三维能量多普勒超声参数对重度宫腔粘连松解术后疗效评估

Efficacy of severe intrauterine adhesiolysis of patients evaluated by three-dimensional energy Doppler ultrasonography

目的:探讨子宫内膜三维能量多普勒超声参数对宫腔镜下重度宫腔粘连松解术(TCRA)疗效评价及对宫腔粘连复发的预测价值。方法:选择2018年1月-2020年1月本院行TCRA手术的重度宫腔粘连(IUA)患者126例,按照术后粘连复发情况分为未复发组与复发组,在治疗前后行三维能量多普勒超声检查,比较治疗前后子宫内膜超声参数及对宫腔粘连复发的预测价值。结果:宫腔形态评估为治愈和有效的患者,治疗后子宫内膜容积(EV)、血管指数(VI)、血流指数(FI)、血管血流指数(VFI)均高于治疗前(P<0.001),宫腔形态评估为无效的患者治疗前后上述指标无差异(P>0.05);治疗后12个月内宫腔粘连复发率23.7%,未复发组子宫内膜VI、FI、VFI大于复发组(P<0.05),子宫内膜EV复发与未复发组无差异(P>0.05)。治疗后子宫内膜FI、VFI对宫腔粘连复发有预测效能(P<0.05),VFI预测效能更佳,VI对宫腔粘连复发无预测效能(P>0.05)。结论:子宫内膜三维能量超声参数可较好的评价TCRA手术治疗效果,还可以预测宫腔粘连复发风险。

Objective:To investigate the effectiveness of severe intrauterine adhesiolysis for treating patients with severe intrauterine adhesions(IUA)evaluated by three-dimensional energy Doppler ultrasonography parameter,and to study the value of ultrasonography for predicting the recurrence of IUA.Methods:126 patients with severe IUA who underwent intrauterine adhesiolysis were selected as the research subjects from January 2018 to January 2020.According to whether postoperative adhesions recurred,these patients were divided into group A(patients without adhesions recurrence)and group B(patients with adhesions recurrence).All of The patients were given three-dimensional energy Doppler ultrasonography examination before and after intrauterine adhesiolysis.The ultrasonography parameter and the recurrence of IUA of the patients before and after treatment were compared,and the predictive value of ultrasonography parameter for intrauterine adhesion recurrence was analyzed.Results:The values of endometrial volume(EV),vascular index(VI),blood flow index(FI),and vascular blood flow index(VFI)of the patients with cured and effectiveness after treatment evaluated by uterine morphology were significant higher than those before treatment(P<0.001),while which of the patients with invalid treatment evaluated by uterine morphology had no significant different from the patients before treatment(P>0.05).Within 12 months after treatment,the recurrence rate of intrauterine adhesions of these patients was 23.7%.The endometrial VI,FI,and VFI values of the patients in group A were significant higher than that of the patients in group B(P<0.05),but there was no significant difference in endometrial EV value of the patients between group A and B(P>0.05).After treatment,the endometrial FI and VFI values had some predictive values for the recurrence of intrauterine adhesions(P<0.05),and the VFI value had the better predictive effect,while VI value had no predictive effect for the recurrence of intrauterine adhesions(P>0.05).Conclusion:The endometrial parameters by three-dimensional energy Doppler ultrasonography can better evaluate the therapeutic effect of intrauterine adhesiolysis,and can predict the risk of recurrence of intrauterine adhesions.