摘要目的 探讨超声图像特征联合剖宫产史评分对胎盘植入的诊断价值.方法 对151例晚孕期孕妇行常规、彩色多普勒超声检查,根据手术结果将其分为植入组和非植入组,记录两组孕妇剖宫产次数、胎盘厚度,比较两组是否前置胎盘、胎盘后间隙是否消失、胎盘内是否存在胎盘陷窝、胎盘后肌层是否变薄或消失、子宫－膀胱交界线是否不规则、胎盘后方是否存在丰富血流信号等超声图像特征的差异.根据单因素分析结果进行Logistic回归分析,对进入回归模型的特征赋值后绘制ROC曲线确定最佳诊断截点.结果 采用是否有前置胎盘、胎盘陷窝、胎盘后丰富血流信号等3个图像特征联合剖宫产史评分诊断胎盘植入的ROC曲线下面积AUC为0 .991 ,以4 .5分为最佳截断点所对应的诊断敏感性和特异性分别为91 .1%、 100%.结论 超声图像特征联合剖宫产史评分对胎盘植入的诊断具有较高实用价值.

abstractsObjective To evaluate the diagnostic value of ultrasound image features combined with cesarean section scores for placenta accreta . Methods A total of 151 pregnant women in the later trimester of pregnancy underwent two-dimensional and color Doppler ultrasonography . According to the results of the operation ,they were divided into the accreta group and the non-accreta group . The number of cesarean section and placental thickness in the two groups were recorded . The ultrasound image characteristics of the placenta previa ,the placenta posterior gap disappeared ,the placental lacuna in the placenta ,the muscle layer becoming thin or disappeared after the placenta ,the anatomical region of the uterus-bladder junction line and the abundant blood flow signal behind the placenta were compared between the two groups . Logistic regression analysis was performed according to the results of single factor analysis . After assigning the characteristics of the regression model ,the ROC curve was drawn to determine the best diagnostic intercept point . Results The presence of placenta previa ,placental lacuna and placental enriched blood flow signals combined with cesarean section scores were used to diagnose placenta accreta ,the area under the ROC curve was 0 .991 ,based the best cut-off point with 4 .5 ,the corresponding diagnostic sensitivity and specificity were 91 .1% and 100% ,respectively . Conclusions Ultrasound image features combined with cesarean section history scores have a high practical value in the diagnosis of placental accreta .