经阴道多普勒超声对药物流产后宫腔残留的诊断价值

目的 探讨经阴道多普勒超声对药物流产后宫腔残留的诊断价值,研究各参数对诊断的意义.方法 选取2013年12月至2016年12月在南京医科大学附属无锡市人民医院妇科门诊及住院部经药物流产后阴道流血超过2周的患者102例,使用多普勒诊断仪进行超声诊断,超声诊断为有残留的患者进行清宫术,刮出物进行病理学诊断.超声未诊断出残留患者结合人绒毛膜促性腺激素(hCG)水平进行抗炎或清宫治疗.结果 102例患者中有87例经超声显示有宫腔残留,其中82例经病理学检测为变性、坏死或机化的蜕膜、绒毛组织残留.宫腔残留组的子宫内膜厚度(ET)值(t=7.872,P=0.000)、血流信号异常(χ2=71.893,P=0.000)、团块回声(χ2=90.527,P=0.000)的患者所占比例均显著高于无残留组,阻力指数(RI)值低于无残留组(t=-4.055,P=0.000).单个指标时准确度最高的为ET>10mm、团块回声和血流信号,其准确度分别为91.18%、89.22%和86.27%.使用两个或多个超声指标合并诊断宫腔残留可显著提高诊断的准确率.血流信号和团块回声合并后准确率可提高至89.22%.合并血流信号、团块回声和ET≥10mm三项的诊断准确率与血流信号和团块回声相似.结论 经阴道彩色多普勒超声检测能够显示宫腔残留情况,其中团块回声和血流信号异常是重要的参考指标,对药物流产后宫腔残留具有较高的诊断价值.

Diagnostic value of transvaginal doppler ultrasound for intrauterine residue of medical abortion

Objective To evaluate the diagnostic value of transvaginal doppler ultrasound for intrauterine residue of medical abortion and to analyze the value of each parameter on diagnosis .Methods One hundred and two patients experiencing vaginal bleeding after medical abortion for more than 2 weeks treated in gynecological clinic and inpatient department in Wuxi People ' s Hospital Affiliated to Nanjing Medical University from December 2013 to December 2016 were enrolled in this study .Doppler sonography diagnosis was applied for diagnosis.Patients diagnosed with intrauterine residue by ultrasonography were treated with dilation and curettage therapy .Pathological diangosis was done to scraps .Patients detected with no intrauterine residue by ultrasound were treated with anti -inflammatory drug or dilation and curettage therapy according to their human chorionic gonadotropin ( hCG) level.Results Eighty-seven patients in 102 were revealed with intrauterine residue , and among them 82 patients were diagnosed with degeneration , necrosis or decidua or villus tissue remains through pathological exams .Endometrial thickness ( ET) value of patients in residue group was significantly higher than that in non residue group (t=7.872, P=0.000).Proportion of patients with abnormal blood flow signal (χ2 =71.893, P=0.000) and hyperechoic mass (χ2 =90.527, P=0.000) in residue group was higher than that in non residue group .Resistance index ( RI) in residue group was lower than that in non residue group (t=-4.055, P=0.000).When single indicator was used to diagnose intrauterine residue , ET>10mm, blood flow signal and hyperechoic mass obtained highest accuracy of 91.18%, 89.22% and 86.27%, respectively.The diagnostic accuracy could be improved remarkably by referring to two or more indicators .Combination of blood flow signal and hyperechoic mass could improve the accuracy to 89.22%.Accuracy of combined test of blood flow signal , hyperechoic mass and ET≥10 mm was similar with that of hyperechoic mass combined with blood flow signal .Conclusion Transvaginal doppler ultrasound can indicate intrauterine residue . Hyperehoic mass and abnormal blood flow signal are important reference indexes , which has great diagnostic value for intrauterine residue of medical abortion .