经阴道三维超声、断层超声显像技术诊断早期异位妊娠临床研究
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摘要
目的:探讨早期异位妊娠采用经阴道三维超声联合断层超声显像技术诊断的准确性。方法:选择停经4~6周的130例疑似异位妊娠患者,所有患者均接受腹部三维超声检查、阴道三维超声检查、断层超声显像检查,分析腹部超声、阴道三维超声、断层超声显像的声像图。以手术病理及临床随访结果作为确诊标准,计算腹部超声、阴道三维超声、断层超声显像对早期异位妊娠的诊断灵敏度、特异度、准确性,并比较腹部超声、阴道三维超声、断层超声显像对不同类型异位妊娠的诊断符合率。采用Kappa一致性检验,分析腹部超声、阴道三维超声、断层超声显像诊断结果与手术病理及临床随访结果之间的一致性。结果:断层超声显像、阴道三维超声的诊断灵敏度、特异度、准确性均高于腹部超声诊断结果(P<0.05),而断层超声显像与阴道三维超声的诊断灵敏度、特异度、准确性比较差异均无统计学意义(P>0.05)。经Kappa一致性检验分析,腹部超声、阴道三维超声、断层超声显像诊断结果与手术病理及临床随访结果之间的一致性Kappa值分别为0.514、0.723、0.748。断层超声显像、阴道三维超声对输卵管妊娠、剖宫产后瘢痕妊娠的诊断符合率均高于腹部超声(P<0.05),而断层超声显像与阴道三维超声的诊断符合率比较差异无统计学意义(P>0.05)。结论:在早期异位妊娠诊断中,采用断层超声显像、阴道三维超声均具有显著的诊断价值,临床上可采取断层超声显像与阴道三维超声联合诊断,以进一步提高其诊断准确性。
Objective:To study and discuss the accuracy of early ectopic pregnancy transvaginal three-dimensional ultrasound combined with tomographic ultrasound imaging diagnosis.Methods:130 cases of suspected ectopic pregnancy patients,underwent abdominal three-dimensional ultrasound,transvaginal three-dimensional ultrasonography tomographic ultrasound imaging,analysis,abdominal ultrasound,transvaginal three-dimensional ultrasound,sonographic tomographic ultrasound imaging.Surgical pathology and clinical follow-up results were calculated as standard,abdominal ultrasound,transvaginal three-dimensional ultrasound,the accuracy of tomographic ultrasound imaging in early diagnosis of ectopic pregnancy,sensitivity,specificity,and abdominal ultrasound,transvaginal three-dimensional ultrasound,tomographic ultrasound imaging in diagnosing different types of ectopic pregnancy.The Kappa consistency test,analysis of abdominal ultrasound,transvaginal three-dimensional super the sound consistency between tomographic ultrasound imaging diagnosis and surgical pathology and clinical follow-up results.Results:Tomographic ultrasound imaging,the diagnostic sensitivity and specificity of three-dimensional transvaginal ultrasound,the accuracy is higher than that of abdominal ultrasound diagnosis(P<0.05),and the diagnostic sensitivity of tomographic ultrasound imaging and transvaginal three-dimensional ultrasound specificity and accuracy were compared no statistical significance(P>0.05).The Kappa consistency test analysis,abdominal ultrasound,transvaginal three-dimensional ultrasound,the consistency between Kappa tomographic ultrasound imaging diagnosis results and surgical pathology and clinical follow-up results were 0.514,0.723,0.748.tomographic ultrasound imaging,three-dimensional transvaginal ultrasound for tubal pregnancy,cesarean section rate was higher than that of abdominal ultrasound diagnosis with postpartum scar pregnancy(P<0.05),and the diagnosis of tomographic ultrasound imaging and transvaginal three-dimensional ultrasound coincidence rate was no statistical significance(P >0.05).Conclusion:In the early diagnosis of ectopic pregnancy,the use of tomographic ultrasound and three-dimensional ultrasound of vagina has significant diagnostic value.Clinically,the combination of tomographic ultrasound and threedimensional ultrasound can be used to further improve the accuracy of diagnosis.
