剖宫产后子宫憩室的MRI评估

Caesarean scar diverticulum:evaluation of the severity of prolonged postmenstrual bleeding with MRI

目的探讨剖宫产后子宫憩室MRI测量参数与患者月经时间延长严重程度的关系,提高对剖宫产后子宫憩室的认识。方法选取我院221例剖宫产后子宫憩室患者,根据患者月经延长时间将其分为轻症组(≤14天,119例)和重症组(>14天,102例)。回顾性分析患者的盆腔MRI图像,观察并记录子宫位置(前位、中位及后位)和子宫憩室形状(半圆、烧瓶、楔形及不规则),测量憩室残存肌层厚度(residual myometrial thickness,RMT)、憩室深度(Depth)及子宫憩室体积(VOI)。采用统计学方法比较两组患者以上各测量参数的差异。结果前位子宫125例,中位9例,后位87例,两组患者的子宫位置差异无统计学意义(P=0.661)。憩室形状半圆形137例,烧瓶状40例,楔形31例,不规则形13例,两组患者的憩室形状差异无统计学意义(P=0.821)。重症组RMT(2.5±1.3)mm<轻症组RMT(3.0±1.4)mm,差异有统计学意义(P=0.014)。憩室深度及憩室体积在两组间差异无统计学意义(P=0.579,P=0.709)。结论剖宫产后子宫憩室RMT与月经延长严重程度相关。

Objective To discuss the relationships between the measurement parameters of MRI and the severity of prolonged postmenstrual bleeding,increasing the understanding of caesarean scar diverticulum(CSD).Methods 221 women with a history of CSD in our hospital were enrolled.The patients were divided into mild group(≤14 days,119 cases)and severe group(>14 days,102 cases)according to the duration of menstruation.MR images were analyzed retrospectively.The uterine position(anterior,middle or posterior)and the shape of CSD(semi-circular,flask,wedge-shaped or irregular)were observed and recorded.The parameters including the residual myomertrial thickness(RMT),the depth and volume of CSD were measured.Statistical methods were used to compare the differences of the above parameters of CSD between the two groups.Results No significant difference was found in uterine position and the shape of CSD between the two groups(P=0.661,P=0.821).Severe group had a thinner RMT than mild group(2.5±1.3)mm vs(3.0±1.4)mm,with a significant difference(P=0.014).The depth and volume did not differ significantly between two groups(P=0.579,P=0.709).Conclusion The RMT of CSD is associated with the severity of prolonged postmenstrual bleeding.