宫腔镜诊治流产清宫后宫内异常回声

Management of cavitary uteri occupying or anechoic after abortion to remove with hysteroscopy

目的:探讨宫腔镜诊治流产清宫后宫内异常回声的临床价值。方法:对人流或药流不全清宫后而B超提示子宫腔妊娠物残留或滋养细胞疾病可能78例,实行宫腔镜诊治,分析B超、宫腔镜及病理检查结果。结果:B超诊断宫内妊娠物残留57例,提示滋养细胞疾病18例,提示子宫疤痕处妊娠绒毛3例。宫腔镜下诊断宫内妊娠物残留有74例,绒毛滋养细胞肌层浸润1例,绒毛植入子宫峡部剖宫产疤痕处3例。病检78例中绒毛植入肌层1例,子宫峡部绒毛2例,1例宫腔镜电切肌层组织中有滋养细胞增生,宫内妊娠物残留74例中有2例滋养细胞增生活跃与B超提示宫肌层血流丰富病例相吻合,临床最后确诊宫内残留72例。B超诊断宫内妊娠物残留、子宫疤痕处绒毛植入,胎盘部位滋养细胞肿瘤阳性率分别是(57/74)79.17%、(3/3)100.00%、(3/18)16.67%。宫腔镜诊断宫内妊娠物残留中有2例滋养细胞肿瘤漏诊,术后靠B超确诊,校正宫腔镜诊断宫内妊娠物残留阳性率(72/72)100%,故宫腔镜诊断滋养细胞肿瘤准确率33.33%(1/3),联合B超能提高该病诊断正确率。结论:对流产清宫后B超提示宫内异常回声者,应首选宫腔镜诊治,以提高临床诊断及治疗效果,防范不必要的扩大治疗。

Objective： To probe the value to diagnose and cure in cavitary uteri occupying lesion or anechoic after abortion to remove by hysteroseopy. Methods： 78 Cases were diagnosed and treated with hysteroscope to cureilage after induced abortion and drug miscarriage for ultrasonic images showed occupying lesion in uterine cavity or low - echo - level rich bloodstream in myometrlum to uterine trophobiastic disease, statistical analysis was used to compare the outcome for ultrasonic, hysteroscopic and pathological report. Results： B - ultrasonic diagnosed residual trophoblastic tissue （RTT） of 57 cases and trophoblastic disease of 18 cases and located uteri metrascar of 3 patient. Hysteroseopy diagnosed RTT of 74 cases and trophonema into uterus muscular - layer （TIUM） of 3 cases and metra - scar of I case, respectively. Pathological report corrected RTT of 74 cases and metra - scar of 3 cases and TIUM of I patient. Positive rate was 79. 17% , 100% and 16. 67% to diagnose placeutal resid in uterine cavity or trophonema insert, and placentalsit trophocyte tumor by ultrasonic, respectively. But 33. 33% with hysteroscopy to correct diagnose trophocyte tumor accurate was 100% with hysteroscopy combine ultrasonic; to revise diagnosis correct rate combined both of them. Conclusion： To diagnose and treat ocupying lesion or anechoic in cavitary uteri after abortion to remove deal with hysteroscopy selectively. It maybe elevate clinical diagnosis and therapeutic efficacy or containmented unwanted to enlarge management.