三维超声参数对子宫内膜息肉合并不孕症患者术后妊娠结局的预测价值

Predictive value of three-dimensional ultrasound parameters for postoperative pregnancy outcome in patients with endometrial polyps combined with infertility

目的观察子宫内膜息肉(endometrial polyp,EP)合并不孕症患者宫腔镜术后三维超声参数,分析其对妊娠结局的预测价值。方法选取2020年3月至2021年3月于永康医院进行检查的80例EP合并不孕症患者作为研究对象,所有患者均接受宫腔镜手术治疗,根据术后临床妊娠情况分为妊娠成功组(n=62)和妊娠失败组(n=18)。比较两组患者宫腔镜术后子宫内膜形态学特征(子宫内膜厚度、子宫内膜容积、子宫内膜形态分型)及子宫动脉与螺旋动脉血流动力学参数[搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI),测量收缩期峰值血流速度(peak systolic velocity,PSV)],采用多因素Logistic线性回归分析超声参数与EP合并不孕症患者妊娠失败的关系。结果两组患者年龄、不孕症类型、不孕症病程、子宫内膜形态分型比较,差异均无统计学意义(P>0.05),妊娠成功组子宫内膜厚度、子宫内膜容积均显著大于妊娠失败组(P<0.05),妊娠成功组子宫动脉及螺旋动脉的PI、RI均显著低于妊娠失败组(P<0.05),PSV显著高于妊娠失败组(P<0.05)。Logistic回归分析结果显示,子宫内膜厚度,子宫动脉PI、RI、PSV,螺旋动脉PI、RI、PSV均为EP合并不孕症患者妊娠失败的独立影响因素(P<0.05)。结论EP合并不孕症患者宫腔镜术后三维超声参数与妊娠结局有关,其中子宫内膜厚度及子宫动脉、螺旋动脉血流动力学参数是妊娠失败的独立影响因素,对妊娠结局的预测具有一定的价值。

Objective To investigate the predictive value of three-dimensional ultrasound parameters after hysteroscopy in patients with endometrial polyp(EP)combined with infertility and to analyze their predictive value for pregnancy outcome.Methods A total of 80 patients with EP combined with infertility examined in Yongkang Hospital from March 2020 to March 2021 were selected for the study.All patients were treated with hysteroscopic surgery and were divided into a successful pregnancy group(n=62)and a failed pregnancy group(n=18)according to their clinical pregnancy status after surgery.The endometrial morphological characteristics(endometrial thickness,endometrial volume,and endometrial morphology classification),hemodynamic parameters of uterine artery and spiral artery[pulbeat index(PI),resistance index(RI),and peak systolic velocity(PSV)]were compared between the two groups after hysteroscopy.Multi-factor Logistic linear regression was used to analyze the relationship between ultrasound parameters and pregnancy failure in patients with EP combined with infertility.Results Compared with the age,type of infertility,duration of infertility and endometrial morphological typing of the two groups,the differences were not statistically significant(P>0.05).The endometrial thickness and endometrial volume were significantly greater in the successful pregnancy group than those in the failed pregnancy group(P<0.05).The PI and RI of both uterine and spiral arteries were significantly lower in the successful pregnancy group than those in the failed pregnancy group(P<0.05),and the PSV was significantly higher in the failed pregnancy group(P<0.05).Logistic regression analysis showed that endometrial thickness,uterine artery PI,RI,PSV,spiral artery PI,RI,PSV were independent influencing factors of pregnancy failure in EP patients with infertility(P<0.05).Conclusions Three-dimensional ultrasound parameters after hysteroscopy in patients with EP combined with infertility are associated with pregnancy outcome,with endometrial thickness and uterine artery and spiral artery haemodynamic parameters being independent influences on pregnancy failure and valuable in predicting pregnancy outcome.