经直肠超声观察底蜕膜部位血流情况预测药物流产结局的研究  

Study on Prediction of Drug Abortion through Transrectal Ultrasound Observation of Blood Flow of Decidua Basalis

作　　者：张立花[1] 张纪云[1] 刘现翠[1] 陈福美[1] 李恩苗[1] 刘韶平[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》2012年第8期558-562,共5页Reproduction and Contraception

摘　　要：目的:探讨预测药物流产后是否需清宫的超声诊断血流指标。方法:因非意愿妊娠自愿要求药物流产的早孕妇女孕囊排出后,行直肠超声检查,根据底蜕膜部位血流分成3种类型,Ⅰ型:无血流信号;Ⅱ型:星点状或短棒状血流信号,阻力指数(resistance index,RI)>0.6;Ⅲ型,火球状血流信号,RI≤0.6。比较3种类型患者药物流产后的转归情况,主要评价指标有流产后出血天数、出血量、是否施行清宫手术和清宫组织病理结果。结果:Ⅰ型20例,其中18例(90.0%)出血天数≤7 d,20例流产后出血量均<月经量,均未行清宫术;Ⅱ型64例,其中40例(62.5%)流血天数≤7 d,22例(34.4%)经宫缩剂及止血剂治疗后出血逐渐停止,仅2例(3.1%)出血时间>15 d,施行清宫术;Ⅲ型10例,流血天数均>15 d,流产后出血量均>月经量,全部予以清宫(100.0%)。结论:药物流产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型预示流产完全;Ⅱ型预示大多数能流产完全(96.9%),仅少数病例需要清宫处理;Ⅲ型预示不全流产。Objective： To explore predictors in ultrasonic diagnostic index which can determine whether curettage is needed or not after drug abortion. Methods： After discharge of the pregnancy sac, the decidua basalis transrectal ultrasound blood flow was divided into 3 types： type Ⅰ, no blood flow signal; type Ⅱ, star shape or rod-like flow signal, resistance indexe（RI ）〉 0.6; type Ⅲ, fireball shape bloodstream signal, RI ≤ 0.6. Outcomes of three types of abortion were compared through 4 indexes： bleeding days after abortion, amount of bleeding, whether currentage was operated or not and pathological findings. On the 15th day after drug abortion, patients were divided into complete abortion group and incomplete abortion group according to the decision criteria. Results： Type Ⅰ included 20 cases, of which 18 cases＇ （90.0%） bleeding days ≤ 7 d. The bleeding volume of all cases of type Ⅰ who did not have uterine curettage was less than menstrual volume. In 64 cases of type 11,40 cases＇ （62.5%） bleeding day were less than 7 d, 22 patients （34.4%） recivered after the treatment with contractions agent and astringent, and the bleeding time of only 2 cases＇ （3.1%） was more than 15 d, performing uterine curettage. Ten cases of type Ⅲ received uterine curettage （100.0%）, whose bleeding duration〉15 d, the amount of bleeding 〉 menstrual volume. Conclusion： The blood flow of decidua basalis transrectal color ultrasound application state can be divided into three types. Type Ⅰ indicates abortion completely; most of typeⅡ （96.9%） have complete abortion, only a few cases need anti-inflammatory cleaning uterine cavity; type Ⅲ indicates incomplete abortion.

关 键 词：药物流产 底蜕膜 直肠超声 彩色多普勒 子宫螺旋动脉 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]