经直肠超声对药物流产中底蜕膜部位血流的研究  

Study of Blood Flow of Decidua Basalis in Medical Abortion by Transrectal Ultrasound

作　　者：张立花[1] 刘韶平[2] 陶国伟[2] 赵书水[1] 展新风[2] 程琳[2] 

机构地区：[1]济南市第三人民医院,济南250101 [2]山东大学齐鲁医院,济南250012

出　　处：《生殖与避孕》2007年第8期541-544,共4页Reproduction and Contraception

摘　　要：目的:寻找可判断药物流产后是否需清宫的超声影像学指标。方法:孕囊排出后,即刻应用直肠彩色超声观测底蜕膜部位的血供状态,并分成3型,Ⅰ型:无血流信号;Ⅱ型:星点状或短棒状血流信号,RI>0.6;Ⅲ型:火球状血流信号,RI≤0.6。比较3种血流信号类型流产的转归。用以下4项指标评价流产转归:流产后流血天数、流血量、是否需清宫、病理结果。结果:Ⅰ型10例,其中9例(90%)流血天数≤7d,全部病例流血量均<月经量,超声复查均无残留物,均不需清宫。Ⅱ型32例,其中20例(62.5%)血流时间≤7d,21例(65.6%)流血量<月经量,31例(96.9%)超声复查无残留,1例(3.1%)施行清宫术。Ⅲ型5例,流血天数均>15d,流血量均相当于月经量,超声显示宫内均有组织残留,全部行清宫术。结论:药流后底蜕膜部位血流状态可应用经直肠彩色超声将其分为3种类型:Ⅰ型预示完全流产;Ⅱ型大部分病例流产完全,仅3.1%的病例流产不全需清宫;Ⅲ型预示不全流产,100%需要清宫。Objective： To determine the criteria of diagnosing incomplete abortion by ultrasound imaging. Methods： The decidua basalis was investigated by transrectal color Doppler ultrasonography before taking medicine. Abortion tablets were taken. The technique of CDFI （color Doppler flow imaging） via transrectal ultrasound was performed to monitor the blood supply status at the decidua basalis after pregnancy sac exclusion. The situation was divided into three types： （1）no blood signals in the decidua; （2）star-like or short rod appearance, RI〉0.6; （3）fireball blood signals, RI ≤ 0.6. In addition, a routine uterine re-examination was carried out 15 d later. Four indicators were used to evaluate the outcome： the bleeding days after sac exclusion; the amount of bleeding blood; curettage; pathology. Results： Of 10 cases in Type Ⅰ, the bleeding days of 9 cases （90%） were ≤ 7 d, the amount of bleeding blood of all cases was less than menstrual volume, no residuum, no case required curettage. Of 32 cases in Type Ⅱ, the bleeding days of 20 cases （62.5%） were ≤ 7 d, the amount of bleeding blood of 21cases （65.6%） 〈menstrual volume; 31 cases（96.9%） had residuum by ultrasound imaging, 1 case（3.1%） required curettage. Five cases were in type Ⅲ, the bleeding days of all cases 〉15 d, the amount of bleeding blood 〉 menstrual volume, all cases had residuum by ultrasound imaging and had curettage. Conclusion： The status of blood flow images at the decidua basalis after the medical abortion was divided into three types by transrectal ultrasound, type Ⅰ means complete abortion, while most of type Ⅱ reveals complete abortion and only 3.1% of cases means the possible residua and required curettage. Type Ⅲ indicates incomplete abortion and 100% needs curettage.

关 键 词：彩色多普勒 药物流产 底蜕膜部位 直肠超声 子宫螺旋动脉 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]