超声对子宫肉瘤与子宫肌瘤鉴别诊断的临床应用价值

Value of ultrasonography in the differential diagnosis between uterine sarcomas and leiomyomas

目的 探讨彩色多普勒超声鉴别诊断子宫肉瘤与子宫肌瘤的临床应用价值。方法 分析病理证实的60例子宫肉瘤和150例子宫肌瘤的超声表现，比较二者的病变数目、位置、形态、边界、液化、结构、回声类型及彩色多普勒血流分布等超声征象的差异。结果 子宫肉瘤和肌瘤患者的平均年龄和年龄分布特点的差异有统计学意义（P〈0．05）。阴道出血、阴道脱垂物等症状是子宫肉瘤较特异的症状。超声显示病灶体积．形态及内部结构与病理一致性好。肉瘤病灶体积显著大于肌瘤病灶（P＜0．01）。典型恶性病变为体积较大的蜂窝样混合回声、边界模糊，形态不规则或分叶状。典型良性病变为边界清晰的圆或椭圆形漩涡状中低回声，质地均匀，液化灶少见。单发病灶、形态不规则、蜂窝状混合回声和不规则液化结构对恶性病变的诊断意义较大（P＜0．05）。彩色多普勒超声显示肉瘤病灶多血流丰富，内部及周边分布可呈“镶嵌样”，肌瘤多为规则分布的点条状血流（P＜0．01）。部分临床分期、组织学分化程度较好的子宫肉瘤与合并液化坏死的不典型子宫肌瘤的超声征象相互重叠，鉴别诊断较为困难。结论 彩色多普勒超声对子宫肌瘤和子宫肉瘤鉴别诊断有临床应用价值，综合分析灰阶及彩色多普勒征象可提高诊断准确率。

Objective To evaluate the contribution of ultrasonography （US） in the differential diagnosis of uterine leiomyomas and sarcomas. Methods Retrospectively analyzed the US features of 150 leiomyomas and 60 uterine sarcomas, compared the number, size, location, morphology, margin and the echo patterns of the benign and malignant lesions,together with their CDFI distinctions. Results The patients with leiomyomas were significantly younger than those with sarcomas （P〈 0. 05）. The occurrence of vaginal bleeding and vaginal lesion was statistically higher among sarcomas than in leiomyomas（ P〈0.05）. Sonographic features like the tumor size, shape and echo texture were well associated with macroscopic configuration. The size of sarcomas was larger than that of leiomyomas（ P 〈0.05）. Uterine sarcomas were identified as large, solitary, irregular, ill-defined, honeycombed heterogenous pattern with echo-free areas scattered in the tumor. Gray-scale US characteristics between leiomyomas and sarcomas showed statistical significance （P〈 0.05）. Rich peripheral and internal vascularity with an irregular shape was the characteristic color flow imaging pattern of uterine sarcoma. Uterine leiomyomas was featured with regular hypovascularity or avascularity（ P〈0.05）. Conclusions Color Doppler US is valuable in differentiating uterine sarcomas from uterine leiomyomas. Analysis of gray-scale together with color Doppler flow features can improve the accuracy of differential diagnosis.