三维超声定量分析对瘢痕妊娠术中大出血的预测价值

目的探究三维超声定量分析对瘢痕妊娠术中大出血的预测价值。方法选取2014年3月至2019年3月在遂昌县人民医院联合上级医院诊断及治疗的瘢痕妊娠患者201例,所有患者术前均进行三维超声检查,并行刮宫术联合子宫动脉栓塞,根据术中是否发生大出血分为观察组与对照组,比较两组三维超声的结果,应用ROC曲线评价三维超声指标对患者术中大出血的预测效能。结果本研究共有37(18.41%)例患者发生术中大出血,观察组与对照组在一般资料上差异无统计学意义(P>0.05),观察组最大直径、损伤体积、血管形成指数、血管形成-血流指数均显著大于对照组,差异具有统计学意义(P<0.05),而残留肌层厚度、阻力指数显著小于对照组,差异具有统计学意义(P<0.05),最大直径、损伤体积、残留肌层厚度、血管形成指数、血管形成-血流指数、阻力指数在其最佳截点预测术中大出血的AUC分别为0.727、0.829、0.661、0.810、0.853、0.812,各指标间差异无统计学意义(P>0.05),其中血管形成指数具有较好的诊断灵敏度,损伤体积具有较好的诊断特异度,差异具有统计学意义(P<0.05)。结论三维超声定量分析对瘢痕妊娠手术中大出血具有一定预测价值,值得进一步研究探讨。

The value of quantitative analysis of 3D ultrasonography in predicting intraoperative hemorrhage for cesarean scar pregnancy

Objective To explore the value of quantitative analysis of 3 D ultrasonography in predicting intraoperative hemorrhage for cesarean scar pregnancy.Methods From March 2014 to March 2019,201 patients with scar pregnancy diagnosed and treated in our hospital and superior hospital were selected.All the patients underwent 3 D ultrasonography examination before curettage combined with uterine artery embolization.According to whether intraoperative hemorrhage occurred during the operation,the patients were divided into observation group and control group,and the results of 3 D ultrasonography were compared between the two groups.The ROC curve was used to evaluate the efficacy of 3 D ultrasound indexes in the prediction of intraoperative hemorrhage in patients.Results In this study,a total of 37 patients(18.41%)suffered intraoperative hemorrhage.There was no significant difference in the general data between the observation group and the control group(P>0.05).The maximum diameter,lesion volume,vessels index,vessels and flow index of the observation group were significantly higher than those of the control group(P<0.05),while the thickness of residual muscle layer and resistance index were significantly lower than that of the control group(P<0.05).The AUC of maximum diameter,lesion volume,thickness of residual muscle layer,vessels index,vessels and flow index,resistance index at the optimal cut-off point for predicting intraoperative hemorrhage was 0.727,0.829,0.661,0.810,0.853 and 0.812,respectively,with no significant difference among the indicators(P>0.05),where vessels index had better diagnostic sensitivity and lesion volume had better diagnostic specificity(P<0.05).Conclusions Quantitative analysis of 3 D ultrasonography has certain predictive value in predicting intraoperative hemorrhage for cesarean scar pregnancy,which is worth further study.