基于3D-TVS子宫内膜面积成像评估宫腔粘连的新方法

A New Method for Assessing the Intrauterine Adhesion by Three-dimensional Endometrial Area Imaging

【目的】探讨一种基于经阴道三维超声(3D-TVS)下子宫内膜面积成像评估宫腔粘连(IUA)的新方法。【方法】回顾性分析2017年1月至2018年1月因可疑IUA或者不孕症在我院行宫腔镜检查或者手术的121例患者病史,术前3D-TVS子宫内膜面积大小及手术资料。按照宫腔镜下AFS分期标准对IUA患者进行分期,ROC曲线分析3D-TVS下子宫内膜面积诊断IUA的准确性,Logistic回归分析IUA的影响因素。【结果】根据3D-TVS子宫内膜面积诊断IUA,ROC曲线下面积为0.839,界值点为4.23cm^2,灵敏度为0.86,特异度为0.74,诊断准确率76.03%。根据宫腔镜下IUA的AFS分期,进一步计算不同程度IUA的3D-TVS子宫内膜面积界值点,具体为:轻度IUA(4.02,4.23]cm^2,中度IUA(3.23,4.02]cm^2,重度IUA≤3.23cm2。Logistic回归分析显示:流产孕周每增加一周,IUA的发生率就增加30.6%[OR=1.306,95%CI(1.112-1.532),P=0.001],3D-TVS子宫内膜面积每减少1cm^2,IUA的发生率就增加18.9%[OR=0.189,95%CI(0.079-0.450),P<0.001]。【结论】3D-TVS下子宫内膜面积可以作为一种简单、快速的诊段IUA的指标,并在一定程度上反映IUA的严重程度。

【Objective】To investigate a new method for assessing the intrauterine adhesion(IUA)by three-dimensional(3D)endometrial area imaging.【Methods】A total of 121 women with suspected IUA or tubal factor infertility undergoing hysteroscopy were enrolled in this retrospective study.The patients were divided into two groups:those with IUA and those without IUA.The endometrial area cutoff point was calculated to classify the patients with IUA into mild, moderate,and severe subgroups according to their AFS classification.【Results】When IUA were diagnosed based on the endometrial area,the area under the receiver operating characteristic(ROC)curve was 0.839,the cutoff point was 4.23 cm^2,the sensitivity was 0.86,and the specificity was 0.74,the diagnostic efficiency is 76.03%.We further classified IUA into mild,moderate,and severe groups based on the endometrium area as follows:mild IUA(4.02,4.23]cm^2,moderate IUA(3.23,4.02]cm^2,and severe IUA≤3.23 cm^2.The incidence rate of IUA increased by 30.6% for each one-unit decrease in abortive gestational age and increased by 18.9% for each one-unit decrease in endometrial area.【Conclusion】 3D endometrial area imaging is a simple and fast tool for IUA diagnosis and severity assessment,providing a new diagnosis method for gynaecologists to assess IUA.