子宫内妊娠物残留的超声影像特征和诊断分析

The value and characteristics of ultrasonography in the diagnosis of retained products of conception

目的探讨超声诊断子宫内妊娠物残留（RPOC）及其对临床的指导意义。方法157例中、晚期妊娠后临床怀疑RPOC的病例进行盆腔超声检查。超声阳性结果与清宫术后病理检查结果对照，超声阴性结果给予临床保守治疗，后随访3—6个月（平均约4．5个月）。结果157例病例中，二维超声检查阳性98例，手术后病理阳性73例，超声诊断准确率、敏感性、特异性较高，为84％、100％、70％。其二维声像图特征以显示子宫腔内团块的准确率较高（89％）；子宫内膜异常和子宫腔内复合性积液的准确率较低，为42％和60％，误诊率较高，为44％和32％。超声检查阴性的59例，经临床治疗随访，证实均为阴性。另外，二维超声检查98例阳性中随机有47例应用了CDFI，其中30例病理阳性中，21例显示异常血流（70％）；17例病理阴性中，11例显示异常血流（66％）。结论二维超声显示子宫腔内团块时，其诊断RPOC的意义较大；二维超声显示无子宫内团块、内膜异常和宫腔内复合性积液时，基本可排除RPOC；CDFI对诊断RPOCs无确切意义。

Objective To investigate the value and characteristics of ultrasonography in the diagnosis of retained products of conception.Methods One hundred and fifty seven cases of clinically suspected retained products of conception（RPOC） were examined by two- dimensional ultrasound and CDFI. The patients with sonographic positive results underwent surgical intervention and pathologic examination, the remaining patients were followed clinically. Results In 157 cases, 98 cases were sonographic positive results, 73 cases were pathologic positive results. An endometrial mass （49/73, 67% ） was the most specific appearance of RPOC; The isolated finding of either complex fluid in the uterine cavity （12/73,17%） or the thickness of endometrium more than 10mm （8/73,11%） bad low diagnostic value. Fifty nine cases were with senographic negative results and were confirmed by clinic. In 30 sonographic positive results cases, 21 cases were with abnormality of bloed（70% ）, in 17 senographic negative results cases, 11 cases were with abnonnality of blood（66% ） . Conclusion The endometrial mass is the most sensitive and specific two- dimensional sonographic characteristic for RPOC; If no mass or endometrial fluid is seen and the endometrial thickness is less than 10mm, RPOC are extremely excluded. CDFI has no exact value in the diagnosis of RPOC.