宫腔镜下重度宫腔粘连松解术后子宫内膜下血流的三维能量多普勒超声变化

Three-dimensional energy Doppler ultrasonographic changes of subendometrial blood flow after hysteroscopic release of severe intrauterine adhesion

目的探讨三维能量多普勒超声在宫腔镜下重度宫腔粘连松解术后应用的临床价值。方法选择2016年1月至2018年1月本院计算收治的有生育要求、行宫腔镜下粘连松解术的121例重度宫腔粘连患者作为研究对象,术前术后采用三维能量多普勒观察患者子宫内膜体积(EV)、内膜区血管指数(VI)、血流指数(EI)、血管血流指数(VFI),计算术前术后EV、VI、EI、VFI升高比值对术后妊娠的预测价值。结果患者术后EV、VI、FI、VFI水平与术前比较,差异均有统计学意义(P <0.05)。其EV、VI、FI和VFI的平均升高比值分别为(2.40±0.86)cm3、3.91±1.02、1.21±0.14和13.76±4.60。其中妊娠组患者EV、VI、FI、VFI升高比值均显著高于未妊娠组(P <0.05)。EV、VI、FI、VFI升高比值预测妊娠的ROC曲线下面积(AUC)分别为0.797、0.729、0.735和0.794。EV+VI+FI+VFI>临界值预测妊娠的灵敏度和特异性分别为0.426和0.986,特异性显著高于EV、VI、FI、VFI单独预测(P均<0.05);EV或VI或FI或VFI>临界值预测妊娠的灵敏度和特异性分别为0.872和0.581,预测灵敏度显著高于EV、VI、FI、VFI单独预测(P均<0.05)。结论三维能量多普勒检查重度宫腔粘连患者术前术后子宫内膜体积及血流灌注指标的改变,有助于预测患者术后妊娠情况。

Objective To explore the clinical value of three-dimensional energy Doppler ultrasound in the treatment of severe intrauterine adhesions after hysteroscopy. Methods A total of 121 patients with severe intrauterine adhesions who had fertility requirements and underwent hysteroscopy were selected as the study subjects from January 2016 to January 2018. The endometrial volume(EV), endometrial vascular index(VI), blood flow index(EI) and vascular blood flow index(VFI) of the patients were observed by three-dimensional energy Doppler ultrasound before and after surgery, and the predictive value of increased ratios of EV, VI, EI and VFI to postoperative pregnancy was calculated. Results The postoperative EV, VI, FI and VFI levels of the patients were significantly increased compared with those before surgery, and the differences were statistically significant(P < 0.05). The average increased ratios of EV, VI, FI and VFI were(2.40±0.86) cm^3, 3.91±1.02, 1.21±0.14 and 13.76±4.60, respectively. The increase ratios of EV, VI, FI and VFI in the pregnant group were significantly higher than those in the non-pregnant group, with statistically significant differences(P < 0.05). The AUC values of EV, VI, FI and VFI were 0.797, 0.729, 0.735 and 0.794, respectively. The sensitivity and specificity of EV+VI+FI+VFI > Cut-off in predicting pregnancy were 0.426 and 0.986 respectively, and the specificity was significantly higher than that of EV, VI, FI and VFI alone(P < 0.05). The sensitivity and specificity of EV or VI or FI or VFI > Cut-off in predicting pregnancy were 0.872 and 0.581, respectively, and the sensitivity was significantly higher than that of EV, VI, FI and VFI alone( P < 0.05). Conclusion The changes of endometrial volume and blood perfusion indexes in patients with severe intrauterine adhesion detected by three-dimensional energy Doppler can help predict the postoperative pregnancy of patients.