经腹部超声实时引导在重度宫腔粘连宫腔镜手术中的应用价值  

Application value of real-time ultrasonic guidance during hysteroscopic adhesiolysis of severe intrauterine adhesions

作　　者：戴晨燕[1] 胡娅莉[1] 朱湘虹[1] 汤晓秋[1] 王慧焱[1] 朱慧 李亚玲[1] Dai Chenyan;Hu Yali;Zhu Xianghong;Tang Xiaoqiu;Wang Huiyan;Zhu Hui;Li Yaling(Department of Gynaecology and Obstetrics,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,210008

出　　处：《中华医学超声杂志（电子版）》2020年第5期447-450,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：中国科学院“干细胞与再生医学研究”战略性先导科技专项(XDA01030505);江苏省第十四批“六大高峰人才”高层次人才培养方案(WSW-074)。

摘　　要：目的探讨经腹部超声实时引导在重度宫腔粘连宫腔镜手术中的应用价值。方法回顾性分析2017年1月至2019年6月因重度宫腔粘连在南京鼓楼医院妇科手术室接受宫腔镜手术治疗的患者236例,所有患者均接受宫腔镜下粘连分离及治疗手术,并于术前接受专项超声检查、术中行经腹部超声实时引导及监护。结果236例重度宫腔粘连手术治疗病例中,粘连分离后脐带间充质干细胞或骨髓干细胞胶原膜支架植入共108例,节育环包裹生物膜植入15例,瘢痕化薄型子宫内膜生长因子内膜下多点注射71例。所有超声引导下宫腔镜手术均未发生术中子宫穿孔、异常出血,支架或生物膜植入到位,内膜下注射定位准确,宫腔解剖学形态基本恢复正常,手术成功率100%。结论经腹部超声实时引导宫腔镜手术治疗重度宫腔粘连为手术精准性及安全性提供了可靠保障,具有降低手术风险、减少手术并发症等优点,值得临床推广应用。Objective To explore the value of real-time transabdominal ultrasound monitoring in hysteroscopic surgery for severe intrauterine adhesion.Method Patients who received hysteroscopic adhesiolysis due to severe intrauterine adhesion at Nanjing Druw Tower Hospital from January 2017 to June 2019 were analyzed retrospectively.Transvaginal ultrasound and preoperative evaluation were performed routinely before the operation.Patients with complex surgery identified through clinical discussion and evaluation before surgery were given real-time monitoring by transabdominal ultrasound during the operation.Result A total of 236 cases of severe intrauterine adhesion were included,all of which underwent hysteroscopic adhesiolysis.After the operation,108 cases were implanted with umbilical cord mesenchymal stem cells or bone marrow stem cells on collagen membrane scaffolds,15 cases were implanted with biological membrane wrapped by contraceptive ring,71 cases of thin endometrium were injected with growth factor under the endometrium.No uterine perforation or abnormal bleeding occurred during surgery.Conclusion Real-time transabdominal ultrasound monitoring in hysteroscopic surgery for severe intrauterine adhesion has advantages of increasing the safety and success rate of the operation,decreasing the risk of the operation,and reducing the complications,which is worthy of clinical promotion.

关 键 词：超声检查 宫腔粘连 宫腔镜检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R713.4[医药卫生—诊断学]