三维超声在子宫中隔切开术预后评估中的价值  

Value of Three-dimensional Transvaginal Ultrasound in the Prognostic Evaluation of Uterine Septum Incision

作　　者：宋雪凌[1] 王丽颖[1] 张红霞 杨艳[1] 张佳佳[1] 马彩虹[1] Song Xueling;Wang Liying;Zhang Hongxia(Center of Reproductive Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院生殖医学中心,北京100191

出　　处：《中国微创外科杂志》2019年第1期26-30,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：国家重点研发计划课题(2016YFC1000201);院内重点项目(Y67437-10)

摘　　要：目的探讨经阴道三维超声成像(3-dimentional transvaginal ultrasound,3DTVU)对子宫中隔切开术后(transcervical incision of septum,TCIS)是否需要再次手术的预测价值。方法 2015年1月～2017年12月行子宫中隔切开术162例,年龄(30. 9±4. 6)岁,子宫完全中隔34例,不完全中隔128例。术后2个月行三维超声检查,记录残留中隔的长度及宫底内膜内陷的夹角,复查宫腔镜,记录宫腔修复、粘连情况及中隔残留长度,并与超声测量结果相比较。结果 (1)三维超声显示37例(22. 8%)宫腔形态正常,三维超声提示子宫内膜回声不均诊断宫腔粘连的灵敏度为100%(10/10),特异度92. 6%(25/27)。(2)其余125例超声检查见残留中隔,可测量到内膜凹陷长度和夹角。取120°为诊断角度,灵敏度92. 6%(63/68),特异度35. 1%(20/57)。内膜夹角> 120°的患者80. 0%(20/25)宫腔镜探查为弓形及正常宫腔形态(阴性预测值),无需宫腔镜手术;夹角≤120°的患者63. 0%(63/100)存在残隔及宫腔粘连(阳性预测值),需二次宫腔镜手术。结论三维超声提示宫腔形态正常且子宫内膜回声均匀可不行二次宫腔镜检查;若超声显示宫腔形态正常但回声欠均,或子宫内膜夹角≤120°,建议二次宫腔镜探查。Objective To explore the predictive value of three-dimensional ultrasound imaging (3DTVU) for the necessity of second-look surgery after uterine septum incision. Methods From January 2015 to December 2017,162 patients with septate uterus underwent transcervical incision of septum (TCIS) operation in our center.The average age was (30.9±4.6) years old.There were 34 cases of complete uterine septum and 128 cases of incomplete uterine septum.All the patients underwent 3DTVU and second-look surgery two months later.The length of the remaining septum and the angle of internal indentation in the uterus cavity were measured by 3DTVU.The repair status of uterine cavity,the adhesion of uterus cavity and the length of remaining septum were all recorded under the second-look surgery and compared with the results by 3DTVU. Results ① The 3DTVU image showed normal cavity in 37 patients (22.8%).The sensitivity of 3DTVU diagnosis was 100%(10/10) while the specificity was 92.6%(25/27) when the 3DTVU showed heterogeneous endometrial echoes,and confirmed as adhesions by hysteroscopy.② The other 125 cases had a residual uterine septum,and the angle of internal indentation could be measured by 3DTVU.The angle >120° were considered as diagnosis value.The sensitivity was 92.6%(63/68) while the specificity was 35.1%(20/57).A total of 80% of the patients with angle over 120° were observed with normal uterine cavity (negative predictive value).In patients with an angle less than 120°,63.0%(63/100) patients had rudimental septum and intrauterine adhesions (positive predictive value),which need further surgery.Conclusions If 3DTVU indicates the morphology of the uterine cavity is normal and accompanied with homogeneous endometrial echo,the second-look operation could be omitted.However,if the 3DTVU indicates the morphology of the uterine cavity is normal but accompanied with anheterogeneous endometrial echo or the angle of the internal indentation is less than 120°,a second-look hysteroscopy is highly suggested.

关 键 词：三维经阴道超声 经宫颈子宫中隔切开术 内膜夹角 二次探查手术 

分 类 号：R713.4[医药卫生—妇产科学] R445.1[医药卫生—临床医学]