经阴道超声检查诊断宫内残留的临床应用 ?(1)
【摘要】 目的：分析流产后宫内残留患者经阴道超声检查的图像特征，探讨超声检查各参数对宫内残留的诊断价值。方法：选取2018年6月-2019年6月在厦门市第五医院妇科病房因怀疑宫内残留而行宫腔镜手术患者96例，刮出组织行病理学诊断，根据病理结果分为有绒毛组(宫内残留组)和无绒毛组。收集所有患者的临床基本特征及超声图像特征，比较两组间的差异。结果：96例患者中，有绒毛组共84例，无绒毛组共12例，有绒毛组阴道出血时间长于无绒毛组，有绒毛组宫内膜厚度明显厚于无绒毛组，有绒毛组中，宫内膜线不清晰与宫腔内簇状丰富血流信号比例明显高于无绒毛组，差异均有统计学意义(P<0.05)。结论：经阴道超声检查诊断流产后宫内残留价值明确，肌壁内丰富血流信号及宫内膜线不清晰高度提示宫内残留可能。然而宫内未见异常血流信号不能排除宫内残留，部分患者最终需依靠病理学确诊。
【关键词】 宫内残留 经阴道超声检查 宫内膜线 血流信号
[Abstract] Objective： To analyze the characteristics of transvaginal ultrasonography in patients with retained products of conception， and to explore the diagnostic value of various parameters of ultrasonography in retained products of conception. Method： A total of 96 patients who suspected retained products of conception underwent hysteroscopy from June 2018 to June 2019 in the gynecology department of Xiamen Fifth Hospital， they were divided into the villus group and the non-villus group according to the pathological results. The basic clinical features and ultrasonographic features of all patients were collected and the differences between the two groups were compared. Result： Among 96 patients， 84 were in the villus group and 12 cases in the non-villus group. In the villus group， vaginal bleeding time was longer than that in the non-villus group， endometrial thickness， unclear endometrial line and color doppler flow in the villus group were significantly higher than those in the non-villus group， the differences were significant differences (P<0.05). Conclusion： The diagnostic value of transvaginal ultrasound for retained products of conception after abortion is clear. Enhanced myometrium vascularity and unclear endometrial lines highly suggest the possibility of retained products of conception. However， the lack of vascularity cannot exclude retained products of conception. Pathology is still needed.
隨着社会发展及女性生育观念的改变，人为终止妊娠的发生率越来越高。流产后宫内残留是常见的并发症，可影响子宫复旧，延长阴道出血时间，增加盆腔感染的概率[1-2]。对部分假阳性的病例，激进的二次清宫会对子宫内膜造成进一步损伤，使宫腔粘连、不育等并发症的概率增加。宫腔内残留的绒毛组织与坏死的蜕膜及积血进行鉴别具有重要意义。超声检查可动态监测流产的状态并提供流产过程中的处理意见[3]，减少误诊、漏诊宫内残留引起的并发症。本研究回顾性收集临床怀疑宫内残留行宫腔镜引导下清宫的病例，分析流产后宫内残留的临床及超声特征，为正确诊断宫内残留提供参考依据。
1 资料与方法
1.1 一般资料
2018年6月-2019年6月因怀疑宫内残留在笔者所在医院住院并行宫腔镜手术96例，其中行药物流产75例，人工流产21例，根据病理结果，将检出绒毛成分的病例分为有绒毛组(宫内残留组)及无绒毛组。其中有绒毛组(宫内残留组)共84例，无绒毛组(对照组)共12例(其中9例为蜕膜组织，1例为子宫内膜息肉，1例为增值期内膜，1例为宫腔积血)。
1.2 方法
分析方法：针对选取的研究对象阴道超声的检查结果进行回顾性分析。
宫腔镜清宫术前进行超声检查：所有的患者均使用美国记忆公司Logiq-E9多普勒超声诊断仪进行超声诊断，阴道超声探头频率为5～9 MHz。患者排空膀胱后取截石位，探头套上消毒避孕套，放入阴道穹隆部位，横向和纵向检查子宫及双侧附件区情况，记录子宫形态、大小、宫内膜厚度，观察宫腔线是否清晰、宫腔内有无异常分布及异常丰富的血流信号。, http://www.100md.com(陈婷)
【关键词】 宫内残留 经阴道超声检查 宫内膜线 血流信号
[Abstract] Objective： To analyze the characteristics of transvaginal ultrasonography in patients with retained products of conception， and to explore the diagnostic value of various parameters of ultrasonography in retained products of conception. Method： A total of 96 patients who suspected retained products of conception underwent hysteroscopy from June 2018 to June 2019 in the gynecology department of Xiamen Fifth Hospital， they were divided into the villus group and the non-villus group according to the pathological results. The basic clinical features and ultrasonographic features of all patients were collected and the differences between the two groups were compared. Result： Among 96 patients， 84 were in the villus group and 12 cases in the non-villus group. In the villus group， vaginal bleeding time was longer than that in the non-villus group， endometrial thickness， unclear endometrial line and color doppler flow in the villus group were significantly higher than those in the non-villus group， the differences were significant differences (P<0.05). Conclusion： The diagnostic value of transvaginal ultrasound for retained products of conception after abortion is clear. Enhanced myometrium vascularity and unclear endometrial lines highly suggest the possibility of retained products of conception. However， the lack of vascularity cannot exclude retained products of conception. Pathology is still needed.
隨着社会发展及女性生育观念的改变，人为终止妊娠的发生率越来越高。流产后宫内残留是常见的并发症，可影响子宫复旧，延长阴道出血时间，增加盆腔感染的概率[1-2]。对部分假阳性的病例，激进的二次清宫会对子宫内膜造成进一步损伤，使宫腔粘连、不育等并发症的概率增加。宫腔内残留的绒毛组织与坏死的蜕膜及积血进行鉴别具有重要意义。超声检查可动态监测流产的状态并提供流产过程中的处理意见[3]，减少误诊、漏诊宫内残留引起的并发症。本研究回顾性收集临床怀疑宫内残留行宫腔镜引导下清宫的病例，分析流产后宫内残留的临床及超声特征，为正确诊断宫内残留提供参考依据。
1 资料与方法
1.1 一般资料
2018年6月-2019年6月因怀疑宫内残留在笔者所在医院住院并行宫腔镜手术96例，其中行药物流产75例，人工流产21例，根据病理结果，将检出绒毛成分的病例分为有绒毛组(宫内残留组)及无绒毛组。其中有绒毛组(宫内残留组)共84例，无绒毛组(对照组)共12例(其中9例为蜕膜组织，1例为子宫内膜息肉，1例为增值期内膜，1例为宫腔积血)。
1.2 方法
分析方法：针对选取的研究对象阴道超声的检查结果进行回顾性分析。
宫腔镜清宫术前进行超声检查：所有的患者均使用美国记忆公司Logiq-E9多普勒超声诊断仪进行超声诊断，阴道超声探头频率为5～9 MHz。患者排空膀胱后取截石位，探头套上消毒避孕套，放入阴道穹隆部位，横向和纵向检查子宫及双侧附件区情况，记录子宫形态、大小、宫内膜厚度，观察宫腔线是否清晰、宫腔内有无异常分布及异常丰富的血流信号。, http://www.100md.com(陈婷)