阴道三维超声对剖宫产术后子宫切口憩室导致的子宫异常出血的诊断价值

The diagnostic value of transvaginal three-dimensional ultrasound in uterus abnormal bleeding caused by uterine incision diverticulum after cesarean section

目的:探讨经阴道三维超声检查对剖宫产术后子宫切口憩室导致的子宫异常出血的诊断价值。方法:收集2011年1月至2015年7月在本院就诊,行阴道超声检查的480例有剖宫产史患者的临床资料进行回顾性分析,如发现存在切口憩室,则测量并记录其深度、长度、宽度及憩室前方残存肌层厚度,描述憩室的形状,经三维处理计算憩室容积大小,同时在整个系统回顾中对患者阴道出血情况进行跟踪随访。结果:480例患者中,118例发现有切口憩室声像,70例呈三角形,33例呈半圆形,15例其他形状,其中56例伴有子宫异常出血与憩室的容积及深度明显相关,同时月经量PBAC评分值高者,伴有子宫异常出血的概率越大,而出血与憩室的形状、长度、宽度无相关;憩室体积OR值(OR=15.809)最大,是判断子宫切口憩室导致子宫异常出血的最主要因素。结论:经阴道三维超声能方便、快捷、准确地诊断由切口憩室引起的子宫异常出血,对指导临床用药及手术治疗有重要意义。

Objective To explore the diagnostic value of transvaginal three-dimensional ultrasound in uterus abnormal bleeding caused by uterine incision diverticulum after cesarean section. Methods We collected480 cases with cesarean section patients from January 2011 to July 2015 in our hospital. A retrospective analysis of the cases was performed by transvaginal ultrasound, if the incision diverticulum was found, for measuring and recording the depth, length, width and assessing the residual muscle layer thickness and the shape and volume of the diverticulum with vaginal bleeding in the following up. Results 118 cases were found incision diverticulum by ultrasound in 480 patients, including 70 cases of triangular, 33 cases of semicircle, 15 cases of other shapes, of which 56 patients of uterine abnormal bleeding were significantly correlated with the volume and depth of the diverticulum. While menstruation PBAC scores were higher, the greater probability associated with abnormal uterine bleeding, but bleeding did not associate with the shape and length and width of diverticula; In this study we also found that OR value（OR = 15.809） of the diverticulum volume maximum was the key factors leading to the abnormal uterine bleeding in uterine incision diverticulum. Conclusion Transvaginal three-dimensional ultrasound can be convenient, fast and accurate diagnosis of uterine abnormal bleeding caused by incision diverticulum, and is of important significance for guiding clinical medication and surgical treatment.