摘要
目的探讨B超联合宫腔镜在宫内妊娠组织残留诊断和治疗中的临床价值。方法 2009年1月-2010年1月22例因人工流产、药物流产、足月或引产及自然流产后B超提示宫内异常回声,其中19例门诊行宫腔镜检查及定位诊刮,另3例剖宫产术后因宫内残留妊娠组织周围血流丰富未行宫腔镜检查及定位诊刮,进一步住院行宫腔镜、宫腔镜联合腹腔镜和（或）超声监护手术。结果 19例门诊宫腔镜检查均提示宫内妊娠组织残留,定位诊刮病理：绒毛和（或）蜕膜样组织12例,纤维及骨组织1例,增生期或分泌期子宫内膜5例,未刮出组织物1例。B超联合宫腔镜术前诊断宫内残留妊娠组织阳性预测值68.4%（13/19）。6例门诊定位诊刮阴性者,4例行腹腔镜监护宫腔镜手术,术后病理为退变绒毛及蜕膜组织;2例行单纯宫腔镜手术,术后病理分别为退变绒毛及蜕膜组织和退变绒毛。宫腔镜手术未见宫内妊娠组织残留4例（18.2%）,其中药物流产后3例,人工流产后1例但合并宫腔粘连。单纯宫腔镜手术8例（36.4%）,腹腔镜监护宫腔镜手术6例（27.3%）,超声监护宫腔镜手术6例（27.3%）,腹腔镜和超声联合监护宫腔镜手术2例（9.1%）。合并宫腔粘连和（或）子宫不全中隔7例（31.8%）。22例随访12-24个月,平均18.8月：血hCG值升高的4例均在术后1-2周恢复正常;月经恢复正常,无阴道不规则出血,月经后超声提示宫腔内膜线清晰,无宫内异常回声。结论 B超联合宫腔镜检查及定位诊刮可以明确宫内残留妊娠组织的性质、位置、大小及是否合并其他宫内疾患,宫腔镜联合腹腔镜和（或）B超诊断和治疗宫内妊娠组织残留疗效确切。
Objective To evaluate the diagnostic and therapeutic value of hysteroscopy combined with B-ultrasonography for residual pregnancy tissues. Methods We collected 22 cases with intrauterine abnormal echo after induced abortion, medical abortion, normal pregnancy or spontaneous abortion from January 2009 to January 2010. Among the patients, 19 cases were diagnosed by hysteroscopy combined with location diagnostic curettage. The other 3 cases did not underwent hysteroscopy and location diagnostic curettage because of affluent bloodstream signal around the intrauterine pregnancy tissues. The 22 cases were diagnosed with residual intrauterine pregnancy tissues and thus recieved hysteroscopy or hysteroscopy combined with laparoscopy and （or） B-ultrasonography. Results Outpatient hysteroscopy suggested that the 19 cases all had residual intrauterine pregnancy tissues. There were nap and（or） decidua tissues in 12 of them by location diagnostic curettage, and fiber and osseous tissues in 1 of them, proliferative-phase or secretory-phase endometium were detected in 5 of them, and no tissue in 1 of them. The positive predictive value of B-ultrasonography combined with hysteroscopy was 68.4% （13/19）. In the 6 patients who were diagnosed as negative at outpatient by curettage,4 recieved hystersocopy under the miniotoring by laparoscopy, and postoperative pathological examination showed villus degenration and decidual tissues ;the other two recieved simple hysteroscopy and postoperative pathology showed villus degenration and decidual tissues plus villus degeneration, respectively. Hysteroscopic operation suggested normal uterine cavity in 4 cases （ 18. 2% , 3 cases after medical abortion, 1 case combined with intrauterine adhesion after induced abortion ）. Eight cases （36. 4% ） underwent only hysteroscopic surgery, 6 cases （27.3%） received laparoscopic-guided hysteroscopic surgery, 6 cases （27.3%） had B- ultrasonography-guided hysteroscopic surgery, and 2 cases （ 9.1% ） underwent laparoscopic and B-ultrasonography-guided hysteroscopic surgery. Seven cases were complicated with intrauterine adhesions and（or） uterine septum. Follow-up was achieved for 12 to 24 months in 22 cases with a mean of 18.8 months,during which,the 4 patients who had increased serum hCG showed the level of hCG decreased to a normal range in 1-2 months postoperatively, and the menstruation recovered at the same time without irregular vaginal bleeding;B-ultrasonography suggested normal intrauterine endometrium without abnormal echo. Conclusions Hysteroscopy combined with B-ultrasonography and location diagnostic curettage can confirm the nature, location, size of residual pregnancy tissues and complications. And hysteroscopy combined with laparoscopy and （or） B-ultrasonography is a safe and accurate diagnostic and therapeutic method for intrauterine pregnancy residues.
出处
《中国微创外科杂志》
CSCD
2011年第9期797-800,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
宫腔镜
B超
宫内妊娠组织残留
Hysteroscopy
B-ultrasonography
Residual pregnancy tissues
