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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (05) : 447 -450. doi: 10.3877/cma.j.issn.1672-6448.2020.05.010

所属专题： 文献；

妇产科超声影像学

经腹部超声实时引导在重度宫腔粘连宫腔镜手术中的应用价值
戴晨燕1, 胡娅莉1, 朱湘虹1, 汤晓秋1, 王慧焱1, 朱慧1, 李亚玲1,†()   
  1. 1. 210008　南京大学医学院附属鼓楼医院妇产科
  • 收稿日期:2019-12-30 出版日期:2020-05-01
  • 通信作者: 李亚玲
  • 基金资助:
    中国科学院"干细胞与再生医学研究"战略性先导科技专项(XDA01030505); 江苏省第十四批"六大高峰人才"高层次人才培养方案(WSW-074)

Application value of real-time ultrasonic guidance during hysteroscopic adhesiolysis of severe intrauterine adhesions

Chenyan Dai1, Yali Hu1, Xianghong Zhu1, Xiaoqiu Tang1, Huiyan Wang1, Hui Zhu1, Yaling Li1,†()   

  1. 1. Department of Gynaecology and Obstetrics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2019-12-30 Published:2020-05-01
  • Corresponding author: Yaling Li
  • About author:
    Corresponding author: Li Yaling, Email:
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戴晨燕, 胡娅莉, 朱湘虹, 汤晓秋, 王慧焱, 朱慧, 李亚玲. 经腹部超声实时引导在重度宫腔粘连宫腔镜手术中的应用价值[J]. 中华医学超声杂志（电子版）, 2020, 17(05): 447-450.

Chenyan Dai, Yali Hu, Xianghong Zhu, Xiaoqiu Tang, Huiyan Wang, Hui Zhu, Yaling Li. Application value of real-time ultrasonic guidance during hysteroscopic adhesiolysis of severe intrauterine adhesions[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(05): 447-450.

目的

探讨经腹部超声实时引导在重度宫腔粘连宫腔镜手术中的应用价值。

方法

回顾性分析2017年1月至2019年6月因重度宫腔粘连在南京鼓楼医院妇科手术室接受宫腔镜手术治疗的患者236例，所有患者均接受宫腔镜下粘连分离及治疗手术，并于术前接受专项超声检查、术中行经腹部超声实时引导及监护。

结果

236例重度宫腔粘连手术治疗病例中，粘连分离后脐带间充质干细胞或骨髓干细胞胶原膜支架植入共108例，节育环包裹生物膜植入15例，瘢痕化薄型子宫内膜生长因子内膜下多点注射71例。所有超声引导下宫腔镜手术均未发生术中子宫穿孔、异常出血，支架或生物膜植入到位，内膜下注射定位准确，宫腔解剖学形态基本恢复正常，手术成功率100%。

结论

经腹部超声实时引导宫腔镜手术治疗重度宫腔粘连为手术精准性及安全性提供了可靠保障，具有降低手术风险、减少手术并发症等优点，值得临床推广应用。

关键词: 超声检查, 宫腔粘连, 宫腔镜检查
Objective

To explore the value of real-time transabdominal ultrasound monitoring in hysteroscopic surgery for severe intrauterine adhesion.

Method

Patients who received hysteroscopic adhesiolysis due to severe intrauterine adhesion at Nanjing Druw Tower Hospital from January 2017 to June 2019 were analyzed retrospectively. Transvaginal ultrasound and preoperative evaluation were performed routinely before the operation. Patients with complex surgery identified through clinical discussion and evaluation before surgery were given real-time monitoring by transabdominal ultrasound during the operation.

Result

A total of 236 cases of severe intrauterine adhesion were included, all of which underwent hysteroscopic adhesiolysis. After the operation, 108 cases were implanted with umbilical cord mesenchymal stem cells or bone marrow stem cells on collagen membrane scaffolds, 15 cases were implanted with biological membrane wrapped by contraceptive ring, 71 cases of thin endometrium were injected with growth factor under the endometrium. No uterine perforation or abnormal bleeding occurred during surgery.

Conclusion

Real-time transabdominal ultrasound monitoring in hysteroscopic surgery for severe intrauterine adhesion has advantages of increasing the safety and success rate of the operation, decreasing the risk of the operation, and reducing the complications, which is worthy of clinical promotion.

Key words: Ultrasonography, Intrauterine adhesion, Hysteroscopy
图1 宫腔重度粘连超声图像。图a为二维超声显示子宫内膜厚薄不均、边缘不清晰且连续性中断，多普勒显示内膜及内膜下血流信号稀疏；图b为实时三维宫腔成像显示宫腔轮廓不清，宫腔形态呈细管状，双侧宫角部不显示
图2 超声引导下宫腔镜检查及粘连分离术。图示经腹部超声子宫横切面，超声引导宫腔镜微型剪分离右侧宫角部
图3 重度宫腔粘连患者干细胞胶原膜支架植入超声图像。图示经腹部超声子宫矢状切面，显示干细胞胶原膜支架放置于宫腔内，球囊适度充盈
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