不全纵隔子宫与弓形子宫的三维超声鉴别诊断

Differential diagnosis of incomplete seperate uterus and arcuate uterus by three-dimensional ultrasonography

目的探讨不全纵隔子宫与弓形子宫的三维超声鉴别特点。方法对宫、腹腔镜确诊为不全纵隔子宫和弓形子宫的各50例患者行二维及三维超声多平面成像,分析二者的声像图特点及鉴别要点。结果二维超声显示42例不全纵隔子宫患者双侧宫腔间见肌层分隔低回声,38例弓形子宫患者宫底部内膜显示不连续,宫底部中央区增厚的肌层向宫腔突出。三维超声显示50例不全纵隔子宫患者可见两侧内膜在子宫下部相互融合,呈"Y"形,夹角深度﹥10mm,两侧内膜夹角﹤90°;50例弓状子宫患者宫底处内膜呈浅"V"形,夹角深度﹤10mm,两侧内膜夹角﹥90°。二维超声诊断不全纵隔子宫和弓形子宫的符合率分别为84%和76%,三维超声诊断不全纵隔子宫和弓形子宫的符合率均为100%,二者比较差异有统计学意义(P﹤0.05)。结论三维超声冠状面可清晰显示子宫宫腔结构和外观形态,并可直观显示不全纵隔子宫和弓形子宫的纵隔长度及两侧内膜夹角,对二者的诊断较二维超声更具优势。

Objective To evaluate the role of three-dimensional （3D） ultrasonography in the differential diagnosis of incomplete seperate uterus and arcuate uterus.Methods Fifty cases of incomplete seperate uterus and 50 cases of arcuate uterus diagnosed by hysteroseopy and laparoscope were examined by two-dimensional （2D） and 3D uhrasonography.Their uhrasonograhphic characteristics and the differentiate points between them were analyzed.Results The hypoechoic museularis separation between the bilateral uterine cavities was shown by 2D uhrasonography in 42 cases of incomplete seperate uterus. Endometrium discontinuity was found in the fundus of arcuate uterus in 38 cases as the incrassate museularis in central region protruded toward the uterine cavity.It was shown that the endometium fused at the lower part of incomplete seperate uterus in all 50 cases by 3D ultrasonography.h appeared as ＂Y＂ shape.The included angle depth exceeded 10 mm and the included angle was smaller than 90°.The endometrium in the fundus of arcuate uterus appeared as ＂V＂ shape in all 50 cases.The included angle depth was smaller than 10 mm and the included angle exceeded 90°.The diagnostic accordance rates of incomplete seperate uterus and arenate uterus were 84% and 76% by 2D ultrasonography while they were 100% by 3D nltrasonography, which was statistically significant （P 〈 0.05 ）.Conclusion Three-dimensional uhrasonography can easily display the structure of uterine cavity and the appearance morphology of uterus, intuitively show the distance between endometrium and fundus of uterus and assess the included angle between bilateral endometrium.It is superior to 2D uhrasonography in the differential diagnosis of incomplete seperate uterus and areuate uterus.