经直肠与经阴道超声诊断肠道BE的对照分析

Comparative analysis of transrectal and transvaginal ultrasound for diagnosis of bowel endometriosis

目的比较经阴道超声(TVUS)和经直肠超声(TRUS)对肠道子宫内膜异位症(BE)患者的诊断价值。方法选取秦皇岛经济技术开发区医院2011年3月至2014年5月临床拟诊为BE而需要手术治疗的26例患者,术前邀请两名经验丰富的超声科医生进行TVUS和TRUS检查,对疾病是否累及肠壁进行判断,评价两种技术的诊断价值。结果 26例患者中有14例经术后病理确诊为BE,TVUS和TRUS的准确率分别为80.8%和88.5%,敏感性分别为85.7%和78.6%,特异性分别为75%和100%,阳性预测值分别为80%和100%,阴性预测值分别为81.8%和80%,两者诊断效能基本相当。与金标准比较差异均无统计学意义(Kappa值分别为0.611、0.772,均P>0.05),而回盲部及阑尾病例较易漏诊。结论 TVUS与TRUS对BE的诊断价值相当,而TVUS操作更简便,应该作为临床首要选择,TRUS则可作为TVUS阴性时的补充手段。

Objective To compare the diagnostic value of transvaginal ultrasound （TVUS） and transrectal ultrasound （TRUS） in patients with bowel endometfiosis （BE）. Methods From March 2011 to May 2014, 26 patients who were suspected as BE and needing surgery were selected in Qinhuangdao Economic and Technological Development Zone Hospital. TVUS and TRUS were carried out by two experienced ultrasound practitioners preoperatively. The diagnostic value of both technologies was evaluated. Results Totally 14 patients were diagnosed as BE pathologically. The accuracy rate of TVUS and TRUS was 80.8% and 88.5% , respectively. Sensitivity of them was 85.7% and 78.6% , respectively, and specificity was 75% and 100%, respectively. Positive predictive value was 80% and 100% , respectively, while negative predictive value was 81.8% and 80%, respectively. Diagnostic value of two inspections was almost equivalent. There was no statistical difference compared with gold standard （ Kappa value was 0. 611and 0. 772, respectively, both P 〉 0.05）. But the lesion in ileocecal junction and appendix would be missed easily. Conclusion The diagnostic value of TVUS and TRUS in BE is equivalent. However, TVUS is more convenient in operation and should be the first choice for diagnosis. TRUS could be supplementary means when TVUS is negative.