摘要
目的 探讨腔内三维超声联合临床指标在剖宫产术后子宫切口憩室致子宫异常出血的价值。方法 收集2017年1月~2023年4月在石河子市人民医院行阴道超声检查的126例剖宫产术后合并子宫切口憩室的患者资料。根据患者剖宫产术后出血情况分为组1(无异常出血,n=72)、组2(异常出血,n=54),所有患者均行阴道超声(二维超声及三维超声)检查。分析比较两组间临床特征(子宫位置、剖宫产次数以及剖宫产缝线方式等)以及子宫切口憩室超声特征(憩室形态、憩室容积、憩室长度、憩室深度以及残余肌层厚度等)的差异,建立基于临床及超声特征的预测模型,探索剖宫产术后合并子宫切口憩室患者子宫异常出血的独立危险因素,并评价此模型的预测价值。结果 两组间剖宫产次数、子宫位置、子宫内膜厚度、憩室深度、憩室长度、憩室容积、憩室比以及残余肌层厚度的差异均有统计学意义(P<0.05);多因素回归分析显示,子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是子宫异常出血的独立危险因素(OR=0.087、10.385、4.658、12.892、0.001,P<0.05),与各单因素相比,此模型预测子宫异常出血的AUC为0.936,高于各单因素(AUC=0.567、0.705、0.836、0.895、0.870,P<0.05),该联合预测模型以-6.28为截断值时,敏感度为87.04%,特异性为91.67%,准确度为89.68%,且与临床诊断结果有良好一致性(Kappa=0.789,P<0.001)。结论 子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是剖宫产术后子宫切口憩室合并子宫异常出血的独立危险因素,超声及临床特征对预测剖宫产术后子宫切口憩室致子宫异常出血有重要预测价值。
Objective To explore the value of three-dimensional ultrasound combined with clinical indicators in uterine incision diverticulum after cesarean section.Methods From January 2017 to April 2023,the data of 126 patients with uterine incision diverticulum after cesarean section who underwent vaginal ultrasound examination in Shihezi People's Hospital were collected.According to the bleeding after cesarean section,the patients were divided into group 1(no abnormal bleeding,n=72)and group 2(abnormal bleeding,n=54).All patients underwent vaginal ultrasound(two-dimensional ultrasound and three-dimensional ultrasound)examination.The clinical characteristics(uterine location,cesarean section frequency,cesarean section suture method,etc.)To establish a prediction model based on clinical and ultrasound characteristics,to explore independent risk factors for abnormal uterine bleeding in patients with uterine incision diverticulum after cesarean section,and to evaluate the predictive value of this model.Results There were statistically significant differences in the number of cesarean sections,uterine position,endometrial thickness,diverticulum depth,diverticulum length,diverticulum volume,diverticulum ratio,and residual base layer thickness between the two groups(P<0.05),multivariate regression analysis showed that uterine location,cesarean section frequency,diverticulum volume,diverticulum ratio and residual muscle thickness were independent risk factors for abnormal uterine bleeding(OR=0.087,10.385,4.658,12.892,0.001,P<0.05),compared with each single factor,the AUC of this model for predicting abnormal uterine bleeding was 0.936,which was significantly higher than each single factor(AUC=0.567,0.705,0.836,0.895,0.870,P<0.05).When-6.28 was the cut-off value,the sensitivity was 87.04%,the specificity was 91.67%,and the accuracy was 89.68%,which was in good agreement with the clinical diagnosis results(Kappa=0.789,P<0.001).Conclusion Uterine location,number of cesarean sections,volume of diverticulum,ratio of diverticulum and thickness of residual muscle layer are independent risk factors for uterine incision diverticulum combined with abnormal uterine bleeding after cesarean section.Abnormal uterine bleeding caused by incisional diverticulum has important predictive value.
作者
肖莉
齐慧丽
洪蕾
许沙
王继祥
张良良
XIAO Li;QI Huili;HONG Lei;XU Sha;WANG Jixiang;ZHANG Liangliang(Department of Ultrasound,Shihezi People's Hospital,Shihezi 832000,China;Department of Gynecology,Shihezi People's Hospital,Shihezi 832000,China;Department of Trauma and Orthopedics,Shihezi People's Hospital,Shihezi 832000,China)
出处
《分子影像学杂志》
2024年第2期143-150,共8页
Journal of Molecular Imaging
基金
新疆生产建设兵团重点领域科技攻关计划(2021AB033)。
关键词
子宫切口憩室
阴道三维超声
剖宫产术
子宫异常出血
uterine incision diverticulum
vaginal three-dimensional ultrasonography
cesarean section
abnormal uterine bleeding
