经阴道彩色多普勒血流成像诊断宫腔少量残留物

Transvaginal color Doppler ultrasound in diagnosis of residual substance in uterus cavity

目的探讨经阴道彩色多普勒血流成像(TVS-CDFI)诊断宫腔少量残留物的价值。方法对105例肉眼已确认有胚胎组织排出或刮出后阴道少量流血10d以上的早孕流产患者行TVS-CDFI检查,观察宫腔内情况,对可疑残留物作记录,测量其血流参数:收缩期峰值速度(Vmax)、舒张末期速度(Vmin)、阻力指数(RI),并对其声像图特点进行总结。结果 105例早孕流产患者中,96例表现为宫腔少量残留物(91.4%)、7例为正常宫腔(6.7%)、2例诊断不确定(漏诊,1.9%)。二维图像可概括为3种类型:Ⅰ型28例(26.7%),宫腔回声强弱不均匀,内见稍高回声团;Ⅱ型68例(64.7%),宫腔回声不均匀;Ⅲ型9例(8.6%),内膜回声均匀。彩色多普勒血流显像可探及类滋养层血流信号者38例,显示率36.2%;3种类型的二维图像类滋养层血流信号显示率分别为100%(Ⅰ型)、11.8%(Ⅱ型)、22.2%(Ⅲ型)。结论 TVS-CDFI诊断宫腔少量残留物的准确性高,是临床首选的检查诊断方法。

Objective To explore the value of transvaginal color Doppler ultrasound （TVS - CDFI） in diagnosis of residual substance in uterus cavity. Methods TVS - CDFI was performed on 105 patients with vaginal bloody 10 d after abortion which was confirmed by observing the embryonic tissue. Then the uterus cavity condition was observed, the suspected residual substance was recorded, and the blood flow parameters were measured, including systolic peak velocity （Vmax） , end- diastolic velocity （Vmin） and resistance index（RI）. Results There were 96 patients with residual substance in uterus cavity（91.4% ） , 7 patients with normal uterus cavity （ 6.7% ）, and 2 patients were not confirmed （ misdiagnosis 1.9% ）. The sonograms of residual substance in the uterus cavity were divided into three types：type I including 28 cases（26.7% ） , the echo in uterine cavity was not uniform with inside hyperechogenicity; type Ⅱ including 68 eases（64.7% ）, the echo in uterine cavity was not uniform; type llI including 9 cases （8.6%） , the echo of endometium was uniform. The color Doppler flow imaging detected trophoblastic blood flow signals in 38 cases with the display rate of 36.2%. The display rate in the three types was 100% （ type Ⅰ ）, 11.8% （ type Ⅱ ） and 22.2% （ type Ⅲ）, respectively. Conclusion TVS - CDFI has high accuracy in diagnosis of residual substance in uterus cavity, it is the first choice in clinical diagnosis.