阴道超声在药物流产后出血病因诊治中的作用

摘要

目的探讨阴道超声在药物流产后出血原因分析及选择治疗方法中的作用。方法经阴道超声观察188例药物流产妇女子宫和卵巢形态，结合内膜病理与外周血E2、P水平分析药物流产后出血原因，并根据阴道超声所见采取不同的治疗方法。结果 158例药物流产后出血中67例（43.6 %）伴卵巢黄体囊肿, 对照组30例无1例伴卵巢黄体囊肿；激素水平测定B组（卵巢黄体囊肿组）E2明显高于A组（卵巢正常图像组）(P<0.001);临床治疗过程中B组患者较A组患者出血时间长, 且继卵巢黄体囊肿消失后血止。结论卵巢妊娠黄体持续存在并分泌雌孕激素是药物流产后出血的原因之一。阴道超声不仅在用药前为药物流产选择适应症，准确评价流产效果，而且可以提示药物流产后出血原因并指导临床选择最佳治疗方法。%Objective　To evaluate the significance of transvaginal ultrasonography in the diagnosis and treatment of bleeding after abortion with mifepristone.Methods　The bleeding causes in 188 cases after medical abortion were analyzed according to the characteristics of transvaginal utero(ovarian ultrasonogram, the pathological changes of endometrium, and the levels of estradiol(E2) and progesterone(P) in the plasm of patients. The different treatments were given based on transvaginal utero-ovarian ultrasonogram.Results　Of 158 cases with uterogenic bleeding after medical abortion, the ovarian ultrasonograms of 67 cases (43.6 %) showed corpus luteum cyst. On the contrary, no corpus luteum cyst was found in the control group (30 cases). The level of estradiol(E2) of patients in group B (cases with ovarian corpus luteum cyst)was much higher than that in group A （ cases without corpus luteum cyst）(P<0.001). During the clinical treatment,the duration of bleeding of the patients in group B was longer than that in group A. In addition, the bleeding of patients in group B stopped after disappearance of corpus luteum cyst.Conclusion　The ovarian corpus luteum persisting and secreting the estrogen and progestogen is one of the causes of bleeding after abortion with mifepristone. The transvaginal ultasonography not only can be used for choosing the patients of medical abortion and for evaluating the effect of abortion, but also can suggest the bleeding causes after abortion with mifepristone and guide the treatment.