Objective:To study and discuss the accuracy of early ectopic pregnancy transvaginal three-dimensional ultrasound combined with tomographic ultrasound imaging diagnosis.Methods:130 cases of suspected ectopic pregnancy patients,underwent abdominal three-dimensional ultrasound,transvaginal three-dimensional ultrasonography tomographic ultrasound imaging,analysis,abdominal ultrasound,transvaginal three-dimensional ultrasound,sonographic tomographic ultrasound imaging.Surgical pathology and clinical follow-up results were calculated as standard,abdominal ultrasound,transvaginal three-dimensional ultrasound,the accuracy of tomographic ultrasound imaging in early diagnosis of ectopic pregnancy,sensitivity,specificity,and abdominal ultrasound,transvaginal three-dimensional ultrasound,tomographic ultrasound imaging in diagnosing different types of ectopic pregnancy.The Kappa consistency test,analysis of abdominal ultrasound,transvaginal three-dimensional super the sound consistency between tomographic ultrasound imaging diagnosis and surgical pathology and clinical follow-up results.Results:Tomographic ultrasound imaging,the diagnostic sensitivity and specificity of three-dimensional transvaginal ultrasound,the accuracy is higher than that of abdominal ultrasound diagnosis(P<0.05),and the diagnostic sensitivity of tomographic ultrasound imaging and transvaginal three-dimensional ultrasound specificity and accuracy were compared no statistical significance(P>0.05).The Kappa consistency test analysis,abdominal ultrasound,transvaginal three-dimensional ultrasound,the consistency between Kappa tomographic ultrasound imaging diagnosis results and surgical pathology and clinical follow-up results were 0.514,0.723,0.748.tomographic ultrasound imaging,three-dimensional transvaginal ultrasound for tubal pregnancy,cesarean section rate was higher than that of abdominal ultrasound diagnosis with postpartum scar pregnancy(P<0.05),and the diagnosis of tomographic ultrasound imaging and transvaginal three-dimensional ultrasound coincidence rate was no statistical significance(P >0.05).Conclusion:In the early diagnosis of ectopic pregnancy,the use of tomographic ultrasound and three-dimensional ultrasound of vagina has significant diagnostic value.Clinically,the combination of tomographic ultrasound and threedimensional ultrasound can be used to further improve the accuracy of diagnosis.
引文
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[4]Moschos E,Wells CE,Twickler DM,et al.Biometric sonographic findings of abnormally adherent trophoblastic implantations on cesarean delivery scars[J].Journal of Ultrasound in Medicine,2014,33(3):475-481.
[5]储静波.腹部B超检查与阴道B超在异位妊娠诊断中的比较[J].中外医疗,2016,35(11):176-178.
[6]Ghaneie A,Grajo JR,Derr C,et al.Unusual Ectopic Pregnancies Sonographic Findings and Implications for Management[J].Journal of Ultrasound in Medicine,2015,34(6):951-962.
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[8]李蒙森,石有振,郑瑜,等.经阴道三维超声联合断层超声显像技术在早期异位妊娠诊断中的应用[J].中华医学超声杂志:电子版,2015,6(2):128-135.
[9]Dai Q,Wang LL,Shao XH,et al.Clinical effectiveness of multiple-drug injection treatment in unruptured ectopic pregnancies:A retrospective study[J].Journal of Ultrasound in Medicine,2012,31(10):1627-1634.
[10]周静,刘丹,彭莉晴,等.异位妊娠超声图像特点及阴道联合腹部超声诊断异位妊娠的价值[J].海南医学院学报,2015,21(7):1002-1004,1008.
[11]闫建军.腹部彩色超声与阴道彩色超声在诊断早期异位妊娠的诊断率对比研究[J].河北医学,2016,22(6):1002-1004.
[12]Frates MC,Doubilet PM,Peters HE,et al.Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels[J].Journal of Ultrasound in Medicine,2014,33(4):697-703.
[13]赖莉萍,何明玉.腹部B超与阴道B超在异位妊娠诊断中的比较分析[J].现代医用影像学,2017,26(3):816-818.
[14]张建国,方开峰,韩路.经腹部超声联合经阴道超声对早期异位妊娠的诊断价值[J].安徽医药,2016,20(1):152-153.
[15]车月玫.经腹部与经阴道超声诊断异位妊娠158例对比分析[J].陕西医学杂志,2014,44(9):1204-1206.
[16]谢则金,王厚照,林一,等.血清β-HCG、孕酮联合阴道超声检测对早期异位妊娠的诊断价值[J].临床军医杂志,2014,42(8):822-823,830.
