摘要
目的运用超声多普勒检测剖宫产疤痕妊娠患者行子宫动脉栓塞术后子宫肌层及内膜动脉的PI、RI值,并结合临床及实验室指标,阐述子宫肌层及内膜的血流变化与宫腔粘连的关系。方法选取2017年11月至2018年9月在昆明市妇幼保健院妇科住院部经阴道超声诊断孕周为5~8周II型剖宫产切口妊娠患者为实验对象,实验对象行双侧子宫动脉栓塞术后宫腔镜下清宫术。术后于月经复潮第1月、第3月的第5日抽血测FSH、LH、E2值。并于经净后3 d阴道超声测量子宫肌层及内膜血流的PI、RI值和子宫内膜厚度。若清宫术后出现经量减少或闭经患者,行宫腔镜检查确定有无宫腔粘连及宫腔粘连分度。结果(1)纳入30名研究对象,研究对象于子宫动脉栓后1、3月的FSH、LH及E2指标数值均在正常范围。且比较栓塞后1月、3月FSH、LH、E2值差异无统计学意义(P>0.05);(2子宫肌层及内膜的血流PI、RI值于栓塞后24 h下降幅度最大;且子宫肌层及内膜PI持续下降至栓塞后3月;自栓塞后1月起子宫肌层及内膜血流的RI值开始上升,至栓塞后3月时仍低于栓塞前水平;(3宫腔粘连与既往流产次数、清宫术中出血量、清宫术后月经复潮时间呈正相关;与栓塞术前子宫肌层血流RI、栓塞后1月子宫内膜血流PI呈负相关。将与宫腔粘连有相关性的因素带入Logistic回归分析发现,既往人工流产史及栓塞后1月内膜血流PI是宫腔粘连的独立危险因素(P<0.01)。结论行双侧子宫动脉栓塞术对剖宫产切口妊娠患者子宫肌层及内膜血流存在影响。栓塞后1月子宫内膜血流恢复不佳与宫腔粘连发生有关。
Objective To explore the relationship between blood flow changes in myometrium and endometrial artery and intrauterine adhesions after uterine artery embolization by ultrasonography doppler.Me thods From November 2017 to September 2018,patients diagnosed with 5-8 weeks gestation by type II cesarean section in the Gynecological Inpatient Department of Kunming Maternity and Child Care Hospital were selected as the experimental subjects.The subjects underwent hysteroscopic hysterectomy after bilateral uterine artery embolization.After the operation,FSH,LH and E2 values were measured on the 5 th day of the 1 st month and the 3 rd month.The PI,RI and endometrial thickness of myometrium and endometrial blood flow were measured by transvaginal ultrasonography 3 days after the treatment.In patients with reduced menstrual volume or amenorrhea,hysteroscopy was performed to determine the degree of intrauterine adhesions and intrauterine adhesions.Re s ults(1) A total of30 subjects were included in this study,and the values of FSH,LH and E2 in the first and third months after uterine artery occlusion were within the normal range.There was no significant difference in FSH,LH and E2 values between the first and third months after embolization(P > 0.05).(2) The blood flow PI and RI values of myometrium and intima decreased the most at 24 h after embolization.And the myometrium and intima PI continued to decline until 3 months after embolization.RI values of myometrium and intima blood flow began to rise one month after embolization,and were still lower than the level before embolization three months after embolization.(3) There was a significant positive correlation between intrauterine adhesions and previous abortion times,intraoperative blood loss during curettage,and the time of menstruation after curettage.There was a significant negative correlation between RI of myometrial blood flow before embolization and PI of endometrial blood flow at 1 month after embolization.Logistic regression analysis showed that previous history of artificial abortion and PI of intimal blood flow at 1 month after embolization were independent risk factors for uterine cavity adhesion(P < 0.01).Conclus ion Bilateral uterine artery embolization has an effect on uterine myometrium and endometrial blood flow in pregnancy patients with cesarean section.The poor recovery of endometrial blood flow in 1 month after embolization was related to intrauterine adhesions.
作者
王超群
徐琳
WANG Chao-qun;XU Lin(Dept.of Gynecology,Maternal and Child Health Hospital of Kunming,Kunming Yunnan 650032,China)
出处
《昆明医科大学学报》
CAS
2020年第2期120-126,共7页
Journal of Kunming Medical University
基金
昆明市妇幼保健院院内科研基金资助项目(2017-19)。
关键词
子宫动脉栓塞术
剖宫产疤痕妊娠
子宫肌层及内膜
血流影响
Uterine artery embolization
Caesarean section scar pregnancy
Myometrium and endometrium
Blood flow affect
