经阴道超声弹性成像评估宫颈锥切术后宫颈硬度的临床研究

目的探讨采用环形电刀切除术(LEEP)行宫颈锥切术后宫颈硬度改变及其对妊娠的影响。方法选取已行宫颈LEEP的高级别宫颈上皮内瘤变的育龄期患者63例,年龄24~38岁,平均年龄32.8岁。术前及术后6个月行常规经阴道超声和超声弹性成像,记录三支血流的阻力指数(RI)和搏动指数(PI)。非参数Mann-Whitney U检验比较LEEP后妊娠和流产患者宫颈硬度的差异。根据妊娠后分娩情况,将患者进行分组,即妊娠组(成功妊娠)和流产组(妊娠终止)。结果所有患者完成随访。37例患者在随访期间妊娠(妊娠组),26例患者流产(流产组)。两组患者年龄、体质量指数等一般资料比较,差异无统计学意义(P> 0.05)。两组患者的宫颈长度在LEEP术前和术后6个月差异均无统计学意义(t=1.73、4.79,P> 0.05)。妊娠组患者LEEP后6个月血流RI明显高于流产组患者(0.88±0.38 vs 0.43±0.23;t=0.32,P=0.007)。妊娠组LEEP后宫颈弹性评分明显低于LEEP术前(1.97±0.45)分vs (3.00±0.74)分;t=9.34,P=0.000]及流产组患者(1.97±0.45)分vs (2.92±0.54)分;t=10.32,P=0.000]。然而,流产组患者LEEP术前和术后宫颈弹性评分差异无统计学意义(2.92±0.54)分vs (2.96±0.65)分;t=1.35,P=0.592]。LEEP术后宫颈弹性评分预测妊娠后分娩的准确度为79.4%,灵敏度为85.3%,特异度为72.4%,阳性预测值为78.4%,阴性预测值为80.8%。结论超声弹性成像有助于评估LEEP后宫颈硬度改变,并可有效预测术后妊娠后分娩的可能性。

Transvaginal elastography for assessment of cervix stiffness after cervical conization

Objective To investigate stiffness change of cervix after loop electrosurgical excision procedure(LEEP) by transvaginal elastography and its potential impact for future pregnancy. Methods A total of 63 females with high-grade cervical intraepithelial neoplasia performed cervical LEEP in childbearing age were enrolled, which aged 24-38 years old with mean age of 32.8 years old. The conventional transvaginal ultrasonography and elastography before and 6-month LEEP were performed. The resistance index(RI) and pulsation index(PI) of three blood flows were recorded. The nonparametric Mann-Whitney U test was used to compare differences in cervical stiffness between pregnant and aborted female after LEEP. All of them were divided into pregnant group(n = 37, successful pregnancy) and abortion group(n = 26, pregnancy failure) according to childbirth condition. Results All patients completed 12-month follow-up, 37 cases(pregnancy group) were pregnant and 26 pregnancy failure(abortion group). There were no significant differences in general data of age and body mass index between 2 groups(P >0.05). There was no significant difference in cervical length before and 6-month after LEEP between 2 groups(t = 1.73, 4.79, P >0.05). The blood flow resistance index of 6-month after LEEP was significantly higher than that of abortion group(0.88 ± 0.38 vs 0.43 ± 0.23;t = 0.32, P = 0.007). The cervical elasticity score after LEEP in pregnant group was significantly lower than that of before LEEP(1.97 ± 0.45) scores vs(3.00 ± 0.74) scores;t = 9.34, P = 0.000] and abortion group(1.97 ± 0.45) scores vs(2.92 ± 0.54) scores;t = 10.32, P = 0.000]. But there was no significant difference in cervical elasticity before and after LEEP in abortion group(2.92 ± 0.54) scores vs(2.96 ± 0.65) scores;t = 1.35, P = 0.592]. The cervical elasticity score after LEEP predicted the accuracy of postpartum delivery was 79.4 %, sensitivity was 85.3 % and specificity was 72.4 %, the positive predictive value was 78.4 % and negative predictive value was 80.8 %. Conclusion It is demonstrated that elastography is useful in evaluating cervix stiffness after LEEP, which could also provide potential means to predict future pregnancy after LEEP.