【摘要】 目的：宫腔粘连(intrauterine adhesions,IUA)是因各种原因造成的子宫内膜基底层受损，导致子宫肌壁相互粘连，表现为月经量减少、闭经、不孕等临床症状。宫腔镜下宫腔粘连分离术(hysteroscopic adhesiolysis,HA)是其主要治疗策略。对于中、重度粘连或宫角粘连患者，术后再粘连发生率较高。传统中药“养膜方”可促进子宫内膜生长。经阴道三维超声(three-dimensional transvaginal ultrasonography,3D-TVUS)检查可判断IUA，评估子宫容受性。本研究旨在探讨3D-TVUS在判断中医药方养膜方治疗IUA效果中的价值。方法：回顾性收集2021年1月至8月在中南大学湘雅三医院妇科和长沙市江湾医院妇科行HA的患者资料，纳入符合条件的患者共275例，根据术后处理措施将所选患者分为两组：养膜方组(n=138)为HA术后使用养膜方和宫形硅胶支架；激素组(n=137)为HA术后使用雌、孕激素和宫形硅胶支架。分析两组患者术前一般资料、术前和术后3D-TVUS参数。结果：3D-TVUS检查结果显示：与激素组相比，养膜方组子宫内膜更厚(P<0.001)，角间距离更宽(P=0.016)，子宫内膜回声更为均匀(P=0.018)，双侧可见输卵管口比例更高(P<0.001)，子宫内膜形态(III线征)更好(P=0.012)，且养膜方组的子宫内膜血流、子宫内膜蠕动及子宫活动度比激素组更好(均P<0.001)。结论：通过3D-TVUS检查得到的子宫内膜的厚度、回声、血流、蠕动，可见输卵管口数，子宫活动度及角间距离是评价IUA患者术后药物治疗预后的重要因素。3D-TVUS在判断养膜方治疗宫腔粘连效果中具有重要意义。更多还原

【Abstract】 Objective: Intrauterine adhesions(IUA) is the damage of the basal layer of the endometrium caused by various reasons, resulting in adhesion of the uterine muscle walls to each other, which is manifested as clinical symptoms such as spanomenorrhea, amenorrhea, and infertility. Hysteroscopic adhesiolysis(HA) is the main treatment, for patients with moderate or severe adhesion or angular adhesion, the incidence of postoperative adhesion is high. Traditional Chinese medicine “Yangmo decoction” can promote endometrial growth. Three-dimensional transvaginal ultrasonography(3D-TVUS) can judge IUA and evaluate uterine receptivity through three-dimensional imaging. This study aims to investigate the value of 3D-TVUS in judging the efficacy of Yangmo decoction in the treatment of intrauterine adhesions.Methods: The clinical data of patients who underwent HA at two different centers in department of Gynecology of Third Xiangya Hospital of Central South University and Changsha Jiangwan Hospital from January 2021 to August 2021 were retrospectively collected. A total of 275 eligible patients were included. According to the postoperative management measures, the selected patients were divided into two groups. Yangmo decoction group(n=138): the use of Yangmo decoction and uterine-shaped silicon stent post HA; Hormone group(n=137): the use of estrogen, progesterone and uterine-shaped silicon stent post HA. The preoperative general data, preoperative and postoperative 3DTVUS parameters of the two groups were analyzed.Results: The endometrial thickness of Yangmo decoction group was thicker than that of hormone group(P<0.001), the intercornual distance was wider(P=0.016), the endometrial echo was more homogeneous(P=0.018), the percentage of bilaterally visible tubal opening was higher(P<0.001), the endometrial morphology was better(P=0.012), and endometrial blood flow, endometrial motility and uterine motion were better in Yangmo decoction group than that in the hormone group(all P<0.001).Conclusion: The endometrial thickness, echo, blood flow, and peristalsis, the number of visible tubal opening, uterine motion, and the intercornual distance obtained by 3D-TVUS examination are important factors to evaluate the prognosis of postoperative drug treatment for IUA. 3D-TVUS is of great significance in evaluating the efficacy of Yangmo decoction in the treatment of IUA.更多还原