经阴道三维超声探查子宫瘢痕憩室血流特点

Blood flow characteristics of uterine scar diverticulum probed by transvaginal three-dimensionalultrasound

目的 经阴道三维能量多普勒超声分析剖宫产术后子宫瘢痕憩室周边肌层的血流灌注参数，探讨瘢痕憩室周边肌层细小血管的形成特点及临床价值。方法 收集 2014 年 3 月至 2017 年 5 月来本院就诊且有过剖宫产术史的患者，分别对超声诊断子宫瘢痕憩室形成者与子宫瘢痕恢复完整者进行经阴道三维能量多普勒超声检查，并使用 Vocal 软件处理计算分析子宫瘢痕处的血流参数 VI 值、FI 值、VFI 值。结果病例组子宫后位占比 74.12%，对照组 35.65%（P=0.005）；病例组剖宫产次数（1.55±0.64）次，对照组（1.09±0.56）次（P=0.004）。在月经早期病例组患者子宫瘢痕憩室周边血流参数 VI 值（5.719±3.012）、FI 值（35.266±5.818）、VFI 值（2.104±1.370），对照组 VI 值（1.359±0.893）、FI 值（28.809±3.409）、VFI 值（0.415±0.304），病例组结果均明显增高。结论 在月经早期子宫瘢痕憩室血供的特点是瘢痕憩室周边血流丰富，流速低，血管新生且以血管生成为主。瘢痕完整血供特点是瘢痕周边血流稀少。后位子宫较易发生瘢痕憩室，剖宫产次数越多产生瘢痕憩室的几率越大。

Objective To analyze the blood flow parameters of the peripheral muscle of uterine scar diverticulum by transvaginal 3D energy Doppler ultrasonography and to explore the formation characteristics and clinical value of the small peripheral muscle vessels of diverticulum. Methods The patients with a history of cesarean section treated at our hospital from March, 2014 to May, 2017 were collected. The patients diagnosed with uterine scar diverticulum or completely recovered uterine scar by ultrasound were detected by transvaginal 3D energy Doppler untrasonography. The values of VI, FI, and VFI were analyzed with Vocal software. Results The proportion of posterior position was 74.12% in the case group and was 35.65% in the control group （P = 0.005）. The case group took （1.55 ±0.64） times cesarean section and the control group （1.09 ±0.56） （P=- 0.004）. In the early period of menstruation, the values of VI, FI, and VFI were （5.719±3.012）, （35.266±5.818）, and （2.104±1.370） in the case group and were （1.359±0.893）, （28.809±3.409）, and （0.415±0.304） in the control group. Conclusions In the early stage of menstruation, the blood supply of the uterine scar diverticulum is characterized by rich blood flow surrounding the cicatrial diverticulum, low velocity, and angiogenesis. The complete blood supply of cicatrial scar is characterized by the lack of blood flow around the scar. Posterior uterine uterus is more easily prone to scar diverticulum; and the more frequent caesarean section is, the greater the chance of developing scar diverticulum is.