摘要：
目的 本研究主要采用经阴道彩色多普勒(Transvaginal Color Doppler,TVCD)超声检测早早孕期间患者子宫内膜螺旋动脉显示率,探查早早孕患者双侧输卵管动脉血流动力学差异.方法 选择我院妇产科门诊和住院病人中早早孕患者99例.TVCD超声诊断仪检测子宫内膜厚度、螺旋动脉、观察双侧子宫动脉输卵管支血流,并采用脉冲多普勒检测舒张期最小血流速度(End Diastolic Velocity,EDV)、阻力指数(Resistance Index,RI)、动脉峰值流速(Peak Systolic Velocity,PSV).比较螺旋动脉显示率及双侧输卵管动脉的血流参数,并将检测结果与最终妊娠结果进行对照分析.结果 99例中,42例为宫内妊娠,38例为输卵管妊娠,19例为宫内早孕流产.3组子宫内膜厚度比较,宫内妊娠组子宫内膜厚度比异位妊娠组和自然流产组厚,有显著性差异(P0.05).42例宫内妊娠中,27例子宫内膜内显示螺旋动脉,显示率为64.2%;38例异位妊娠患者中,1例内膜中有动脉血流信号显示,显示率为3.0%;自然流产组显示率为26.3%,3组螺旋动脉显示率差异有统计学意义(P0.05).结论 TVCD检测早早孕期间螺旋动脉显示率可提高异位妊娠的诊断率;滋养细胞的异位种植可以增加其周围组织血流供应.应用TVCD可在早早孕期间探测螺旋动脉和输卵管动脉的血流动力学改变,从而为异位妊娠的诊断提供更多的临床信息.%Objective To explore the differences in arterial blood flow dynamic of the bilateral tubal pregnancy patients during early pregnancy, this research mainly adopted the transvaginal color Doppler (TVCD) ultrasonic detection rate of patients with the endometrial spiral artery. Methods Totally 99 cases of early pregnancy patients from obstetrics clinic and inpatient in our hospital were selected. The rate of spiral artery presentation, endometrium thickness and bilateral tubal artery were detected by TVCD and the hemodynamics parameters were measured by pulse Doppler (PD), such as peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI). Contrast analysis the correlation between the testing results and eventually pregnancy outcomes. Results In the 99 total cases, 3 groups were divided as 42 cases of intrauterine pregnancies, 38 cases of ectopic pregnancies, and 19 cases of spontaneous abortions. The endometrial thickness of the three groups was compared. Intrauterine pregnancies group was thicker than ectopic pregnancy group and spontaneous abortion group, and the difference was statistically significant (P0.05). In the intrauterine pregnancy group, 27 patients had arterial blood flow within the endometrium, the rate of spiral artery presentation was 64.2%; in the ectopic pregnancy group, only 1 patient had areas of endometrial blood flow, and 37 did not; 26.3% of the spontaneous abortion patients had arterial blood flow within the endometrium, the differences among the three groups were significant (P0.05). The hemodynamic parameters of tubal artery between sides hadno significant difference in intrauterine pregnancy group (P>0.05). Conclusion TVCD has important clinical value for the diagnosis of early ectopic pregnancy by testing the thickness of endometrium and spiral artery within endometrium. The abnormal implantation in ectopic pregnancy can cause more blood flow changes in the adjacent supplying vessels. The differences of the hemodynamic parameter of the bilateral tubal artery can provide additional information for the diagnosis of tubal pregnancy.
