超声对医源性子宫壁损伤的诊断价值［摘要］目的评价二维超声及彩色多普勒超声对医源性子宫壁损伤的诊断价值及临床意义。方法2006年1月〜2013年6月在本院或其他医院有过宫腔操作手术病史，临床和超声诊断子宫壁穿透性或非穿透性宫壁损伤的患者37例，对其声像特征进行总结分析。结果11例子宫壁穿透性损伤中有2例伴网膜嵌顿，9例无网膜嵌顿；26例非穿透性宫壁损伤,其中22例单纯非穿透性宫壁损伤患者宫壁有异常丰富的血流区，2例为黏膜下积液，2例为黏膜下血肿。结论子宫穿孔超声诊断准确率高，非穿透性子宫壁损伤临床症状轻，其血流丰富型的宫壁损伤声像图表现与滋养细胞肿瘤和胚胎组织残留及宫腔内、输卵管间质部、子宫峡部瘢痕处妊娠光I才I型稽留流产相似，必须仔细检查，并结合病史、血3-HCG进行鉴别诊断，必要时定期随访、复查，从而减少误诊，避免再次行清宫术，减少患者的痛苦与恐慌。［关键词］二维超声；彩色多普勒超声；医源性损伤；子宫壁穿透性损伤；了宫壁非穿透性损伤［中图分类号］R81［文献标识码］A［文章编号］1674-4721(2014)04(c)-0102-04UltrasoundinthediagnosisofiatrogenicinjuryofuterinewallDepartmentofFunction,ShipaiPeople'sHospitalofDongguanCityinGuangdongProvince,Dongguan523330,China[Abstract]ObjectiveToevaluatethediagnosticvalueandclinicalsignificanceofB-ultrasoundandcolorDopplerultrasoundforiatrogenicinjuryofuterinewall.Methods37casesofpatientswithpenetratingornon—penetratinginjuryofuterinewalldiagnosedbycliniceilandultrasound,whichhadsurgeryhistoryofuterinesurgeryfromJanuary2006toJune2013inourhospitaiorotherhospitals.Thepatients,ultrasoundimagingcharacteristicswereanalyzed.Results11casesofpenetratinguterinewallinjury,ofwhich2caseshadcomplicationofomentumincarcerationwhileother9casesnot.26casesofnon-penetratinguterinewallinjury,ofwhich22patients'uterinewallhadabnormalbloodricharea,2caseshadsubmucosaleffusionand2caseshadsubmucosalhematoma.ConclusionUltrasoundhasahighaccuracyinthediagnosisofuterineperforation.Clinicalsymptomsofpatientswithnon-penetratinguterinewallinjuryaremildanditssonographicfeatureofblood-richareainuterinewal1issimilarwiththoseinpatientswithtrophoblastictumor,embryonictissueresidueandmissedabortionoccurredintheuterinecavity,interstitialtubalorscarsofuterineisthmusin•Therefore,doctorsshouldexaminetheandbloodP-HCG.Regularfollow-upandreviewshouldbeconductedifnecessary,candecreasemisdiagnosis,avoidunnecessaryre-curettagesurgeryandreducethepatients'painandpanic.［Keywords］Two-dimensionalultrasound;ColorDopplerultrasound;Iatrogenicinjury;Penetratinginjuryofuterinewall;Non-penetratinginjuryofuterinewall宫腔操作所致的医源性子宫壁损伤［1］可分为宫壁穿透性损伤和非穿透性损伤。穿透性损伤，即子宫穿孔，如损伤较严重而未及时诊断治疗可导致出血性休克和其他后遗症，被妇产科医师和超声医师高度重视，已往对子宫穿孔报道的文献较多［2］、认识较深、超声诊断准确率高。非穿透性子宫壁损伤患者腹痛及莫他症状轻，不易引起妇产科医师和超声医师重视，在这方面文献报道较少，笔者首次遇到该病例时因宫壁异常光团和光团内血流界常丰富而误诊为滋养细胞肿瘤和胚胎组织残留，给患者带来了恐惧和痛苦，随后发现本科其他医师也有同样的误诊，于是开始关注和搜集医源性子宫壁损伤的病例。医源性子宫壁损伤原因较多［3-4］,本院因未开展宫腔镜检查治疗、未开展子宫肌瘤的介入治疗，所以未搜集到相关损伤病例。本院搜集的病例均与人工流产、清宫、取节育环手术有关，因子宫畸形的病例均在二维超声（简称B超）监测下由有经验的高年资医师进行手术，所以到目前为止未见子宫畸形宫腔手术后出现子宫壁损伤患者。本文主要评价B超及彩色多普勒超声（简称彩超）对医源性子宫壁损伤的诊断价值。1资料与方法1.1一般资料20...