经阴道彩超对产后胎盘植入和胎盘残留的临床诊断价值
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摘要
目的探讨经阴道彩超对产后胎盘植入和胎盘残留的临床诊断价值。方法选取2016年7月～2017年8月间本院收治诊断结果为胎盘残留患者68例,采用随机数字表法分为观察组和对照组各34例,观察组行经阴道彩超检查,对照组行经腹部超声检查。结果经阴道彩超检查阳性诊断率为34例(94.12%),显著高于经腹部超声检查26例(76.47%),差异有统计学意义(P <0.05)。48例植入组患者中40例诊断正确,8例误诊为胎盘植入。20例非植入组患者中15例诊断正确,5例误诊为植入性胎盘残留。其鉴别胎盘残留是否伴有植入的诊断敏感度、特异度及准确性分别为67.7%、85.9%和79.7%。宫腔内病灶的内部回声是否均匀、与子宫肌层分界是否清楚及Adler血流分级指标中,子宫肌层与病灶的界限是否清楚,对比差异有统计学意义(P <0.05)。结论经阴道彩超声检查诊断率更高,且清晰的显示出病灶及血管灌注情况、子宫肌层与病灶的界限,在临床诊断胎盘残留有无植入上具有重要意义,值得临床推广使用。
Objective To explore the clinical diagnostic value of transvaginal color Doppler ultrasound in postpartum placenta increta and placental remnants. Methods 68 patients who were diagnosed with placental remnants in our hospital from July 2016 to August 2017 were selected.According to random number table method,they were divided into observation group and control group,with 34 cases in each group.The observation group was examined by transvaginal color Doppler ultrasound while the control group was examined by transabdominal ultrasound. Results The positive diagnostic rate of transvaginal color Doppler ultrasound was 94.12% in 34 cases,which was significantly higher than that in 26 cases(76.47%) by transabdominal ultrasound.The comparative difference was statistically significant(P < 0.05).In 48 patients with placenta increta,40 cases were diagnosed correctly and 8 cases were misdiagnosed as placenta increta.Among the 20 patients in the non-placenta increta group,15 cases were correctly diagnosed and 5 cases were misdiagnosed as implantable placental remnants.The diagnostic sensitivity,specificity and accuracy of identifying whether placental remnant was associated with placenta increta were 67.7%,85.9% and 79.7%,respectively.Whether the internal echo of the intrauterine lesion was uniform,whether the boundary with myometrium was clear,and whether the boundary between myometrium and the lesion was clear in the Adler blood flow grading index in two groups had differences and the differences were statistically significant(P < 0.05).Conclusion The diagnostic rate of transvaginal color Doppler ultrasound is higher.It can clearly show the lesion and vascular perfusion and the boundaries between the myometrium and the lesion.It is of great significance in the clinical diagnosis of whether placental remnant is combined with placenta increta or not,which is worthy of clinical promotion.
Objective To explore the clinical diagnostic value of transvaginal color Doppler ultrasound in postpartum placenta increta and placental remnants. Methods 68 patients who were diagnosed with placental remnants in our hospital from July 2016 to August 2017 were selected.According to random number table method,they were divided into observation group and control group,with 34 cases in each group.The observation group was examined by transvaginal color Doppler ultrasound while the control group was examined by transabdominal ultrasound. Results The positive diagnostic rate of transvaginal color Doppler ultrasound was 94.12% in 34 cases,which was significantly higher than that in 26 cases(76.47%) by transabdominal ultrasound.The comparative difference was statistically significant(P < 0.05).In 48 patients with placenta increta,40 cases were diagnosed correctly and 8 cases were misdiagnosed as placenta increta.Among the 20 patients in the non-placenta increta group,15 cases were correctly diagnosed and 5 cases were misdiagnosed as implantable placental remnants.The diagnostic sensitivity,specificity and accuracy of identifying whether placental remnant was associated with placenta increta were 67.7%,85.9% and 79.7%,respectively.Whether the internal echo of the intrauterine lesion was uniform,whether the boundary with myometrium was clear,and whether the boundary between myometrium and the lesion was clear in the Adler blood flow grading index in two groups had differences and the differences were statistically significant(P < 0.05).Conclusion The diagnostic rate of transvaginal color Doppler ultrasound is higher.It can clearly show the lesion and vascular perfusion and the boundaries between the myometrium and the lesion.It is of great significance in the clinical diagnosis of whether placental remnant is combined with placenta increta or not,which is worthy of clinical promotion.
