宫腔镜联合超声诊治妊娠终止后宫腔异常回声的临床价值

Value of Hysteroscopy Combined with Ultrasonography in the Diagnosis and Therapy of Intrauterine Abnormalities after Pregnancy

目的探讨宫腔镜联合超声诊治妊娠终止后宫腔内异常回声的临床疗效。方法2005年7月～2007年7月,对正常妊娠终止后超声检查发现宫内异常回声患者45例行宫腔镜联合超声检查,并对宫腔内可疑部位行定位活检,对明确诊断宫内妊娠物残留的患者进行定位刮宫或宫腔镜下妊娠物切除术,合并宫腔粘连或子宫发育异常(如中隔子宫)等宫腔病变的患者,同时进行手术矫治或相应处理。结果45例中39例诊断宫内妊娠物残留(其中合并子宫中隔4例,宫腔粘连3例),宫腔积血+子宫内膜炎4例,剖宫产术后子宫切口瘢痕处憩室形成2例。超声诊断阳性预测值86.7%(39/45),宫腔镜联合超声诊断阳性预测值100%(39/39);全部宫内残留妊娠物均在宫腔镜下切除,宫腔粘连及子宫中隔同时在宫腔镜下矫治,治愈率100%。剖宫产憩室1例经宫腔镜电凝去除憩室内膜,1例药物治疗。结论宫腔镜联合超声安全、准确,是诊断宫腔妊娠物残留的首选方法;宫腔镜手术定位准确,在直视下切除残留妊娠物,不破坏正常内膜组织,可一并处理宫腔内并存病变。

Objective To evaluate the diagnostic and therapeutic value of hysteroscopy combined with ultrasonography for residual pregnancy tissues.Methods Totally 45 cases with intrauterine abnormalities after pregnancy were diagnosed and treated by hysteroscopy combined with ultrasonography in our hospital from July 2005 to July 2007.Biopsy and curettage or resection of residual pregnancy tissues were performed on the patients.Results Among the 45 cases,39 patients were diagnosed with intrauterine pregnancy residues,in which four cases were complicated with uterine septum,three had intrauterine adhesions.In the other six patients,four showed intrauterine hematoma with endometritis,and two had diverticulum at the Cesarean scar.The positive predictive rate of ultrasonography was 86.7%（39/45）,whereas the rate of hysteroscopy combined with ultrasonography was 100%（39/39）.All the cases were cured by hysteroscopic resection,and the patients with intrauterine adhesions and uterine septum were corrected at the same time.The cure rate was 100%.In the two case of diverticulum at the Cesarean scar,one was treated by hysteroscopic endometrial coagulation,and the other received drug therapy.Conclusions Hysteroscopy combined with ultrasonography is a safe and accurate diagnosis and treatment method for intrauterine pregnancy residues.It can be used as the first choice of the disease.