超声测定疤痕肌层厚度在评估疤痕子宫妊娠患者愈合中的应用

摘要

目的 探讨超声测定疤痕肌层厚度在评估疤痕子宫妊娠患者愈合中的应用.方法 选取2013年12月至2016年12月期间我院确诊治疗的疤痕子宫妊娠患者200例,所有患者给予超声检查并测定疤痕肌层厚度,以实际分娩为对照,统计分析所有患者愈合、分娩结局情况.结果 超声测定疤痕肌层厚度评估其愈合Ⅰ、Ⅱ、Ⅲ级的符合率分别为100.00%、87.27%、84.21%,超声测量评估Ⅰ级愈合与实际分娩比较,差异无统计学意义(P＞0.05),而评估Ⅱ、Ⅲ级愈合与实际分娩比较,差异有统计学意义(P＜0.05);愈合Ⅰ级患者疤痕肌层厚度、剖宫产率明显低于Ⅱ、Ⅲ级,差异有统计学意义(P＜0.05);ROC曲线分析结果显示,疤痕肌层厚度以3.20 mm为临界值时,其预测患者剖宫产的敏感度、特异度、准确度分别为94.93%、93.55%、94.50%,与实际结果基本相同,差异无统计学意义(P＞0.05).结论 超声测定疤痕肌层厚度可有效评估疤痕子宫妊娠患者的愈合情况,对剖宫产具有良好的预测效能,有利于指导孕期保健,值得临床作进一步推广.%Objective To discuss the application of ultrasound measurement scar muscle layer thickness in evaluating the union in patient with cesarean scar pregnancy. Methods Two hundred patients with cesarean scar pregnancy were selected from December 2013 to December 2016 in our hospital, all patients were given ultrasound examination and determination of scar muscle layer thickness. The results of union and delivery of all the patients were compared and statistically analyzed. Results The coincidence rates were respectively 100.00%, 87.27% and 84.21% in union level Ⅰ, Ⅱ and Ⅲ assessed by ultrasound scar via muscle layer thickness. There was no statistically significant difference in level Ⅰ healing assessment by ultrasonic measurement in comparison of the actual delivery (P＞0.05). While significant difference was found in assessing union level Ⅱ and Ⅲ (P＞ 0.05). The scar muscle layer thickness and cesarean section rates in level Ⅰ patients were obviously lower than those of level Ⅱ and Ⅲ, the difference was statistically significant (P＜0.05). ROC curve analysis results showed that, when the critical value of the scar muscle layer thickness was 3.20 mm, the forecast sensitivity, specificity and accuracy degree for patients with cesarean section were 94.93%, 93.55% and 94.93% respectively, which was basically the same as the actual results (P＞0.05). Conclusion Ultrasound measurement scar muscle layer thickness can effectively evaluate the healing of uterine scar pregnancy patients, and has good prediction efficiency for cesarean delivery, it is helpful to guide health care during pregnancy, which is worth for further clinical promotion.