经阴道彩色多普勒超声在宫腔内残留物鉴别诊断中的应用

目的探讨经阴道超声检查对宫腔内残留物的鉴别诊断价值。方法78例流产后阴道流血超过2周患者,经阴道超声检查发现宫内异常团状回声,观察其二维声像图和团块内、子宫肌壁的彩色血流及多普勒频谱;根据清宫组织病理结果分为绒毛组织、变性的绒毛织组和蜕膜组织,共3组。结果残留绒毛组织为不均匀低回声,变性绒毛组织和脱膜组织为不均匀高回声;残留绒毛组织内部及相邻的子宫肌壁血流信号丰富;变性绒毛组织内部少血流信号,相邻子宫肌壁血流信号丰富;蜕膜组织内部和相邻子宫肌壁少或无血流信号,差异均有统计学意义(P<0.01)。频谱多普勒显示频谱形态以及阻力指数无明显差异(P>0.05),频谱为类滋养血流频谱,阻力指数在0.37~0.45。结论经阴道超声对早孕流产后的宫内残留物可以做出比较明确的诊断,具有鉴别诊断意义。

Application of intrauterine residue by transvaginal color Doppler flow imaging

Objective To explore the diagnostic value of transvaginal color Doppler flow imaging for detecting intrauterine residue. Methods Seventy-eight patients with abnormal echo in uterus after abortion were divided into three groups according to pathological report(chorionic villi, metamorphic chorionic villi, decidua group). The echo of intrauterine residue,the color flow and the Doppler spectral imaging of inatrauterine residue and myometrium were observed. Results The echo of chorionic villi was hypoechoicity while that of metamorphic chorionic villi and deciduas was hyperechogenicity. The color flow of intrauterine residue and myometrium in chorionic villi group was affluent,it was scanty in metamorphic chorionic villi,but affluent in myometrium, it was scanty in decidua. There was significant difference in the echo and the color flow of intrauterine residue and myometrium(P<0.01). Doppler spectral imaging showed that spectral appearance and resistance index had no significant differance(P>0.05).The Doppler spectral appearance was similar to trophoblastic flow with resistance index ranged from 0.37 to 0.45.Conclusion Transvaginal ultrasonography has practical value in the diagnosis and differential diagnosis of intrauterine residue after abortion.