药物流产后宫内残留物的腹部超声检测及其对清宫术时机的指导作用

doi:10.7517/issn.1674-0475.190709

摘要/Abstract

摘要： 本文对药物流产后宫内残留物的腹部超声检测及其对清宫术时机的指导作用进行了探讨。研究对象为2017年4月~2018年10月我院妇科收治的164例药物流产后宫内组织残留患者，所有患者均行经腹彩色多普勒超声检查，观察宫腔内异常回声团和宫内血流信号及频谱，并记录患者治疗情况和病理结果。依据患者保守治疗成功或转归清宫术分为成功组和转归组，采用多因素Logistic回归方程分析对保守治疗失败转归清宫术有影响的因素。结果显示，164例患者中，79例（48.17%）患者超声检查显示存在滋养血流，其中47例（59.49%）患者采取了清宫术治疗，其余32例（40.51%）患者保守治疗失败转归清宫术治疗；85例（51.83%）患者超声检查显示无滋养血流，其中73例（85.88%）采取保守治疗成功，其余12例（14.12%）患者保守治疗失败转归清宫术；成功组（n=73）和转归组（n=44）患者在就诊时阴道出血时间、阴道出血持续时间、流产次数、宫内残留物大小、滋养血流信号检出率等方面的比较，差异均具有统计学意义（P<0.05）；多因素Logistic回归方程分析结果显示，就诊时阴道出血时间、残留物大小、流产次数、超声检查存在滋养血流均为保守治疗转归清宫术的独立影响因素（P<0.05）。本文结果证实，腹部超声检测显示宫腔内异常回声团块存在滋养血流信号，可作为药物流产不全患者行清宫术治疗的手术指征，有利于改善患者预后。

关键词: 药物流产, 宫内残留物, 经腹彩色多普勒超声检查, 滋养血流, 清宫术

Abstract: In this paper, the abdominal ultrasound testing and its guidance on the timing of uterine curettage for patients with intrauterine residue after medical abortion were investigated. 164 cases of patients with intrauterine residue after medical abortion enrolled in the department of gynecology of our hospital from April 2017 to October 2018 were selected as research objects. All patients received abdominal ultrasound testing, the abnormal intrauterine echogenic mass, intrauterine blood flow signal and spectrum were observed, the treatment and pathological results were recorded. Patients were divided into successful group and the outcome group, and the influencing factors of conservative treatment failed to uterine curettage were analysed by multi-factor logistic regression. Results showed that, among the 164 cases of patients, 79(48.17%) cases were detected with nourish blood flow by ultrasonography, 47(59.49%) cases received uterine curettage, and 32(40.51%) received curettage treatment when the conservative treatment failed. 85(51.83%) cases were detected without nourish blood flow by ultrasonography, 73(85.88%) cases received conservative treatment, and 12 (14.12%) received curettage treatment after conservative treatment failed. There were statistically significant differences on vaginal bleeding time, duration of vaginal bleeding, number of miscarriages, intrauterine residue, and detection rate of nourish blood flow in presentation successful group (n=73) and the outcome group (n=44) (P<0.05). Multi-factor logistic regression analysis showed that vaginal bleeding time, number of miscarriages, intrauterine residue, and ultrasonography detected with nourish blood flow were the independent influencing factors of conservative treatment failed to uterine curettage (P<0.05). This study confirms that abdominal ultrasonography shows the presence of nourish blood flow signal in abnormal echogenic mass can be used as a surgical indication for uterine curettage of patients with intrauterine residue after medical abortion, it is beneficial to improve the prognosis of patients.

Key words: medical abortion, intrauterine residue, transabdominal color doppler ultrasonography, nourish blood flow, uterine curettage

刘佳, 徐珍望. 药物流产后宫内残留物的腹部超声检测及其对清宫术时机的指导作用[J]. 影像科学与光化学, 2020, 38(1): 67-72.

LIU Jia, XU Zhenwang. Abdominal Ultrasound Testing and Its Guidance on the Timing of Uterine Curettage for Patients with Intrauterine Residue after Medical Abortion[J]. Imaging Science and Photochemistry, 2020, 38(1): 67-72.

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