术前经阴道三维超声检查对术中宫腔粘连判断的价值

The value of preoperative transvaginal three-dimensional ultrasound in the evaluation of hysteroscopic adhesiolysis

目的探讨术前经阴道三维超声检查(3D-TVUS)对判断宫腔粘连分离术(HA)的指导价值。方法收集2018年3—12月本院诊治的中重度宫腔粘连患者,筛选182例术前行3D-TVUS者作为研究组,以一般资料进行1:1匹配,将180例术前未行3D-TVUS者作为对照组,比较分析两组术前一般资料、术中情况及术后美国生育协会(AFS)评分。结果研究组和对照组中术前仅一侧输卵口可见者分别为75例和74例,HA术后输卵管口分离显露率分别为29例(38.7%,29/75)和17例(23.0%,17/74);研究组和对照组中术前双侧输卵管口不可见者分别为107例和106例,HA术后单侧输卵管口分离显露率分别为38例(35.5%,38/107)和18例(17.0%,18/106),双侧显露率分别为39例(36.5%,39/107)和5例(4.7%,5/106);研究组和对照组术后AFS评分分别为(5.0±2.5)分和(6.4±2.9)分,两组比较,差异均有统计学意义(P <0.05)。结论术前3D-TVUS可提高术者HA术中输卵管口分离显露率,进而改善HA术后疗效。

Objective To study the value of preoperative transvaginal three-dimensional ultrasound in evaluating hysteroscopic adhesiolysis(HA). Methods The patients with moderate to severe intrauterine adhesions treated in our hospital from March to December 2018 were collected, and 182 patients who had undergone 3 D-TVUS before surgery were selected as the study group. The general data were used for 1:1 matching, and 180 patients did not perform 3 D-TVUS before HA were enrolled as the control group. Preoperative general information, intraoperative findings and postoperative American Fertility Society(AFS) scores of the two groups were analyzed and compared. Results For those whose unilateral fallopian tube ostium was visible before surgery, the exposure rates of the study group(75 cases)and control group(74 cases) were 29 cases(38.7%) and 17 cases(23.0%) respectively;Among the patients whose bilateral fallopian tubes were not visible before surgery, the exposure rates of unilateral fallopian tube separation after HA in the study group(107 cases) and the control group(106 cases) were 38 cases(35.5%) and 18 cases(17.0%), respectively, the bilateral exposure rates were 39 cases(36.5%) and 5 cases(4.7%). The postoperative AFS scores of the study and control groups were(5.0±2.5) and(6.4±2.9) respectively. The differences between the two groups were statistically significant(P < 0.05). Conclusions Preoperative 3 D-TVUS can increase the exposure rate of tubal ostia and improve the curative effect of HA.