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目的:采用三维能量多普勒定量研究剖宫产后子宫瘢痕部位妊娠(CSP)血管微循环的特点,为CSP诊治提供依据。方法:选取确诊为胚囊型CSP且接受子宫动脉栓塞化疗后人工流产治疗的患者43例作为研究对象,常规检测手术前后血流搏动指数(PI)、阻力指数(RI)和血β-绒毛膜促性腺激素(β-hCG)值,三维彩色能量多普勒(3D-CPA)检测手术前后血管形成指数(VI)、血管形成-血流指数(VFI)及血流指数(FI)。采用相关性分析方法分析栓塞化疗术前VI、VFI、FI与PI、RI及β-hCG的关系;采用t检验分析栓塞化疗术前后VI、FI、VFI、PI、RI的变化;依据术中出血量是否>100 ml将患者分为出血量>100 ml组(A组)和出血量≤100 ml组(B组),采用t检验分析两组术前VI、FI、VFI值的差异。结果:VI与β-hCG呈正相关(r=0.858,P<0.05),VI、VFI、FI与PI、RI均无相关性(P>0.05);VFI、FI与β-hCG无相关性(P>0.05);栓塞化疗前VI显著高于栓塞化疗后(t=-8.861,P<0.05),栓塞化疗前后VFI、FI差异无统计学意义(P>0.05);A组患者VI明显高于B组的患者(t=-6.130,P<0.05),两组VFI、FI差异无统计学意义(P>0.05)。结论:采用3D-CPA定量评估CSP血管微循环参数中VI值是比较有价值的参数,可为CSP的诊治提供依据。
OBJECTIVE: To quantitatively study the characteristics of blood vessel microcirculation in pregnancy (CSP) of uterine scar after cesarean section using three-dimensional energy Doppler to provide basis for the diagnosis and treatment of CSP. Methods: Forty-three patients who were diagnosed as embryo-sac type CSP and treated with artificial abortion after uterine artery embolization and chemotherapy were enrolled. Routine measurement of blood flow index (PI), resistance index (RI) and blood β- The values of β-hCG, 3D-CPA were measured before and after operation. The indexes of angiogenesis, blood flow index (VFI) and blood flow index (FI) were measured before and after operation. The relationship between VI, VFI, FI, PI, RI and β-hCG before embolization and chemotherapy was analyzed by correlation analysis. The changes of VI, FI, VFI, PI and RI before and after embolization and chemotherapy were analyzed by t test. The patients were divided into two groups: the bleeding volume> 100 ml group (A group) and the bleeding volume≤100 ml group (B group), the differences of preoperative VI, FI and VFI between the two groups were analyzed by t test. Results: There was no significant correlation between VI and β-hCG (r = 0.858, P <0.05), but there was no correlation between VI, VFI, FI and PI and RI (P> 0.05) > 0.05). The VI before embolization was significantly higher than that after embolization (t = -8.861, P <0.05). There was no significant difference in VFI and FI before and after embolization (P> 0.05). The VI in group A was significantly higher than that in group B (T = -6.130, P <0.05). There was no significant difference in VFI and FI between the two groups (P> 0.05). Conclusion: The quantitative evaluation of VI value in CSP microcirculation parameters by 3D-CPA is a valuable parameter, which can provide a basis for the diagnosis and treatment of CSP.