经阴道宫腔声学造影诊断子宫内膜息肉的价值

The Value of Transvaginal Sonohysterography in the Diagnosis of Endometrial Polyps

目的:探讨经阴道子宫腔造影技术(Transvaginal sonohysterography,SHG)诊断子宫内膜息肉的价值。材料和方法:对39例有异常阴道出血者行SHG检查,并将检查结果与经阴道超声(Transvaginal sonography,TVS)、诊断性刮宫或宫腔镜所获得的结果进行比较分析。结果:病理证实的子宫内膜息肉34例,粘膜下子宫肌瘤3例,子宫内膜增生1例。SHG诊断子宫内膜息肉32例,均可清晰地显示宫腔轮廓和病灶的形态,30例与内膜界限清楚,可见病灶附着部位,23例于结节内部或蒂部显示血流信号;TVS诊断子宫内膜息肉26例,均可见子宫内膜稍强回声结节,其中19例边界清楚,6例可见病灶附着部位;8例结节内部或蒂部显示血流。使用TVS34例均未显示宫腔的轮廓。本组子宫内膜病例在宫腔轮廓及病灶附着部位方面SHG和TVS的显示率分别为94.1%、88.2%和0%、17.6%。SHG明显优于TVS(P<0.001)。SHG诊断粘膜下子宫肌瘤3例,回声与基底部的子宫肌层相似,略低于子宫内膜,病灶基底部与子宫肌层无界限,表面可见内膜与造影剂构成的亮线,1例可见蒂部,CDFI显示2例内部血流丰富,1例见肌层血管穿入病灶。TVS诊断粘膜下子宫肌瘤2例,表现为为子宫内膜低回声结节,1例子宫内膜呈非均质改变,CDFI可见内部丰富的血流信号(SHG显示宫腔内为2枚粘膜下子宫肌瘤,已得到HSC证实)。结论:SHG能明显提高病变的显示率,对于子宫内膜息肉的术前诊断具有重要的临床价值。

Purpose： Endometrial polyps（EP） are one of the most frequently encountered endometrial abnormalities. This study was designed to use transvaginal sonohysterography（SHG） in diagnosing EP. Materials and Methods： SHG was performed in 39 women with abnormal vaginal bleeding. The resuhs of SHG were compared with that of transvaginal sonography （TVS）, and with the pathologic results of uterine explorative curette or hysteroscopy. Results： Pathology confirmed 34 endometial polys, 3 submucous myomas and one endometrial hyperplasia. SHG revealed endometial polys in 32 patients by clearly displaying the shape of uterine cavity and the outline of the lesions. SHG displayed distinctively the extent of endometrium and the sites of lesion attachment in 30 cases, and the blood flow inside the lesion or pedicel in 23. TVS diagnosed endometial polys in 26 cases as hypereehoie nodules of endometrium. Out of 26 cases, 19 had distinctive outlines, 6 showed lesion attachment sites, and 8 had flow signs. TVS could not visualized uterine cavity. The detection rates of SHG and TVS in uterine cavity shape and lesion attachment site were 94.1%, 88.2%, 0% and 17.6% respectively. SHG correctly diagnosed 3 cases of submucous myomas. Conclusion： SHG markedly improved the detection rates of EP lesions, their relations to endometrium and perfusion characteristics of edometrial polyps.