【摘要】：研究目的胎盤植入(placenta accrete PIA)是指蛻膜基底層發(fā)育不良從而導(dǎo)致胎盤絨毛的異常附著,是一種極其嚴(yán)重的婦產(chǎn)科急癥,也是造成產(chǎn)婦產(chǎn)后大出血的一個(gè)重要原因。早期發(fā)現(xiàn)及術(shù)前充分評估是降低母胎并發(fā)癥的重要因素。因此本文通過比較彩色多普勒超聲檢查、核磁共振成像檢查以及兩者聯(lián)合應(yīng)用診斷胎盤植入,旨在分析這些方法對胎盤植入孕期診斷及術(shù)前評估的價(jià)值。方法(1)本研究回顧性分析了天津市中心婦產(chǎn)科醫(yī)院從2013年7月到2015年5月收治的62位臨床可疑胎盤植入患者,涉及前置胎盤、多次剖宮產(chǎn)史及孕中晚期反復(fù)無痛性陰道出血者,均于孕28周后行彩色多普勒超聲檢查、核磁共振成像檢查,兩種檢查相隔天數(shù)≤5天。胎盤植入最終確診以手術(shù)發(fā)現(xiàn)或病理診斷或臨床分析綜合確定。(2)本研究中使用的彩超診斷儀是E8、GEV730以及SEQUIA-512,采用的核磁共振檢查是Siemens Symophony 1.5T超導(dǎo)核磁共振掃描儀以及Siemens公司自有的LEONARDO圖像處理工作站。(3)針對收集整理的數(shù)據(jù)資料通過SPSS 22.0軟件進(jìn)行統(tǒng)計(jì)分析,并將配對計(jì)數(shù)資料實(shí)施卡方檢驗(yàn),此即為McNemar檢驗(yàn)與Kappa系數(shù)檢驗(yàn)。其中,McNemar檢驗(yàn),α=0.05,如果p≤0.05則差異具備統(tǒng)計(jì)學(xué)意義;p0.05表示差異不具備統(tǒng)計(jì)學(xué)意義。Kappa系數(shù)檢驗(yàn)所得到的值可劃分成6個(gè)區(qū)段,所體現(xiàn)的是一致性程度。如果k0,則代表一致性程度極差;如果k=0.0~0.2,則代表一致性程度微弱;如果k=0.21~0.40,則代表一致性程度弱;如果k=0.41~0.60,則代表具有中度一致性;如果k=0.61~0.80,則代表具有高度一致性;如果k=0.81~1.00,則代表一致性程度極強(qiáng)。研究結(jié)果1.彩超可疑胎盤植入者49人,最終診斷胎盤植入者46人,彩超不診斷胎盤植入者13人,最終診斷非胎盤植入者9人,可以得出彩超檢查的靈敏度92.00%,特異度75.00%,準(zhǔn)確率88.70%,由此可見彩超檢查具有較高的診斷準(zhǔn)確率。2.核磁可疑胎盤植入者50人,最終診斷胎盤植入者46人,核磁不診斷胎盤植入者12人,最終診斷非胎盤植入者8人,可以得出核磁檢查的靈敏度92.0%,特異度66.67%,準(zhǔn)確率87.09%,由此可見核磁檢查的也具有較高的診斷準(zhǔn)確率。3.彩超和核磁聯(lián)合診斷可疑胎盤植入者45人,最終診斷胎盤植入者43人,二者聯(lián)合診斷不考慮胎盤植入者8人,最終診斷非胎盤植入者7人,可以得出聯(lián)合檢查的靈敏度97.73%,特異度77.78%,準(zhǔn)確率94.33%,兩者聯(lián)合檢查能夠顯著提升靈敏度、特異度及準(zhǔn)確率,并能降低假陽性和假陰性率。研究結(jié)論1、彩色多普勒超聲檢查對于胎盤植入具有較高的診斷準(zhǔn)確率,因而是首選的診斷方法。MRI作為輔助的影像診斷方式,結(jié)果的判讀可與超聲結(jié)果相結(jié)合。2、彩超和核磁都對胎盤植入都具備良好的診斷價(jià)值,二者聯(lián)合檢查可以明顯提高診斷價(jià)值,有效降低誤診率及漏診率。
[Abstract]:Objective placenta accreta (placenta accrete PIA) is an abnormal attachment of placental villi due to dysplasia of decidua basal layer. It is an extremely serious emergency of obstetrics and gynaecology and an important cause of postpartum hemorrhage. Early detection and full preoperative evaluation are important factors to reduce maternal and fetal complications. The purpose of this paper is to analyze the value of these methods in the diagnosis of placenta accreta during pregnancy and preoperative evaluation by comparing color Doppler ultrasonography, magnetic resonance imaging and combined application of the two methods in the diagnosis of placenta accreta. Methods (1) from July 2013 to May 2015, 62 patients with suspected placenta accreta, including placenta previa, history of cesarean section and recurrent painless vaginal bleeding, were retrospectively analyzed in Tianjin Obstetrics and Gynecology Hospital from July 2013 to May 2015. Color Doppler ultrasonography and magnetic resonance imaging were performed after 28 weeks of pregnancy. The interval between the two examinations was less than 5 days. The final diagnosis of placenta accreta is confirmed by surgical discovery or pathological diagnosis or clinical analysis. (2) the color ultrasound diagnostic instrument used in this study is E8G GE V730 and SEQUIA-512, MRI is Siemens Symophony 1.5T superconducting nuclear magnetic resonance scanner and Siemens. The company has its own LEONARDO image processing workstation. (3) to collect and organize the data through the SPSS 22.0 software for statistical analysis, The matched counting data are tested by chi-square test, which is called McNemar test and Kappa coefficient test. If p 鈮，

本文編號：2202726