腹部超声联合阴道灌注0.9%氯化钠诊断幼女阴道异物的临床价值

Diagnostic value of abdominal ultrasound combined with transvaginal perfusion of normal saline for vaginal foreign bodies in young girls

摘要:

目的 分析腹部超声联合阴道灌注0.9%氯化钠对幼女阴道异物的诊断价值。方法 回顾性分析2018年1月—2021年12月就诊于赣州市妇幼保健院妇科的102例疑似阴道异物幼女临床资料。患儿均接受经腹部超声、阴道灌注0.9%氯化钠检查。以宫腔镜诊治结果作为金标准，分析经腹部超声单独检测或腹部超声联合阴道灌注0.9%氯化钠诊断阴道异物的准确性、有效性。结果 宫腔镜结果显示，患儿中阴道炎有21例（20.59%），阴道异物有81例（79.42%），其中棉絮状物、谷物、头发丝等线状物最为常见；单独诊断、联合诊断出阴道异物分别有69例和79例，与宫腔镜诊断结果的K值分别为0.689和0.897。将宫腔镜诊断结果作为金标准，单独诊断、联合诊断阴道异物的敏感性分别为0.765（95% CI：0.594，0.816）、0.951（95% CI：0.826，0.995），特异性分别为0.667（95% CI：0.563，0.786）、0.905（95% CI：0.795，0.972），准确度分别为0.745（95% CI：0.586，0.813）、0.941（95% CI：0.817，0.984），单独诊断、联合诊断的敏感性、特异性、准确度可信区间无重叠，说明有统计学意义。结论 阴道灌注0.9%氯化钠可增强幼女阴道异物在超声下的显影，提升诊断准确性、有效性，且操作简单、损伤小，起到清洁阴道作用。

Abstract:

Objective To analyze the diagnostic value of abdominal ultrasound combined with transvaginal perfusion of normal saline for vaginal foreign bodies in young girls.Methods We retrospectively analyzed the clinical data of 102 young girls with suspected vaginal foreign bodies who were admitted in our hospital from January 2018 to December 2021. All of them underwent abdominal ultrasound and transvaginal perfusion of normal saline. The accuracy and efficacy of abdominal ultrasound alone and abdominal ultrasound combined with transvaginal perfusion of normal saline for diagnosing vaginal foreign bodies, with hysteroscopic findings as the gold standard.Results The hysteroscopic findings showed that there were 21 cases of vaginitis (20.59%) and 81 cases of vaginal foreign bodies (79.42%), among which cotton fibers, grains, hair and other threads were the most commonly observed. The abdominal ultrasound alone and abdominal ultrasound combined with transvaginal perfusion of normal saline diagnosed 69 and 79 cases of vaginal foreign bodies, and the kappa coefficients of them and the hysteroscopic findings were 0.689 and 0.897, respectively. Using the hysteroscopic findings as the gold standard, the sensitivities of abdominal ultrasound alone and abdominal ultrasound combined with transvaginal perfusion of normal saline were 0.765 (95% CI: 0.594, 0.816) and 0.951 (95% CI: 0.826, 0.995), with the specificities being 0.667 (95% CI: 0.563, 0.786) and 0.905 (95% CI: 0.795, 0.972), and the accuracies being 0.745 (95% CI: 0.586, 0.813) and 0.941 (95% CI: 0.817, 0.984). There was no overlap among the confidence intervals of sensitivity, specificity and accuracy of abdominal ultrasound alone and abdominal ultrasound combined with transvaginal perfusion of normal saline for diagnosing vaginal foreign bodies, indicating the statistical differences among these indices.Conclusions Transvaginal perfusion of normal saline can enhance the visibility of vaginal foreign bodies under the abdominal ultrasound, thus improving the diagnostic accuracy and efficacy. Besides, it is easy to operate, causes minor damage, and plays a role in cleaning the vagina.