引文
[1]廖彩华,陈禄英,林丽,等.子宫疤痕妊娠的经腹及经阴道彩色多普勒超声诊断价值分析[J].中国临床医学影像杂志,2016,27(1):42-44.
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[10]孔丽君,周莉,杨丽,等.产前超声检查和磁共振成像对胎盘植入诊断的准确性评估[J].首都医科大学学报,2016,37(2):238-240.
[11]韩峥.46例胎盘因素所致产后出血的临床分析[J].中国妇幼保健,2016,31(5):961-963.
[12]魏素梅,杨霄,金莹,等.前次剖宫产手术对再次妊娠胎盘植入及其类型的影响[J].实用妇产科杂志,2017,33(10):790-792.
[13]邓应梅.高龄孕产妇合并症及并发症发病率分析及对策[J].中国病案,2016,17(12):57-59.
[14]苏明,张继军,凌华威,等.MRI检查在产后诊断胎盘植入中的价值[J].诊断学理论与实践,2017(5):527-531.
[15]李拓.超声造影在胎盘残留诊断中的价值分析[J].山东医学高等专科学校学报,2017,39(4):298-300.
[16]熊雯,罗红.常规超声联合超声造影诊断胎盘植入的应用价值[J].四川大学学报(医学版),2017,48(2):253-256.
[2]汤敏,闵智乾,张鑫,等.MRI和经腹超声对产前胎盘植入的诊断价值[J].重庆医学,2017,46(4):456-458.
[3]张丽华.经阴道彩色多普勒超声在妇产科急症诊断中的价值[J].中国组织工程研究,2016(a02):248.
[4]刘叶,张文亮,王娜,等.剖宫产不同胎盘娩出时间对产后出血量的影响[J].医学研究杂志,2016,45(7):56-58.
[5]姚盛慧.剖宫产后子宫切口妊娠诊断及治疗中宫腔镜技术的应用[J].中国组织工程研究,2016(b05):145-146.
[6]杨凤娟.经腹部超声联合经阴道超声在妇科急腹症诊断中的价值[J].中国数字医学,2017,12(2):42-44.
[7]Wang Q,Ultrasound D O.Study on Value of Color Doppler Ultrasound in the Prenatal Diagnosis of Placenta Previa Combined with Placenta Implantation[J].Systems Medicine,2017.
[8]施琰.产后出血的发病情况及相关因素的Logistic回归分析[J].中国妇幼保健,2017,32(20):4935-4936.
[9]韩鹏慧,江魁明,郭庆禄,等.超声及MRI在胎盘植入中的诊断价值[J].中国临床医学影像杂志,2016,27(3):194-197.
[10]孔丽君,周莉,杨丽,等.产前超声检查和磁共振成像对胎盘植入诊断的准确性评估[J].首都医科大学学报,2016,37(2):238-240.
[11]韩峥.46例胎盘因素所致产后出血的临床分析[J].中国妇幼保健,2016,31(5):961-963.
[12]魏素梅,杨霄,金莹,等.前次剖宫产手术对再次妊娠胎盘植入及其类型的影响[J].实用妇产科杂志,2017,33(10):790-792.
[13]邓应梅.高龄孕产妇合并症及并发症发病率分析及对策[J].中国病案,2016,17(12):57-59.
[14]苏明,张继军,凌华威,等.MRI检查在产后诊断胎盘植入中的价值[J].诊断学理论与实践,2017(5):527-531.
[15]李拓.超声造影在胎盘残留诊断中的价值分析[J].山东医学高等专科学校学报,2017,39(4):298-300.
[16]熊雯,罗红.常规超声联合超声造影诊断胎盘植入的应用价值[J].四川大学学报(医学版),2017,48(2):253-256.