经阴道三维超声评价AM患者ER的应用研究

Evaluation of endometrial receptivity by transvaginal three-dimensional ultrasound in patients with adenomyosis

目的探讨经阴道三维超声在评估子宫腺肌病(AM)患者子宫内膜容受性(ER)中的应用价值。方法选取2021年6月~2022年1月于江苏省中医院门诊确诊为AM的患者45例(AM组)行前瞻性研究,并选取34例同期健康产后女性作为对照组。在黄体中期行二维及三维超声检查,比较两组子宫内膜的厚度、回声类型、血流分级及子宫内膜、子宫内膜下的容积、血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)。在经阴道三维超声子宫冠状面上观察子宫内膜-肌层结合带(JZ)的形态,测量JZ的最大厚度(JZ_(max))、最小厚度(JZ_(min))、最大厚度与最小厚度的差值(D_(JZ))和平均厚度(M_(JZ))。结果AM组与对照组的年龄、二维超声指标(子宫内膜厚度、回声类型、血流分级)和部分三维超声指标(子宫内膜及子宫内膜下容积、子宫内膜及子宫内膜下VI、FI、VFI)的差异均无统计学意义(P>0.05)。经阴道三维超声观察子宫冠状面,AM患者的JZ形态不规则,厚薄差异大,AM组的JZ_(max)、D_(JZ)大于对照组,AM组的JZ_(min)小于对照组,差异均有统计学意义(P<0.05)。两组间M_(JZ)的差别差异无统计学意义(P>0.05)。结论经阴道三维超声在评价AM患者的ER方面具有重要价值,可为临床诊疗AM患者的不孕症提供影像学依据,其中需要特别关注的三维超声指标包括三维重建后子宫冠状面上的JZ_(max)、JZ_(min)和D_(JZ)。

Objective To evaluate the value of transvaginal three-dimensional ultrasound in endometrial receptivity(ER)in patients with adenomyosis(AM).Methods Forty-five patients diagnosed with AM in our hospital from June 2021 to January 2022 were prospectively studied as AM group,and thirty-four healthy postpartum women were selected as the control group.Two-dimensional and three-dimensional ultrasound examinations were performed in the middle luteal phase.Endometrium thickness,echo types,blood flow grade,endometrial and subendometrial volume,endometrial and subendometrial vascularization index(VI),flow index(FI),vascularization flow index(VFI)were compared between the two groups.The morphology of uterine junctional zone(JZ)was observed on the coronal plane of the uterus by transvaginal three-dimensional ultrasound.The maximum thickness(JZ_(max)),minimum thickness(JZ_(min)),difference between maximum and minimum thickness(D_(JZ))and average thickness(M_(JZ))of_(JZ)were measured.Results There were no significant differences between AM group and control group in age,two-dimensional ultrasound indexes(endometrial thickness,echo type,blood flow grade)and some three-dimensional ultrasound indexes(endometrial and subendometrial volume,endometrial and subendometrial VI,FI,VFI)(P>0.05).The_(JZ)in AM patients was irregular in shape,and the thickness difference was large._(JZ)max and D_(JZ)in AM group were higher than those in control group,_(JZ)min in AM group was lower than that in control group,and the differences were statistically significant(P<0.05).There was no significant difference in M_(JZ)between the two groups.Conclusion Transvaginal three-dimensional ultrasound has important value in evaluating ER in AM patients,and can provide imaging basis for clinical diagnosis and treatment of infertility symptoms in AM patients.Among them,three-dimensional ultrasound indicators that need special attention include_(JZ)max,_(JZ)min and D_(JZ)on the coronal plane of uterus after three-dimensional reconstruction.