人工流产术后组织物滞留的超声诊断及鉴别诊断
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摘要
目的探讨经阴道多普勒超声在人工流产术后组织物滞留(RPOC)诊断及鉴别诊断价值。方法回顾性分析2016年1月～2018年12月就诊并经病理证实的43例人流术后女性患者资料,年龄18～39岁(30.1±4.4岁),所有患者均于术前行经阴道超声检查采集图像信息。由2名经验丰富的超声科医师阅读图像,观察患者子宫、RPOC病灶大小、形态、回声、血流灌注、子宫内膜改变及合并症等,对RPOC进行综合的影像学评估。结果 43例患者中,19例可见子宫增大,其中4例明显向外隆起;41例可见宫内肿物,多呈片状,回声强弱不等,彩色多普勒超声表现示内部血流灌注存在较大差异;31例肿物与子宫分界模糊,其中5例可见与肌层相连的血流信号。内膜增厚、回声不均匀8例,其中2例为超声所见的唯一异常征象。19例可见宫腔积液(血)。另外可见合并子宫肌瘤4例、子宫腺肌瘤2例、卵巢囊性肿物7例、宫内节育环1例。结论经阴道多普勒超声能清晰的显示RPOC病灶形态学、血管灌注信息及邻近结构相关改变,提供诊断和鉴别诊断信息,具有重要的临床应用价值。
Objective To explore the value of transvaginal doppler ultrasound examinations in diagnosis and differential diagnosis of retained products of conception(RPOC) after induced abortion. Methods 43 cases of RPOC after induced abortion were reviewed retrospectivly. The patients were suffered from pathologically proved RPOC in between January 2016 and December 2018, with age from 18 to 39 years(average 30.1±4.4). All patients underwent transvaginal doppler ultrasound examinations preoperatively, and the sonographies were collected. Two experienced ultrasonologists reviewed the sonographies together to analyze the sonographic features of RPOC, including the uterinesize, size, morphology, echo, blood perfusion of RPOC lesions, changes of endometrium, and complications. Results The volume increase of uterus was found in19 cases, among which bulging out of the uterus were found in 3 cases.Masses in uterine cave were found in 41 cases, which present as patchyinhomogeneous echoes. When CDFI was performed to the patients, blood perfusion with varied kinds of degree was detected in the masses. Blur interfaces between the masses and myometrium were found in 31 cases, while blood flow signal connecting masses and myometrium were detected in 5 cases. Abnormal endometrial thickening with inhomogeneous echoes was found in 8 cases, among which the endometrial abnormalities were the only abnormal findings in2 cases. Uterine cavity fluid(blood) was found in 19 cases. Additionally, uterine fibroids, adenomyomas,ovarian cystic masses,intrauterine device were found in 4, 2, 7, and 1 cases, respectively. Conclusion Transvaginal doppler ultrasound examinations can exhibit morphology, blood perfusion of RPOC, and the adjacent tissue changes. It plays a crucial role in diagnosis and differential diagnosis of RPOC in clinical work.
Objective To explore the value of transvaginal doppler ultrasound examinations in diagnosis and differential diagnosis of retained products of conception(RPOC) after induced abortion. Methods 43 cases of RPOC after induced abortion were reviewed retrospectivly. The patients were suffered from pathologically proved RPOC in between January 2016 and December 2018, with age from 18 to 39 years(average 30.1±4.4). All patients underwent transvaginal doppler ultrasound examinations preoperatively, and the sonographies were collected. Two experienced ultrasonologists reviewed the sonographies together to analyze the sonographic features of RPOC, including the uterinesize, size, morphology, echo, blood perfusion of RPOC lesions, changes of endometrium, and complications. Results The volume increase of uterus was found in19 cases, among which bulging out of the uterus were found in 3 cases.Masses in uterine cave were found in 41 cases, which present as patchyinhomogeneous echoes. When CDFI was performed to the patients, blood perfusion with varied kinds of degree was detected in the masses. Blur interfaces between the masses and myometrium were found in 31 cases, while blood flow signal connecting masses and myometrium were detected in 5 cases. Abnormal endometrial thickening with inhomogeneous echoes was found in 8 cases, among which the endometrial abnormalities were the only abnormal findings in2 cases. Uterine cavity fluid(blood) was found in 19 cases. Additionally, uterine fibroids, adenomyomas,ovarian cystic masses,intrauterine device were found in 4, 2, 7, and 1 cases, respectively. Conclusion Transvaginal doppler ultrasound examinations can exhibit morphology, blood perfusion of RPOC, and the adjacent tissue changes. It plays a crucial role in diagnosis and differential diagnosis of RPOC in clinical work.
引文
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[15]吕珊珊,张慧英.宫腔妊娠组织物残留的诊疗进展[J].国际生殖健康/计划生育杂志,2018,37(3):252-6.
[16]Groszmann YS,Murphy A,Benacerraf BR.Diagnosis and management of patients with enhanced myometrial vascularity associated with retained products of conception[J].Ultrasound Obstet Gynecol,2018,52(3):396-9.
[17]Kamaya A,Krishnarao PM,Nayak N,et al.Clinical and imaging predictors of management in retained products of conception[J].Abdom Radiol(NY),2016,41(12):2429-34.
