宫腔粘连分离术前经阴道三维超声检查与术后妊娠结局的相关性  

Correlation between preoperative three-dimensional transvaginal ultrasound and postoperative pregnancy outcomes after hysteroscopic adhesiolysis

作　　者：周静[1] 徐大宝[2] 赵行平 李亚君[1] ZHOU Jing;XU Dabao;ZHAO Xingping;LI Yajun(Jiangwan Research Institute,Central South University&Changsha Jiangwan Hospital,Changsha 410005;Department of Gynecolgy,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学江湾研究院&长沙江湾医院,长沙410005 [2]中南大学湘雅三医院妇科,长沙410013

出　　处：《中南大学学报（医学版）》2023年第12期1830-1837,共8页Journal of Central South University ：Medical Science

基　　金：湖南省临床医疗技术创新引导项目(22021SK53704)。

摘　　要：目的:宫腔粘连主要因子宫内膜损伤导致术后妊娠结局差。因此术前评估宫腔,尤其是子宫内膜情况十分必要。本研究探讨在宫腔镜下宫腔粘连分离术(hysteroscopic adhesiolysis,HA)患者中,术前经阴道三维超声(three-dimensional transvaginal ultrasound,3D-TVS)成像特征与术后患者妊娠结局的相关性。方法:根据纳排标准,纳入2018年2月22日至10月31日在中南大学湘雅三医院或长沙江湾医院进行HA手术的401例患者,收集患者的术前3D-TVS影像学特征数据并随访术后妊娠结局,将影像学特征与宫腔粘连患者妊娠结局(活产和非活产)进行相关性分析及单因素和多因素logistic回归分析。结果:相关性分析结果显示子宫内膜厚度、子宫内膜回声、输卵管口可见性、子宫内膜血流灌注、双侧宫角间距和子宫内膜蠕动波与活产率均相关(均P<0.05);logistic回归分析发现活产组较非活产组子宫内膜厚度更厚(P<0.001)、子宫内膜回声更均匀(P<0.001)、输卵管开口数更多(P<0.001)、双侧宫角间距更宽(P<0.05),同时子宫内膜血流灌注情况更好,子宫内膜蠕动波不规则的例数更多、蠕动波缺乏的例数更少(均P<0.01)。结论:术前3D-TVS影像学表现与HA术后患者妊娠结局密切相关,术前3D-TVS可用于预测HA术后的妊娠结局。Objective:Uterine adhesion is mainly caused by endometrial injury,leading to poor postoperative pregnancy outcome.Therefore,preoperative evaluation on uterine cavity,especially endometrial condition,is very necessary.This study aims to explore the correlation between preoperative three-dimensional transvaginal ultrasound(3D-TVS)imaging characteristics and postoperative pregnancy outcomes after hysteroscopic adhesiolysis(HA).Methods:A total of 401 patients,who underwent HA surgery from February 22,2018 to October 31,2018 at the Third Xiangya Hospital of Central South University or Changsha Jiangwan Hospital,were enrolled,and we collected data regarding the preoperative 3D-TVS imaging characteristics and followed up their postoperative pregnancy outcomes.Correlation analysis and univariate and multivariate logistic regression analysis were performed between imaging features and pregnancy outcomes(live and non-live birth outcomes)in patients with intrauterine adhesion.Results:The results of correlation analysis showed that endometrial thickness,endometrial echo,visible tubal openings,endometrial blood flow,intercornual distance,and endometrial peristalsis were correlated with the live birth rate(all P<0.05).Logistic regression analysis revealed that in the HA patients with the live birth,the endometrial thickness was thicker(P<0.001),endometrial echo was more homogeneous(P<0.001),the number of tubal openings was more(P<0.001),the intercornual distance was wider(P<0.05),the endometrial blood flow,and irregular cases of endometrial peristaltic waves were more and cases of deficiency were fewer(both P<0.01)than those in the non-live birth group.Conclusion:Preoperative 3D-TVS imaging performance is closely related to pregnancy outcomes of HA patients,and preoperative 3D-TVS can be used to predict pregnancy outcomes after HA.

关 键 词：宫腔粘连 宫腔镜下宫腔粘连分离术 经阴道三维超声 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]