子宫肌瘤的诊断

The diagnosis of uterine leiomyoma

子宫肌瘤的症状主要是月经过多、疼痛和压迫症状,与盆腔其它疾病的症状相似,必须通过辅助影象学检查排除子宫肉瘤、子宫腺肌病、子宫内膜癌和卵巢肿瘤等疾病,尤其是行保守性治疗前。超声检查应用最广、花费最少,是诊断子宫肌瘤最好的选择方法。磁共振成像(magnetic resonance imaging,MRI)在子宫肌瘤的精确定位是最好的方法,但由于它的费用较高而限制了临床的应用。计算机断层扫描(computerized tomographic scanning,CT)一般不用于子宫肌瘤的诊断。宫腔镜可明确诊断黏膜下肌瘤和子宫内膜息肉并可同时进行治疗。磁共振血管造影术(Magnetic Resonance Angiography,MRA)、CT血管造影和超声多谱勒技术可以显示肌瘤和子宫外的血管供应,可用于子宫动脉血管栓塞等保守治疗前的评估。子宫肌瘤成功的治疗,必须对子宫肌瘤的数量、大小、位置及黏膜下肌瘤和浆膜下肌瘤进入肌壁间的深度等进行明确诊断。

Symptoms of uterine leiomyomat,including pain, pressure and menorrhagia, may be similar to those of other pelvic conditions. Diseases to exclude when myomata were suspected included uterine leiomyosarcoma, adenomyosis, endometrial carcinoma, and ovarian tumors. Identification of malignancies was especially important with the increasing popularity of uterine - sparing treatment for myomata. Ultrasound was the most widely used and least expensive option, and was a preferred choice for the detection of myomata. Magnetic resonance imaging（MRI） was an excellent technique for the precise mapping of myomata, but is expensive and access may be limited. Computerized tomographic scanning （CT） was not usually employed for the imaging of myomata. Hysteroscopy is useful in women with submucosal fibroids and polyps amenable to surgical intervention at the time of hysteroscopic evaluation. Magnetic resonance angiography （MRA）, CT angiography and Doppler ultrasound may provide information regarding the vasculature of myomata, including evaluation of any extra - uterine blood supply. Effective pretreatment imaging must provide information regarding the number, size and depth of invasion of myoma.