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目的探讨常规超声、超声造影以及两者联合诊断胎盘植入的应用价值。方法收集2013年4月至2016年3月经手术病理诊断为胎盘残留的患者112例,根据病理诊断分为非植入组(n=38)和植入组(n=74)。比较两组常规超声、超声造影特征的区别,以多因素logistic回归建立判别式并比较三种方法预报胎盘残留是否伴有植入的准确性,比较三种方法 ROC曲线的曲线下面积(AUC)。结果常规超声检查发现宫腔内病灶,发现病灶与周围子宫肌层的分界是否清楚在两组间差异有统计学意义(P<0.05)。超声造影的定性分析指标〔包括增强时相、增强强度、造影后病灶与子宫肌层分界是否清楚、边界是否规整、病灶附着处子宫肌层厚度较对侧子宫肌层是否变薄(简称较对侧子宫肌层是否变薄)〕在两组之间差异均有统计学意义(P<0.05)。超声造影(91.1%)以及联合诊断的logit(P)判别式的预报准确性(92.0%)高于常规超声(87.5%),差异有统计学意义(P<0.05)。超声造影AUC(0.922)以及联合诊断(0.952)高于常规超声(0.887)(P<0.05),但超声造影和联合诊断之间的预报准确性和AUC差异均无统计学意义。结论超声造影及联合诊断用于鉴别胎盘植入的价值均高于常规超声,有潜力成为胎盘残留的常规影像诊断方法。
Objective To investigate the value of routine ultrasound and contrast-enhanced ultrasound in the diagnosis of placenta accreta. Methods One hundred and twelve patients with placental residue diagnosed by surgery and pathology from April 2013 to March 2016 were divided into non-implantation group (n = 38) and implantation group (n = 74) according to pathological diagnosis. The differences between conventional ultrasound and contrast-enhanced ultrasound were compared. Multivariate logistic regression was used to establish the discriminant and three methods were compared to predict the accuracy of placental remnant implantation. The area under the curve (AUC) . Results The findings of routine intrauterine ultrasound examination of the uterine cavity, the lesion found around the myometrium and the boundaries clear whether there was a significant difference between the two groups (P <0.05). Qualitative analysis of contrast-enhanced ultrasound angiography (including enhanced phase, enhanced intensity, after the contrast between the lesion and the myometrium boundary is clear, the border is regular, the thickness of the myometrium at the lesion attachment side of the myometrium is thinner (referred to as the right Side of the myometrium is thinning)] in the two groups were statistically significant differences (P <0.05). The predictive accuracy of ultrasound (91.1%) and logit (P) discriminant diagnosis of combined diagnosis (92.0%) was higher than that of conventional ultrasound (87.5%). The difference was statistically significant (P <0.05). AUC (0.922) and combined diagnosis (0.952) were higher than conventional ultrasound (0.887) (P <0.05), but there was no significant difference between the accuracy of AUC and the AUC in CEUS. Conclusion The value of CEUS and combined diagnosis in identifying placenta accreta is higher than that of conventional ultrasound and has the potential to become a routine imaging diagnostic method of placental remnants.