Jiangwan Research Institute, Central South University & Changsha Jiangwan Hospital, Changsha 410005.
Department of Gynecolgy, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Dec 28;48(12):1830-1837. doi: 10.11817/j.issn.1672-7347.2023.230239.
Uterine adhesion is mainly caused by endometrial injury, leading to poor postoperative pregnancy outcome. Therefore, preoperative evaluation on uterine cavity, especially endometrial condition, is very necessary. This study aims to explore the correlation between preoperative three-dimensional transvaginal ultrasound (3D-TVS) imaging characteristics and postoperative pregnancy outcomes after hysteroscopic adhesiolysis (HA).
A total of 401 patients, who underwent HA surgery from February 22, 2018 to October 31, 2018 at the Third Xiangya Hospital of Central South University or Changsha Jiangwan Hospital, were enrolled, and we collected data regarding the preoperative 3D-TVS imaging characteristics and followed up their postoperative pregnancy outcomes. Correlation analysis and univariate and multivariate logistic regression analysis were performed between imaging features and pregnancy outcomes (live and non-live birth outcomes) in patients with intrauterine adhesion.
The results of correlation analysis showed that endometrial thickness, endometrial echo, visible tubal openings, endometrial blood flow, intercornual distance, and endometrial peristalsis were correlated with the live birth rate (all <0.05). Logistic regression analysis revealed that in the HA patients with the live birth, the endometrial thickness was thicker (<0.001), endometrial echo was more homogeneous (<0.001), the number of tubal openings was more (<0.001), the intercornual distance was wider (<0.05), the endometrial blood flow, and irregular cases of endometrial peristaltic waves were more and cases of deficiency were fewer (both <0.01) than those in the non-live birth group.
Preoperative 3D-TVS imaging performance is closely related to pregnancy outcomes of HA patients, and preoperative 3D-TVS can be used to predict pregnancy outcomes after HA.
宫腔粘连主要由子宫内膜损伤引起，导致术后妊娠结局不良。因此，术前对宫腔进行评估，尤其是对子宫内膜状况进行评估非常必要。本研究旨在探讨宫腔镜粘连松解术（HA）前三维经阴道超声（3D-TVS）成像特征与术后妊娠结局的相关性。
回顾性分析 2018 年 2 月 22 日至 2018 年 10 月 31 日在中南大学湘雅三医院或长沙江湾医院行 HA 手术的 401 例患者的临床资料，收集患者术前 3D-TVS 成像特征，并随访其术后妊娠结局。对宫腔粘连患者的影像学特征与妊娠结局（活产和非活产结局）进行相关性分析及单因素和多因素 logistic 回归分析。
相关性分析结果显示，子宫内膜厚度、子宫内膜回声、可见输卵管开口、子宫内膜血流、两宫角距离、子宫内膜蠕动与活产率相关（均<0.05）。logistic 回归分析显示，在 HA 活产患者中，子宫内膜较厚（<0.001）、子宫内膜回声较均匀（<0.001）、输卵管开口较多（<0.001）、两宫角距离较宽（<0.05）、子宫内膜血流较丰富、子宫内膜蠕动波不规则病例较多、子宫内膜蠕动波缺乏病例较少（均<0.01），与非活产组比较差异有统计学意义。
HA 患者术前 3D-TVS 影像学表现与妊娠结局密切相关，术前 3D-TVS 可用于预测 HA 术后妊娠结局。
