经阴道三维超声在中重度宫腔粘连术后随访中的应用价值

Value of transvaginal three-dimensional ultrasound in postoperative follow-up of moderate or severe intrauterine adhesion

目的:探讨经阴道三维超声(transvaginal three-dimensional ultrasound,3D-TVS)在宫腔粘连术后随访中的应用价值。方法:选取经宫腔镜联合3D-TVS诊断为中、重度宫腔粘连(intrauterine adhesion,IUA)并经宫腔粘连分离术(transcervical resection of adhesion,TCRA)治疗的患者132例,术后3个月行3D-TVS,比较手术前后子宫内膜容积及血流参数的变化,同时行宫腔镜复查,比较两者结果。结果:TCRA后组与术前组比较,宫腔容积、血流指数(flow index,FI)及血管血流指数(vascularizationflowindex,VFI)增加,差异有统计学意义(P<0.05),内膜血管指数(vascularization index,VI)虽有所增加,但差异无统计学意义(P>0.05)。术后3D-TVS评估复发宫腔粘连的灵敏度为85.0%(51/60),特异度为83.3%(60/72),准确率为84.1%(111/132)。结论:3D-TVS便捷有效,评估结果与宫腔镜检查结果一致性较高,可用于术后内膜恢复的评价,手术前后宫腔容积及血流参数的改变可作为辅助诊断的依据。

Objective:To study the application value of transvaginal three-dimensional ultrasound(3D-TVS)in the postoperative follow-up of intrauterine adhesions.Methods:A total of 132 patients with moderate or severe intrauterine adhesion were diagnosed by hysteroscopy and 3D-TVS and treated by transcervical resection of adhesion(TCRA).All patients received the examination of 3D-TVS and the results were compared with those of secondary hysteroscopy three months later.Pre-and post operative endometrial volume and blood flow parameters of 3D-TVS were observed and compared.Results:The endometrial volume,flow index(FI)and vascularization flow index(VFI)after TCRA were increased compared with those before TCRA(P<0.05).Although the vascularization index(VI)was slightly increased after TCRA,the difference was not statistically significant(P>0.05).The sensitivity,specificity and accuracy of postoperative 3D-TVS for the diagnosis of intrauterine adhesions were 85.0%(51/60),83.3%(60/72),84.1%(111/132),respectively.Conclusion:In accordance with hysteroscopy,3D-TVS is useful to evaluate the endometrial volume and blood flow parameters with convenience and reliable quality.