经阴道彩超在绝经前子宫内膜良性病变诊治中的应用

Transvaginal Ultrasonic Evaluation of Uterus Endometrial Benign Lesions in the Premenopause Women and Supervision in the Process of Surgery

目的运用经阴道彩超诊断绝经前子宫内膜良性病变,并对子宫内膜息肉和黏膜下肌瘤术中进行超声监测,提高超声在此类疾病诊治中的应用价值。方法经阴道彩超观察88例绝经前诊断子宫内膜良性病变内膜厚度、回声、形态及血流分布等情况,与术后病理结果进行对照;并对诊断子宫内膜息肉和黏膜下肌瘤的患者行宫腔镜检查和治疗,其中10例术中运用彩超进行监测。结果经阴道彩超对绝经前内膜良性病变诊断:本组病例88例,内膜息肉55%(48/88),单发占46%(22/48),其中10例单发充满宫腔的内膜息肉误诊为单纯内膜增生;多发占54%(26/48);黏膜下肌瘤23%(20/88),内膜增生23%(20/88)。血流检出率:内膜息肉单发者血流检出率为85%(18/22),多发者为73%(19/26),黏膜下肌瘤为100%(20/20),内膜增生为80%(16/20)。经阴道超声检查结果与术后病理检查结果比较差异无统计学意义。10例术中应用彩超进行监护,手术切除干净,无子宫穿孔等并发症。结论经阴道彩超可对绝经前子宫内膜良性病变做出诊断及鉴别诊断,可作为此类患者随访的一种有价值、无创检查手段,为其下一步诊治提供了可靠的依据。彩超可对宫腔镜切割提供方便、安全地监测。

Objective To delineate uterus endometrial benign lesions in the premenopause women by the transvaginal ultrasound （TVS）, and guide them in the process of the endometrial polyps and submucosal myomas surgery by transabdominal sonography（TAS）, to improve ultrasonic capability to detect them. Methods Eighty eight women with endometrial benign lesions observed by TVS were inspected endomential thickness, echoes morphology and color flow imaging, contrasted with the pathologic findings;those diagnosed as endometrial polyps and submucosal myomas treated with hysteroscopy, ten cases were detected by ultrasonic imaging in the process of resection. Results The causes in the group of premenopause were suggested as follows： among 88 cases, endometrial polyps 55% （48/88）, whereas single accounted for 46% （22/48）, multiple 54% （26/48）, 10 single polyps which fill in uterus cavity were misdiagnosed as simple endometrial hyperplasia, submucosal fibroids 23% （20/88）, endometrial hyperplasia 23% （20/88） ; The characteristic of color doppler： the rate of detection in endometrial polyps in single was 85% （18/22）, that in multiple 73% （19/26）, that in submucosal myomas 100% （20/20） and that in endometrial hyperplasia 80% （16/20） respectively; there was no difference between transvaginal diagnosis of abnormal endometrial and that of postoperative pathological results. Among some cases transabdominal color imaging were used to guide clinical treatment in the process of operation, until now there were no complications such as uterus perforation, whether recurrence was found after postoperation or not was still followed up. Conclusion TVS is used to visualize uterus endometrial benign diseases, and has become one of the propriety tools used by the obstetrician to follow up the subjects, provide the valuable proof for the next treatment; Transabdominal color imaging may play a important role in the supervision of curettage.