[17]李芳.超声断层显像技术及经阴经腹超声检查结合血HCG对异位妊娠诊断的价值探讨[J].中外医疗,2012,31(22):174-175.
[18]李蒙森,郑丽,吴燕,等.断层超声显像技术对异位妊娠的诊断价值[J].上海交通大学学报:医学版,2013,33(3):310-313,330.
[19]韩培辰,陈伟.阴腹联合超声在少见部位异位妊娠诊断中的临床价值[J].中国临床医生杂志,2017,45(2):86-88.
[20]余燕华.不同超声路径诊断早期异位妊娠临床价值分析[J].中国妇幼保健,2015,30(3):485-486.
[2]Lermann J,Segl P,Jud SM,et al.Low-dose methotrexate treatment in ectopic pregnancy:A retrospective analysis of 164ectopic pregnancies treated between 2000and 2008[J].Archives of gynecology and obstetrics,2014,289(2):329-335.
[3]邵宾棉.经阴道彩色多谱勒超声对宫外孕的诊断价值[J].陕西医学杂志,2010,39(6):737-738.
[4]Moschos E,Wells CE,Twickler DM,et al.Biometric sonographic findings of abnormally adherent trophoblastic implantations on cesarean delivery scars[J].Journal of Ultrasound in Medicine,2014,33(3):475-481.
[5]储静波.腹部B超检查与阴道B超在异位妊娠诊断中的比较[J].中外医疗,2016,35(11):176-178.
[6]Ghaneie A,Grajo JR,Derr C,et al.Unusual Ectopic Pregnancies Sonographic Findings and Implications for Management[J].Journal of Ultrasound in Medicine,2015,34(6):951-962.
[7]初海鹏,谭秀梅,卢战凯,等.阴道超声和血绒毛膜促性腺激素联合检测在异位妊娠诊断中的应用[J].山东大学学报:医学版,2014,52(z1):138-139.
[8]李蒙森,石有振,郑瑜,等.经阴道三维超声联合断层超声显像技术在早期异位妊娠诊断中的应用[J].中华医学超声杂志:电子版,2015,6(2):128-135.
[9]Dai Q,Wang LL,Shao XH,et al.Clinical effectiveness of multiple-drug injection treatment in unruptured ectopic pregnancies:A retrospective study[J].Journal of Ultrasound in Medicine,2012,31(10):1627-1634.
[10]周静,刘丹,彭莉晴,等.异位妊娠超声图像特点及阴道联合腹部超声诊断异位妊娠的价值[J].海南医学院学报,2015,21(7):1002-1004,1008.
[11]闫建军.腹部彩色超声与阴道彩色超声在诊断早期异位妊娠的诊断率对比研究[J].河北医学,2016,22(6):1002-1004.
[12]Frates MC,Doubilet PM,Peters HE,et al.Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels[J].Journal of Ultrasound in Medicine,2014,33(4):697-703.
[13]赖莉萍,何明玉.腹部B超与阴道B超在异位妊娠诊断中的比较分析[J].现代医用影像学,2017,26(3):816-818.
[14]张建国,方开峰,韩路.经腹部超声联合经阴道超声对早期异位妊娠的诊断价值[J].安徽医药,2016,20(1):152-153.
[15]车月玫.经腹部与经阴道超声诊断异位妊娠158例对比分析[J].陕西医学杂志,2014,44(9):1204-1206.
[16]谢则金,王厚照,林一,等.血清β-HCG、孕酮联合阴道超声检测对早期异位妊娠的诊断价值[J].临床军医杂志,2014,42(8):822-823,830.
[17]李芳.超声断层显像技术及经阴经腹超声检查结合血HCG对异位妊娠诊断的价值探讨[J].中外医疗,2012,31(22):174-175.
[18]李蒙森,郑丽,吴燕,等.断层超声显像技术对异位妊娠的诊断价值[J].上海交通大学学报:医学版,2013,33(3):310-313,330.
[19]韩培辰,陈伟.阴腹联合超声在少见部位异位妊娠诊断中的临床价值[J].中国临床医生杂志,2017,45(2):86-88.
[20]余燕华.不同超声路径诊断早期异位妊娠临床价值分析[J].中国妇幼保健,2015,30(3):485-486.