经阴道彩色多普勒超声对宫内残留物的诊断价值

The diagnostic value of transvaginal color Doppler in the detection of intrauterine remnants

目的探讨经阴道彩包多普勒超声（TV—CDFI）及经腹部彩色多普勒超声（TA—CDFI）诊断宫内残留物的临床价值。方法运用经TV—CDFI及经TA—CDFI诊断宫内残留物98例，并与清宫后病理结果对照。结果98例宫内残留物全部经清宫术后病理证实。超声诊断与病理诊断的符合率TV—CDFI为97．9％，误诊2例；而TA—CDFI则为74．5％，误诊25例。检测小于5mm×5mm的宫内残留物，TV—CDFI的误诊率明显低于TA—CDFI，两者相比较差异有极显著性（P〈0．001）。经彩色多普勒血流显像（CDFI）：残留物在宫腔内时间较长时，血流少，呈稀疏星点状或无血流；在宫腔内时间较短时，血流多，呈密布星点状。脉冲多普勒（PW）呈类滋养层血流频谱，阻力指数RI为0．38～0．55。结论TV—CDFI较TA—CDFI更能清楚地观察到子宫内的异常回声纠及异常的血流，因此能更准确地为临床医生提供有价值的诊断依据。

Objective TO explore the clinical values of transvaginal color Doppler （TV-CDFI） and tansabdominal color Doppler （TA-CDFI） in detection of intrauterine remnants. Methods 98 patients with intrauterine remnants underwent TV-CDFI and TA-CDFI. The findings were then compared with pathological examination after curettage. Results All the patients were pathologically confirmed as intrauterine remnants after suction curettage. The coincidence rate between TV-CDFI and pathological diagnosis was 97.9%, and that between TA-CDFI and pathological diagnosis was 74.5%. There were 2 patients misdiagnosed by TV-CDFI and 25 by TA-CDH. The misdiagnosis rate in detecting intrauterine fetal residue smaller than 5 mm× 5 mm in size by TV-CDFI was much lower than that by TA-CDFI, with a significant difference （P〈0.001）. Color Doppler Flow Imaging （CDFI） showed with the prolonged existence of intrauterine remnants, less blood stream occurred with sparse starlike shape or without blood flow. If the existence of remnants was relatively shortened, blood stream presented dense parse starlike shape. The trophoblast-like blood flow was detected by pulsed wave Doppler, with a resistance index of 0.38-0.55. Conclusions TV-CDFI can detect the abnormal echoic mass and blood flow in the uterus more clearly than TA-CDFI. Therefore, it provides clinicians with more accurate diagnostic support.