探讨超声标准切面质量控制在胎儿结构异常检出中的应用价值。

回顾性分析2018年10月至2020年9月在中日友好医院进行Ⅲ级产科超声检查的4742例孕妇的资料，以开展标准切面质量控制的时间为分界点（2019年10月），将纳入病例分为质量控制前组（B-QC组）和质量控制后组（A-QC组），质量控制内容包括胎儿头颅、胸部、腹部、四肢及附属物的36个标准切面。计算每名孕妇图片存留数目，如图片清晰、切面完整正确则定义为标准切面符合。采用χ²检验比较2组标准切面符合率、胎儿结构异常检出率及漏误诊率有无差别。

B-QC组平均每名孕妇留存超声图像47张，标准切面符合率平均为73%；A-QC组平均每名孕妇留存超声图像89张，标准切面符合率平均为89%。其中4个标准切面（左足底切面、右足底切面、膈肌冠状切面、双肾横切面）A-QC组较B-QC组检出率明显提高（84.5% vs 11.0%、84.5% vs 11.0%、91.0% vs 20.5%、92.5% vs 30.0%），差异均具有统计学意义（χ²=124.831、124.831、201.475、164.582；P均＜0.001）。A-QC组胎儿双眼球水平横切面、鼻唇冠状切面、颜面部正中矢状切面符合率较B-QC组明显提高（89.0% vs 53.5%，100% vs 89.0%，94.0% vs 76.5%），差异均具有统计学意义（χ²=61.523、23.280、24.355；P均＜0.001）。A-QC组左心室流出道切面、三血管切面、三血管-气管切面及胎心率测量切面的符合率较B-QC组明显提高（93.0% vs 84.0%，86.5% vs 61.0%，92.0% vs 53.5%，95.0% vs 36.0%），差异均具有统计学意义（χ²=7.959、33.588、74.769、154.044；P均＜0.001）。A-QC组超声阳性检出率、胎儿结构异常检出率较B-QC组明显提高（15.7% vs 13.3%，1.3% vs 0.5%），差异具有统计学意义（χ²=7.566、7.571，P均=0.006），漏、误诊率较B-QC组降低（0.8% vs 0.9%，0.2% vs 0.3%），但2组间差异无统计学意义（χ²=1.156、0.269，P=0.604、0.282）。

超声标准切面质量控制通过标准化图片留存和评估，促进了Ⅲ级产科超声检查规范化，提高了超声阳性检出率和胎儿结构异常检出率，为临床决策提供了必要依据。

To evaluate the value of standard section quality control in improving the detection rate of fetal structural abnormality.

A total of 4742 pregnant women who underwent second-trimester obstetric ultrasound examination at our hospital from October 2018 to September 2020 were retrospectively analyzed. Taking the time of beginning to implement quality control as the cutoff point (October 2019), the included cases were divided into either a before-quality control (B-QC) group or an after-quality control (A-QC) group. A total of 36 standard sections of fetal skull, chest, abdomen, limbs, and appendages were analyzed. The number of images retained for each pregnant woman was calculated. If the images were clear and the sections were complete and accurate, the standard sections were defined as image coincidence. The χ² test was used to compare the coincidence rate of standard sections, the detection rate of fetal structural abnormality, and the rates of missing diagnosis and misdiagnosis between the two groups.

In the B-QC group, there were 47 ultrasonographic images per pregnant woman on average, and the coincidence rate of standard sections was 73%. In the A-QC group, there were 89 ultrasonographic images per pregnant woman on average, and the coincidence rate of standard sections was 89%. The detection rate of four standard sections (left plantar section, right plantar section, diaphragm coronal section, and double kidney transverse section) in the A-QC group was significantly higher than that in the B-QC group (84.5% vs 11.0%, 84.5% vs 11.0%, 91.0% vs 20.5%, and 92.5% vs 30.0%, χ²=124.831, 124.831, 201.475, and 164.582, respectively, P＜0.001 for all). Compared with the B-QC group, the coincidence rates of the horizontal transverse section of the eyes, the coronal section of the nose and lip, and the median sagittal section of the face in the A-QC group were significantly higher than those in the B-QC group (89.0% vs 53.5%, 100% vs 89.0%, and 94.0% vs 76.5%, χ²=61.523, 23.280, and 24.355, respectively, P＜0.001 for all). The coincidence rates of left ventricular outflow tract section, three-vessel section, three-vessel trachea section, and fetal heart rate section in the A-QC group were significantly higher than those in the B-QC group (93.0% vs 84.0%, 86.5% vs 61.0%, 92.0% vs 53.5%, and 95.0% vs 36.0%, χ²=7.959, 33.588, 74.769, and 154.044, respectively, P＜0.001 for all). The detection rates of fetal structural abnormality and fetal malformation in the A-QC group were significantly higher than those in the B-QC group (15.7% vs 13.3% and 1.3% vs 0.5%, χ²=7.566 and 7.571, P=0.006 and 0.006, respectively). The rates of missed and misdiagnosis were decreased (0.8% vs 0.9% and 0.2% vs 0.3%, respectively), but there was no statistical difference between the two groups (χ²=1.156 and 0.269, P=0.604 and 0.282, respectively).

The quality control of the standard sections of ultrasound can improve the coincidence rate of the standardized image retention in grade Ⅲ obstetric ultrasound examination and increase the detection rate of fetal structural abnormality, thus providing a basis for clinical decision-making.