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[19]杨海军,王福领,胡文江,等.人流术后组织微量残留的彩色多普勒超声诊断[J].中国超声医学杂志,2003,19(5):79-80.
[20]向阳,周琦,吴小华,等.妊娠滋养细胞疾病诊断与治疗指南[J].中国实用妇科与产科杂志,2018,34(9):994-1001.
[21]谢红宁.妊娠滋养细胞疾病的超声特征与诊断[J].肿瘤影像学,2017,26(3):161-4.
[22]吴淑华,李威,颜亭.经腹部及经阴道超声在子宫黏膜下肌瘤诊断中的应用分析[J].医学影像学杂志,2017,27(3):570-3.
[23]向志,杨红.子宫切口瘢痕妊娠物残留超声误诊为宫壁血肿1例[J].临床超声医学杂志,2013,15(3):202.
[24]Goyal S,Goyal A,Mahajan S,et al.Acquired uterine arteriovenous malformation developing in retained products of conception:A diagnostic dilemma[J].J Obstet Gynaecol Res,2014,40(1):271-4.
[2]Greenbaum S,Wainstock T,Dukler D,et al.Underlying mechanisms of retained placenta:Evidence from a population based cohort study[J].Eur J Obstet Gynecol Reprod Biol,2017,216(9):12-7.
[3]Wang PH,Chen CY,Chen CP.Ultrasound and retained products of conception[J].J Med Ultrasound,2015,23(2):63-4.
[4]熊雯,罗红,陈琴,等.超声造影在胎盘残留诊断中的临床应用价值[J].中华医学超声杂志:电子版,2016,13(8):593-7.
[5]廖建梅,杨舒萍,王霞丽,等.经阴道二维联合三维声学造影诊断产后胎盘植人[J].中国超声医学杂志,2018,34(5):442-5.
[6]贺春燕,张军.产后胎盘残留的MRI表现及诊断价值[J].中国临床医学影像杂志,2018,29(7):494-7.
[7]李新敏,古雅丽,任志敏,等.人工流产术后水泡状胎块的漏诊和误诊[J].中华临床医师杂志:电子版,2015,9(20):31-4.
[8]Tan AP.Degenerated retained product of conception misdiagnosed as invasive trophoblastic disease[J].Med J Malaysia,2015,70(2):100-1.
[9]吴静,张倩,王萍.超声检查诊断子宫内膜病变的临床价值[J].中国超声医学杂志,2007,23(9):696-8.
[10]徐晓琴,徐向荣,俞小英,等.人工流产术后宫腔内组织物残留的处理[J].重庆医学,2014,43(26):3497-8,3499.
[11]Amer-Alshiek J,Shiekh O,Agmon A,et al.What is the right timing for ultrasound evaluation after pregnancy termination with mifepristone?[J].Eur J Obstet Gynecol Reprod Biol,2015,189(6):24-6.
[12]Favilli A,Tosto V,Ceccobelli MA,et al.Risk factors analysis and a scoring system proposal for the prediction of retained placenta after vaginal delivery[J].Eur J Obstet Gynecol Reprod Biol,2018,228(9):180-5.
[13]Rufener S,Adusumilli S,Weadock W,et al.Sonography of uterine abnormalities in postpartum and postabortion patients:a potentialpitfall of interpretation[J].J Ultrasound Med,2007,27(3):343-8.
[14]Abbasi S,Jamal A,Eslamian L,et al.Role of clinical and ultrasound findings in the diagnosis of retained products of conception[J].Ultrasound Obstet Gynecol,2008,32(5):704-7.
[15]吕珊珊,张慧英.宫腔妊娠组织物残留的诊疗进展[J].国际生殖健康/计划生育杂志,2018,37(3):252-6.
[16]Groszmann YS,Murphy A,Benacerraf BR.Diagnosis and management of patients with enhanced myometrial vascularity associated with retained products of conception[J].Ultrasound Obstet Gynecol,2018,52(3):396-9.
[17]Kamaya A,Krishnarao PM,Nayak N,et al.Clinical and imaging predictors of management in retained products of conception[J].Abdom Radiol(NY),2016,41(12):2429-34.
[18]Esmaeillou H,Jamal A,Eslamian L,et al.Accurate detection of retained products of conception after first-and second-trimesterabortion by color doppler sonography[J].J Med Ultrasound,2015,23(1):34-8.
[19]杨海军,王福领,胡文江,等.人流术后组织微量残留的彩色多普勒超声诊断[J].中国超声医学杂志,2003,19(5):79-80.
[20]向阳,周琦,吴小华,等.妊娠滋养细胞疾病诊断与治疗指南[J].中国实用妇科与产科杂志,2018,34(9):994-1001.
[21]谢红宁.妊娠滋养细胞疾病的超声特征与诊断[J].肿瘤影像学,2017,26(3):161-4.
[22]吴淑华,李威,颜亭.经腹部及经阴道超声在子宫黏膜下肌瘤诊断中的应用分析[J].医学影像学杂志,2017,27(3):570-3.
[23]向志,杨红.子宫切口瘢痕妊娠物残留超声误诊为宫壁血肿1例[J].临床超声医学杂志,2013,15(3):202.
[24]Goyal S,Goyal A,Mahajan S,et al.Acquired uterine arteriovenous malformation developing in retained products of conception:A diagnostic dilemma[J].J Obstet Gynaecol Res,2014,40(1):271-4.
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