宫腔妊娠组织物残留的诊疗进展

Progress in Diagnosis and Treatment of Retained Products of Conception

宫腔妊娠组织物残留(retained products of conception,RPOC)指妊娠后产生或发育的妊娠组织物在分娩或终止妊娠后仍然存在的现象。超声检查是诊断RPOC的主要方法,血流信号是其超声诊断的要点,局灶性子宫内膜增厚、宫腔内高回声团块或其周围具有低阻力动脉血流时高度提示RPOC。子宫内膜厚度及回声以及超声血管分级对于RPOC的临床诊断起到重要作用;宫腔镜检查是进一步明确诊断的主要方法。RPOC的鉴别诊断主要包括子宫动静脉畸形及妊娠滋养细胞疾病,计算机断层扫描(CT)和磁共振成像(MRI)可有助于其鉴别。治疗方法分为药物治疗和手术治疗。常用药物为米非司酮及米索前列醇。手术治疗从超声引导下的清宫术治疗逐渐发展为宫腔镜下病灶清除,后者具有完全清除率高、术后并发症发生率低的优点,是目前治疗RPOC的主要方法。

The retained products of conception （RPOC） is a presence of the intrauterine tissue related with pregnancy after the birth or termination of pregnancy.Ultrasonography is the principal method of RPOC diagnosis.The signals of blood flow are the main points of the ultrasonic diagnosis,with the characterizes of focal intrauterine membrane thickening,a intrauterine hyperechoic mass or a low-resistance arterial blood flow around the mass.The endometrial thickness and echo,as well as the ultrasound vascular grading,play an important role in the clinical diagnosis of RPOC,while hysteroscopy is the main method of the confirmed diagnosis.The differential diagnosis of this disease mainly includes arterial venous malformation and pregnancy trophoblastic disease,CT and MRI are helpful for the differential diagnosis.The treatment includes drug therapy and surgery.Mifepristone and misoprostol are of two common drugs for RPOC therapy.Surgical treatment has been gradually developed from the curettage under the guidance of ultrasound to the hysteroscopic focal clearance.With the advantages of high clearance rate and low incidence of complications,the hysteroscopic clearance is currently the main method of RPOC treatment.