经阴道三维超声评估宫腔粘连术后子宫内膜对妊娠结局的预测价值

doi:10.3969/j.issn.1006-7795.2024.03.019

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (3): 501-507.doi: 10.3969/j.issn.1006-7795.2024.03.019

经阴道三维超声评估宫腔粘连术后子宫内膜对妊娠结局的预测价值

赵玉婷, 黄晓武^*, 徐若男, 黄睿, 夏恩兰

首都医科大学附属复兴医院宫腔镜诊治中心，北京 100038

收稿日期:2023-08-29 出版日期:2024-06-21 发布日期:2024-06-13
通讯作者: 黄晓武 E-mail:hxiaowu_fxyy@126.com
基金资助:
首都卫生发展科研专项重点攻关项目（首发2020-1-7027）。

Predictive value of three-dimensional ultrasound evaluation of endometrium on pregnancy outcomes after hysteroscopic adhesiolysis for intrauterine adhesion

hao Yuting, Huang Xiaowu^*, Xu Ruonan, Huang Rui, Xia Enlan

Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing 100038, China

Received:2023-08-29 Online:2024-06-21 Published:2024-06-13
Supported by:
This study was supported by Capital's Funds for Health Improvement and Research(CFH 2020-1-7027).

摘要/Abstract

摘要： 目的探讨经阴道三维超声(three-dimensional transvaginal ultrasound, 3D-TVUS)评估宫腔镜下宫腔粘连分离术(hysteroscopic adhesiolysis, HA)后子宫内膜相关指标对妊娠结局的预测价值。方法收集2020年6月至2022年2月间就诊于首都医科大学附属复兴医院，因有生育要求行HA的患者278例作为研究对象。术后在黄体中期应用3D-TVUS 进行子宫内膜厚度、容积及血流的测定，随访术后宫腔情况及妊娠结局等。根据妊娠结局分为妊娠组与非妊娠组，通过单因素分析和多因素 Logistic 回归分析，确定患者术后临床妊娠的影响因素。根据受试者工作特征曲线评价上述因素对临床妊娠的预测价值。结果 278例患者失访8例、临床妊娠143例、异位妊娠4例、未妊娠123例。多因素分析显示术后宫腔镜探查评分、术后子宫内膜厚度及子宫内膜容积是临床妊娠的独立影响因素(P<0.05)。Logistic预测模型对预测宫腔粘连术后妊娠的曲线下面积为0.827，约登指数为58.5%，灵敏度为74.8%，特异度为83.7%。术后子宫内膜厚度、内膜容积的最佳界值分别为6.22 mm及1.42 mL。结论术后宫腔镜探查评分、子宫内膜厚度及子宫内膜容积对宫腔粘连术后的妊娠结局具有一定预测价值，可作为患者术后妊娠计划及辅助治疗的参考指标。

关键词: 经阴道三维超声, 宫腔粘连, 子宫内膜容积, 妊娠

Abstract: Objective To investigate the predictive value of endometrium-related indicators assessed by three-dimensional transvaginal ultrasound (3D-TVUS)on pregnancy outcome after hysteroscopic adhesiolysis(HA).Methods A total of 278 patients who underwent HA for fertility purposes at the Fuxing Hospital, Capital Medical University, from June 2020 to February 2022 were included in this study. In the mid-luteal phase, 3D-TVUS was performed to assess endometrial thickness, endometrial volume, and blood flow indices. Postoperative follow-up was conducted to evaluate uterine cavity and pregnancy outcomes. Based on the pregnancy outcome, patients were divided into a pregnancy group and a non-pregnancy group. Univariate analysis and multivariate Logistic regression analysis were performed to determine the factors influencing clinical pregnancy. The predictive value of these factors for clinical pregnancy was evaluated by using the area under the receiver operating characteristic curve. Results Among the 278 included patients, 8 cases were lost to follow-up. Clinical pregnancy was achieved in 143 cases, while 4 cases experienced ectopic pregnancy and 123 cases did not achieve pregnancy. Multivariate analysis revealed that postoperative American Fertility Society (AFS) score, endometrial thickness, and volume were independent factors influencing clinical pregnancy (P<0.05). The Logistic regression model for predicting pregnancy after HA had an area under the curve of 0.827, a Youden index of 58.5%, sensitivity of 74.8%, and specificity of 83.7%. The optimal cutoff values for postoperative endometrial thickness and endometrial volume were 6.22 mm and 1.42 mL, respectively. Conclusion Postoperative AFS score, endometrial thickness, and volume were found to be predictive factors for pregnancy outcomes following hysteroscopic adhesion separation. They can serve as reference indices for patients in their postoperative pregnancy planning and assistive treatment decisions.

Key words: three-dimensional transvaginal ultrasound, intrauterine adhesion, endometrial volume, pregnancy

中图分类号:

R713

赵玉婷, 黄晓武, 徐若男, 黄睿, 夏恩兰. 经阴道三维超声评估宫腔粘连术后子宫内膜对妊娠结局的预测价值[J]. 首都医科大学学报, 2024, 45(3): 501-507.

hao Yuting, Huang Xiaowu, Xu Ruonan, Huang Rui, Xia Enlan. Predictive value of three-dimensional ultrasound evaluation of endometrium on pregnancy outcomes after hysteroscopic adhesiolysis for intrauterine adhesion[J]. Journal of Capital Medical University, 2024, 45(3): 501-507.

