产时子宫肌层厚度变化的动态观察

目的 :探讨分娩时宫底优势的形成机理。方法 :B超监测 2 6例进入活跃期的足月初产妇女的子宫肌层厚度的动态变化 ,由专人测量其子宫下段、前壁、宫底部和后壁的子宫肌层厚度 ,宫缩时测量子宫前壁肌层的厚度及人工破膜后测量子宫肌层的厚度。结果 :与对照组相比 ,活跃期的产妇子宫前壁、宫底部和后壁子宫肌层均明显变薄 (P <0 .0 1)。活跃期子宫下段肌层的厚度无明显变化 (P >0 .0 5 )。子宫前壁肌层厚度不受宫缩的影响 (P >0 .0 5 )。人工破膜时尽管羊水指数明显减少 ,但各观察部位子宫肌层厚度无变化 (P >0 .0 5 )。第二产程胎先露下降至棘下 3cm时前壁和宫底部肌层较活跃期明显增厚 (P <0 .0 1)。第三产程结束后 ,宫底部肌层仍较前壁和后壁薄 (P <0 .0 1)。结论 :本研究提示子宫收缩力的大小和方向并不是由子宫肌层的不对称性增厚决定的 ,而可能与宫底表面积的增加导致肌力的增加有关     

Myometrial thickness in pregnancy: longitudinal sonographic study.

The purpose of this study was to evaluate in vivo the changes in myometrial thickness throughout pregnancy. Myometrial thickness was measured in 25 singleton uncomplicated pregnancies. Ultrasonographic sagittal and transverse sections were used to measure uterine wall thickness from the low anterior wall (lower segment) and the anterior, posterior, right, and left walls of the upper segment and from the fundus. In each case four measurements were made in the second and third trimesters. Myometrial thickness of the upper uterine segment remains fairly constant in the first and second trimesters of pregnancy, whereas a significant linear trend was found between a decreasing thickness of the lower uterine segment and advancing gestational age. Myometrial thickness is significantly increased behind the placental insertion site as compared to other portions of the uterine wall. These data may serve as baseline reference values for further studies in the antepartum fetal surveillance of high-risk pregnancies.     

经阴道超声判断子宫内膜癌肌层浸润深度

术前应用经阴道超声（ＴＶＳ）对２７例子宫内膜癌患者进行了检查，测量子宫肌层浸润深度，并与术后组织病理学结果对照。结果显示：２１例可见内膜回声，其平均厚度为１４．５±５．４ｍｍ（４．８～２５ｍｍ）。ＴＶＳ准确判断出８５．２％患者的肌层浸润深度，２２例患者（８１．５％）的超声分期正确。彩色多普勒显示肿瘤内或周围有血流，深肌层浸润者的阻力指数和搏动指数明显低于无肌层浸润者。认为ＴＶＳ对子宫内膜癌的术前分期和制定个体化治疗方案具有重要作用。