanced ultrasound(CEUS)in the diagnosis of scar pregnancy after cesarean section.Methods Selected 148 patients with suspected scar pregnancy after cesarean section as the research object.The patient's visit time is from April 2019 to October 2021.All the research objects underwent CDFI and CEUS examinations.The pathological results were used as the gold standard for calculation.The clinical value indicators of CDFI and CEUS in the diagnosis of scar pregnancy;according to the standard of scar pregnancy classification,patients are divided into exogenous type and endogenous type,and the differences in CDFI blood flow signal and CEUS classification of the two types of scar pregnancy are compared.Results 148 cases of suspected scar pregnancy after cesarean section,age range 24-38 years old,average age 30.8±4.0 years;1.5 to 5.5 years since the last cesarean section,average age 2.96±0.88 years;by pathology Check:116 cases of scar pregnancy were diagnosed(41 cases of exogenous type,75 cases of endogenous type),32 cases of non-scarred pregnancy;CDFI's sensitivity for diagnosing scar pregnancy was 57.76%,specificity was 93.75%,and the area under the ROC curve AUC value The sensitivity of CEUS in diagnosing scar pregnancy is 81.90%,the specificity is 87.50%,and the AUC value of the area under the ROC curve is 0.847;the sensitivity of CDFI combined with CEUS in the diagnosis of scar pregnancy is 92.24%,the specificity is 81.25%,and the area under the ROC curve The AUC value was 0.904;the proportion of patients with gradeⅢblood flow in exogenous scar pregnancy lesions was higher than that of endogenous patients(P<0.05),and the proportion of patients with gradeⅠblood flow in exogenous scar pregnancy lesions was lower than that of endogenous patients(P<0.05);There was no significant difference between the two groups in the distribution of CEUS examination between exogenous scar pregnancy and endogenous scar pregnancy(P>0.05).Conclusion The value of CDFI combined with CEUS in diagnosing scar pregnancy after cesarean section is higher than the two alone.CDFI blood flow characteristics are different between exogenous and endogenous scar pregnancy,which has certain value for identifying the classification of scar pregnancy.