俞惠

摘要：目的：探討经腹部彩超检查联合经阴道彩超检查在诊断剖宫产子宫瘢痕妊娠（CSP）中的应用效果。方法：选取本院2020年03月-2021年04月剖宫产子宫瘢痕妊娠患者112例进行研究。所有患者分别进行经腹部彩超检查、经阴道彩超检查、经腹部彩超检查联合经阴道彩超检查，以病理诊断结果作为诊断的金标准。对比不同诊断方法的剖宫产子宫瘢痕妊娠阳性检出率及不同诊断方法对CSP的诊断价值。结果：经术后组织病理检查诊断，112例患者中，58例包块型CSP，占51.79%;54例孕囊型CSP，占48.21%，阳性检出率100%。经阴道、经腹部彩超诊断，患者的阳性检出率分别为75.00%、81.25%，均低于彩超联合检查的94.64%（P<0.05）。彩超联合检查对包块型CSP的特异性、灵敏度、阴/阳性预测值、诊断符合率分别为98.07%、90.23%、91.49%/97.28%、91.28%;孕囊型CSP分别为97.48%、96.42%、95.31%/98.23%、98.15%，均分别高于经阴道、经腹部彩超的包块型及孕囊型CSP诊断数值。结论： 经腹部彩超检查联合经阴道彩超检查在诊断剖宫产子宫瘢痕妊娠中，诊断符合率较高，能够实时、有效地明确病灶特征，可为患者的临床诊疗及预后提供可靠准确的科学依据。

关键词：经腹部彩超;联合;经阴道彩超;诊断;CSP;诊断价值

中图分类号：R445.1 文献标识码：B DOI：10？郾3969/j.issn.1001-0270.2021.04.02

Application Effect of Transabdominal Color Doppler Ultrasound Examination Combined with Transvaginal Color Doppler Ultrasound Examination in the Diagnosis of Cesarean Section Uterine Scar Pregnancy

YU Hui

（Department of Ultrasound Medicine， Xinyi Peoples Hospital， Guangdong 525300， China）

Abstract： Objective： To explore the effect of transabdominal color Doppler ultrasound combined with transvaginal color Doppler ultrasound in the diagnosis of cesarean section uterine scar pregnancy （CSP）. Methods： A total of 112 cases of cesarean section uterine scar pregnancy patients who were examined in our hospital from March 2020 to April 2021 were selected for the study. All patients underwent transabdominal color Doppler ultrasound examination， transvaginal color Doppler ultrasound examination， transabdominal color Doppler ultrasound examination combined with transvaginal color Doppler ultrasound examination， and pathological diagnosis results were used as the gold standard for diagnosis. Compare the positive detection rate of cesarean section uterine scar pregnancy with different diagnostic methods and the diagnostic value of different diagnostic methods for CSP. Results： Diagnosed by postoperative histopathological examination， of 112 patients， 58 cases of mass-type CSP， accounting for 51.79%; 54 cases of gestational sac-type CSP， accounting for 48.21%， with a positive detection rate of 100%. Through vaginal and transabdominal color Doppler ultrasound diagnosis， the positive detection rates of patients were 75.00% and 81.25%， respectively， which were lower than the 94.64% of combined color Doppler ultrasound （P<0.05）. The specificity， sensitivity， negative/positive predictive value and diagnostic coincidence rate of combined color Doppler ultrasound examination for mass-type CSP were 98.07%， 90.23%， 91.49%/97.28%， 91.28%; gestational sac type were 97.48%， 96.42%， respectively ， 95.31%/98.23%， and 98.15% are higher than the diagnostic values of mass-type and gestational sac-type CSP by vaginal and transabdominal color Doppler ultrasound， respectively. Conclusion： Transabdominal color Doppler ultrasound examination combined with transvaginal color Doppler ultrasound examination has a high diagnostic coincidence rate in the diagnosis of cesarean section uterine scar pregnancy， which can identify the characteristics of the lesion in real time and effectively， and can provide reliable and accurate scientific basis for the clinical diagnosis， treatment and prognosis of patients .

Key Words： transabdominal color Doppler ultrasound; combined; transvaginal color Doppler ultrasound; diagnosis; CSP; diagnostic value

随着医疗技术水平的迅猛发展、人们生活质量的提高及国家开放二胎政策的实施，我国剖宫产术率呈日益上升趋势[1]。由于经剖宫产后产妇的子宫下段会产生裂隙，特别容易在术后内膜缺损处着床并种植，引起剖宫产子宫瘢痕妊娠（CSP）的形成[2]。CSP为产妇术后的并发症之一。通常情况下，CSP患者子宫瘢痕部位具有较多的纤维组织且肌壁单薄，倘若妊娠容易引起子宫大出血、破裂等一系列并发症，严重者可造成子宫切除，甚至危及患者的生命[3]。CSP的早期诊断有利于疾病的早期治疗及改善，对患者的预后意义重大。由于CSP表现无特异性，容易造成误诊或漏诊，进而有可能对患者机体造成更大的伤害[4]。随着影像学技术在临床上的广泛应用，彩色超声诊疗仪已逐渐成为临床首选。……