Application of Ultrasonographic Scoring Combined with Enhanced Blood Flow Display Technique in Dangerous Placenta Previa with Placental Implantation
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摘要:
目的 分析超声评分法联合增强型血流显示技术（E-flow）在凶险型前置胎盘（PPP）合并胎盘植入中的应用价值，旨在提高PPP合并胎盘植入的超声诊断准确率。 方法 对2017年1月至2019年6月在云南省第二人民医院超声诊断的60例疑似PPP合并胎盘植入孕产妇作为研究对象。所有孕产妇常规使用二维、超声评分法、E-flow检查方法，对PPP合并胎盘植入分型，以临床手术和病理结果为金标准并进行对照，对比超声评分法、E-flow、超声评分联合E-flow对PPP合并胎盘植入诊断效能。 结果 60例疑似PPP合并胎盘植入孕妇中，超声评分法联合E-flow灵敏度高于超声评分法（P < 0.05），超声评分法联合E-flow准确度高于超声评分法及E-flow（P < 0.05）。超声评分法联合E-flow在诊断PPP合并胎盘植入的诊断效能高于单一的超声评分法或E-flow。 结论 超声评分法联合E-flow在诊断PPP合并胎盘植入有较高的诊断效能，是值得推广的联合检查方法，能帮助临床治疗提供指导意见。 Abstract:Objective To analyze the application value of ultrasound scoring combined with enhanced flow in dangerous placenta previa（PPP）combined with placenta accreta, in order to improve the ultrasonic diagnosis accuracy of PPP combined with placenta accreta. Methods From January 2017 to June 2019, 60 cases of pregnant and lying-in women with suspected PPP combined placental implantation in the Second People's Hospital of Yunnan Province were studied.Two-dimensional, ultrasound scoring and e-flow examination methods were routinely used in all pregnant women for the classification of PPP combined with placental implantation. Clinical surgery and pathological results were used as the gold standard for comparison, and the diagnostic efficacy of ultrasound scoring, e-flow and ultrasound scoring combined with e-flow for PPP combined with placental implantation was compared. Results Among 60 pregnant women with suspected PPP combined with placental implantation, the sensitivity of ultrasound scoring combined with e-flow was higher than that of ultrasound scoring（P < 0.05）. The accuracy of ultrasonic scoring combined with E-flow was higher than that of ultrasonic scoring combined with e-flow（P < 0.05）. The diagnostic efficiency of ultrasound scoring combined with e-flow in PPP with placental implantation was higher than that of single ultrasound scoring or e-flow. Conclusion Ultrasound scoring combined with E-flow has a higher diagnostic efficiency in the diagnosis of PPP combined with placental implantation. It is a combined examination method to promote the value and can provide guidance for clinical treatment. -
图 1 诊断PPP合并胎盘植入的金标准
A：病理诊断镜下显示子宫肌层内见胎盘绒毛组织（10×30）B：术中见子宫浆膜下扩张血管。
Figure 1. Gold standard for the diagnosis of PPP with placental implantation
图 2 胎盘粘连，胎盘后间隙局部中断
Figure 2. Placental adhesion. Local disruption of the posterior placental space
图 3 胎盘植入超声表现
A：胎盘增厚，胎盘内漩涡回声，子宫膀胱交界面强回线变薄；B：胎盘后间隙消失，胎盘子宫交界面扩张血管；C：胎盘-子宫交界面扩张血管，PW示呈高速低阻频谱。
Figure 3. Ultrasonographic manifestations of placental implantation
图 4 胎盘穿透，子宫相邻的膀胱浆膜层强回声带连续性中断，膀胱内出现扩张血管
Figure 4. The placenta percreta. The strong echo zone of the serous membrane of the bladder adjacent to the uterus was interrupted，and dilated blood vessels appeared in the bladder
表 1 超声诊断胎盘植入程度评分表
Table 1. Evaluation table of the degree of placental implantation diagnosed by ultrasound
评价指标 分值 0 1 2 胎盘位置 正常 边缘或低置 完全 胎盘厚度 < 3 cm 3～5 cm > 5 cm 胎盘后间隙 连续 局部中断 消失 胎盘漩涡 无 有 大片状伴沸水征 胎盘−子宫交界面血流 稀少 多、成团 丰富杂乱 子宫−膀胱交界面 连续 中断 消失 宫颈形态 完整 不完整 消失伴丰富血窦 
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表 2 超声评分法、E-flow及超声评分法联合E-flow诊断效能（%）
Table 2. Diagnostic efficiency of ultrasound scoring，E-flow and combined e-flow（%）
诊断方法 灵敏度 特异度 准确度 超声评分法 77.78（35/45） 66.67（10/15） 75.00（45/60） E-flow 82.22（37/45） 80.00（12/15） 81.67（49/60） 超声评分法+E-flow 97.78（44/45）* 93.33（14/15） 96.67（58/60）*Δ χ2 8.208 11.250 P 0.017 0.245 0.004 与超声评分法比较，*P < 0.05；与E-flow比较，ΔP < 0.05。
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