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。
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.
作者
赵玉婷
黄晓武
徐若男
黄睿
夏恩兰
Zhao Yuting;Huang Xiaowu;Xu Ruonan;Huang Rui;Xia Enlan(Hysteroscopy Center,Fuxing Hospital,Capital Medical University,Beijing 100038,China)
出处
《首都医科大学学报》
CAS
北大核心
2024年第3期501-507,共7页
Journal of Capital Medical University
基金
首都卫生发展科研专项重点攻关项目(首发2020-1-7027)。
关键词
经阴道三维超声
宫腔粘连
子宫内膜容积
妊娠
three-dimensional transvaginal ultrasound
intrauterine adhesion
endometrial volume
pregnancy
