B超观察剖腹产术后子宫复旧临床价值.doc

B超观察剖腹产术后子宫复旧临床价值 　 【关键词】 B超；剖宫产；子宫复旧 Abstract: Objective To explore clinical application value of Bultrasound observing in uterine involution and uterine wound healing after the caesarean birth. Methods The uterine size, morphous and internal structure of 289 cases were observed by Bultrasound 9 day after the caesarean birth. Results The uteral cavity line of 210 cases (72.66%) was clearly shown. 79 patients(27.33%) were found fluid dark area, hyperechoic spot or hyperechoic areas in cavity of uterus. According to sonogram of uterine incision, the uterine wound healing was grouped as A: incision mild eminence (267 cases, 92.33%); B: incision obvious eminence (18 cases, 6.27%); C: localized mass protruding between bladder and uterus(3 cases, 1.03%); D: hematoma in uterine wall (1 case, 0.4% ). Conclusion The result of Bultrasound monitoring uterine involution and uterine wound healing after the caesarean birth can be as a guidance of treatment and has guiding significance to prevent complication such as bleeding. Keywords: Bultrasound；caesarean birth；uterine involution 剖宫产为产科领域中常用的手术，是解决难产和某些产科合并症，挽救产妇和围生儿生命的有效手段。但剖宫产手术本身亦隐藏着许多不安全因素［1］。要了解术后子宫复旧及切口愈合情况，B超检查是比较理想的手段。本文采用B超观察剖宫产术后子宫复旧情况，以探讨其临床应用价值。 1 资料与方法 1.1 临床资料 我院2006年6月至2007年6月行剖宫产289例。手术方式为宫下段作横弧形切口，子宫采用2/0号维乔线，分两层连续缝合，间段加固。 1.2 观察方法 采用韩国Ex8000Liv型实时超声诊断仪，探头为凸阵式，频率为3.5 MHz。膀胱适度充盈后卧位于腹部区作纵、横向扫查，切口扫查以纵切向为主。 2 结果 289例剖宫产术后子宫声像图显示子宫长8.3~14.1 cm，宽8.3~11.2 cm，厚4.9~8.1 cm。宫腔线清晰显示210例，占72.66％。宫腔底部及子宫下段见液性暗区及强回声光点光斑79例，占27.33％。后者经用宫缩剂、生化汤、抗炎治疗1周后复查B超，仍见液性暗区及强回声光点光斑者20例（6.92％），在B超监视下行诊刮术，送病检，其中胎盘残留1例，脱膜残留5例，6例为宫内膜炎变组织，8例为血凝块及破碎内膜组织。 子宫切口部位声像图特征：A类表现为子宫下段前壁切口处轻度隆起，浆膜层略增厚，切口处肌壁回声增强，无低回声和无回声区，提示子宫切口愈合良好（图1a）。B类则为子宫切口明显隆起，凸向膀胱，浆膜层模糊，肌壁间见低回声区，宫腔近切口处见强回声光点。 提示子宫切口处炎性变（图1b）。C类显示子宫切口肌壁与膀胱之间见8.8 cm×2.8 cm无回声区，无回声区内可见稀疏均匀的低回声，也可有条状的强回声或分隔回声，局部为不规则的强回声，子宫直肠凹见3.7 cm×3.2 cm无回声区。提示切口愈合不良，切口部位出血或感染。2例在B超监视下行穿刺抽吸术，1例因抽吸出大量脓液，即时行剖腹探查术，切除子宫切口感染病灶，腹腔冲洗，放置引流条，术后10 d B超复查见子宫切口处2.3 cm×2.0 cm强回声团块，边界清晰，形态规则，内见强回声光点及光斑，20 d后复查B超完全