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目的探讨二维超声与四维超声联合应用对胎儿隐性脊柱裂的诊断价值。方法选择2013年1月至2015年12月到本院进行产前筛查,经普通超声检查怀疑脊柱发育异常且不能明确诊断的胎儿的孕妇80例,根据诊断方法不同将孕妇分为两组,比较两组超声诊断胎儿隐性脊柱裂的效果、超声影像质量、漏诊和误诊率等指标,以评价四维超声的准确性、安全性和临床应用价值。结果二维超声检查确诊隐性脊柱裂2例,四维超声检查确诊7例,新生儿出生后随访结果隐性脊柱裂为8例。二维超声检查与随访结果一致性比较,Kappa=0.184,两者诊断一致性较低;四维超声检查与随访结果一致性比较,Kappa=0.769,两者诊断一致性较好。二维超声诊断胎儿隐性脊柱裂的准确率为25%,四维超声诊断胎儿隐性脊柱裂的准确率为100%,χ2=4.001,P<0.05,差异具有统计学意义。二维超声检出的2例隐性脊柱裂均为孕晚期孕妇,占二维超声检出率的100%。四维超声检出的3例隐性脊柱裂均为孕中期孕妇,占四维超声检出率的37.50%;5例为孕晚期,占四维超声检出率的62.50%。结论超声检查是产前筛查胎儿隐性脊柱裂的简单有效的首选方法,四维超声动态检查可弥补二维超声检查的不足而提供清晰、直观,连续的动态的声像图而提高诊断的准确性。
Objective To investigate the diagnostic value of two-dimensional ultrasound combined with four-dimensional ultrasound in the diagnosis of occult fissure in fetus. Methods From January 2013 to December 2015 to our hospital for prenatal screening, general ultrasound examination suspected spine dysplasia and can not confirm the diagnosis of fetus in 80 pregnant women, according to different diagnostic methods will be divided into two groups of pregnant women, The diagnostic accuracy, safety and clinical value of four-dimensional ultrasound were compared between the two groups in terms of ultrasound diagnosis of fetal recessive spine rupture, ultrasound image quality, missed diagnosis and misdiagnosis rate. Results Two-dimensional ultrasonography confirmed recessive spina bifida in 2 cases, four-dimensional ultrasonography in 7 cases, and neonatal postnatal follow-up results in 8 cases of latent spina bifida. The consistency of two-dimensional ultrasonography and follow-up results, Kappa = 0.184, the diagnostic concordance between the two is lower; four-dimensional ultrasound and follow-up results of consistency, Kappa = 0.769, the diagnosis of good consistency between the two. The accuracy of two-dimensional ultrasound in diagnosis of fetal recessive spina bifida was 25%. The accuracy of four-dimensional ultrasound in diagnosis of fetal recessive spina bifida was 100%, χ2 = 4.001, P <0.05. The difference was statistically significant. Two cases of two-dimensional ultrasound detected recessive spina bifida are third trimester pregnant women, accounting for two-dimensional ultrasound detection rate of 100%. Three cases of four-dimensional ultrasound detected recessive spina bifida were pregnant during the second trimester, accounting for 37.50% of four-dimensional ultrasound detection rate; 5 cases of third trimester, accounting for 62.50% four-dimensional ultrasound detection rate. Conclusion Ultrasonography is a simple and effective method of prenatal screening for latent spina bifida in children. Four-dimensional ultrasonography can make up for the lack of two-dimensional ultrasonography and provide clear, intuitive and continuous dynamic sonography to improve the accuracy of diagnosis Sex.