参考文献

［1］ Yu D, Wong Y M, Cheong Y, et al. Asherman syndrome—one century later［J］. Fertil Steril, 2008, 89(4): 759－779.
［2］ AAGL Elevating Gynecologic Surgery. AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE)［J］. Gynecol Surg, 2017, 14(1): 6.
［3］ Burjoo A, Zhao X P, Zou L X, et al. The role of preoperative 3D-ultrasound in intraoperative judgement for hysteroscopic adhesiolysis［J］. Ann Transl Med, 2020, 8(4): 55.
［4］ Wamsteker K, De Block S. Diagnostic hysteroscopy: technique and documentation［M］//Sutton C, Diamond M. Endoscopic surgery for gynecologists. London: WB Saunders, 1998: 511－524.
［5］ The American fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions［J］. Fertil Steril, 1988, 49(6): 944－955.
［6］ Panayotidis C, Weyers S, Bosteels J, et al. Intrauterine adhesions (IUA): has there been progress in understanding and treatment over the last 20 years?［J］. Gynecol Surg, 2009, 6(3): 197－211.
［7］ Khan Z, Goldberg J M. Hysteroscopic management of asherman's syndrome［J］. J Minim Invasive Gynecol, 2018, 25(2): 218－228.
［8］ Guo E J, Chung J P W, Poon L C Y, et al. Reproductive outcomes after surgical treatment of asherman syndrome: a systematic review［J］. Best Pract Res Clin Obstet Gynaecol, 2019, 59: 98－114.
［9］ Xu J N, Zhang S D, Jin L, et al. The effects of endometrial thickness on pregnancy outcomes of fresh IVF/ICSI embryo transfer cycles: an analysis of over 40,000 cycles among five reproductive centers in China［J］. Front Endocrinol (Lausanne), 2021, 12: 788706.
［10］ Baradwan S, Shafi D, Baradwan A, et al. The effect of endometrial thickness on pregnancy outcome in patients with Asherman's syndrome post-hysteroscopic adhesiolysis［J］. Int J Womens Health, 2018, 10: 77－82.
［11］ Movilla P, Wang J, Chen T, et al. Endometrial thickness measurements among Asherman syndrome patients prior to embryo transfer［J］. Hum Reprod, 2020, 35(12): 2746－2754.
［12］ Fischer C, Copperman A. Use of three dimensional ultrasound imaging in evaluation of Asherman's syndrome［M］//Oleg M, Igor M. Ultrasound imaging － medical applications. Rijeka: Intech Open, 2011: 41－46.
［13］ Tetlow R L, Richmond I, Manton D J, et al. Histological analysis of the uterine junctional zone as seen by transvaginal ultrasound［J］. Ultrasound Obstet Gynecol, 1999, 14(3): 188－193.
［14］ Chien L W, Au H K, Chen P L, et al. Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer［J］. Fertil Steril, 2002, 78(2): 245－251.
［15］云兵, 田军, 杨小芳, 等. 经阴道三维能量多普勒超声在宫腔镜下重度宫腔粘连松解术后检查效果［J］. 中国计划生育学杂志, 2023, 31(1): 100－103.
［16］庞慧贤, 江宁珠, 黄翠平, 等. 阴道三维超声评估宫腔粘连患者的子宫内膜容受性及其对妊娠的影响［J］. 中国现代医学杂志, 2022, 32(6): 68－73.
［17］ Alcázar J L. Three-dimensional ultrasound assessment of endometrial receptivity: a review［J］. Reprod Biol Endocrinol, 2006, 4: 56.
［18］ Hanstede M M F, van der Meij E, Veersema S, et al. Live birthsafter Asherman syndrome treatet［J］. Fertil Steril, 2021,116(4): 1181-1187.
［19］ Chen L, Zhang H, Wang Q, et al. Reproductive outcomes in patients with intrauterine adhesion following hysteroscopic adhesiolysis: experience from the largest women's hospital in China［J］. J Minim Invasive Gynecol 2017,24(2):299-304.

[1]	马恺文, 郑薇, 张浦, 杨徐, 丽丽, 李光辉. 北京地区孕早期孕妇膳食蛋白质摄入与妊娠期糖尿病的关系[J]. 首都医科大学学报, 2023, 44(5): 828-835.
[2]	马郡, 阮祥燕, 许仲婷, 谷牧青, Alfred O.Mueck. 癸女贞胶囊对卵巢储备功能减退女性妊娠结局的影响[J]. 首都医科大学学报, 2023, 44(4): 540-543.
[3]	金凤羽, 阮祥燕, 秦爽, 许新, 杨瑜, 谷牧青, 李妍秋, 杜娟, 程姣姣, 尹晓丹. 定坤丹在氯米芬促排周期中对薄型子宫内膜的疗效观察[J]. 首都医科大学学报, 2023, 44(4): 550-554.
[4]	赵越, 阮祥燕, 谷牧青, 程姣姣, 王月姣, 金婧. 特纳综合征患者生育及妊娠管理的研究进展[J]. 首都医科大学学报, 2023, 44(4): 561-567.
[5]	刘晶, 董媛, 吉彤珍. 妊娠35 ~ 37周女性定植B族链球菌的血清和多位点序列分型及其相互关系[J]. 首都医科大学学报, 2023, 44(2): 311-315.

经阴道三维超声评估宫腔粘连术后子宫内膜对妊娠结局的预测价值

Predictive value of three-dimensional ultrasound evaluation of endometrium on pregnancy outcomes after hysteroscopic adhesiolysis for intrauterine adhesion

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 5

编辑推荐

Metrics

本文评价