经阴道三维超声诊断宫内节育器异常的临床价值

Diagnosis Value of Transvaginal Three-Dimensional Ultrasonography in Migration of Intrauterine Devices

目的:探讨经阴道三维超声诊断宫内节育器异常的临床价值。方法:对有症状,如异常出血、下腹痛、白带异常、带环受孕等,临床医生高度怀疑节育器异常的75例患者,先经阴道二维超声检查,再行经阴道三维超声成像,观察节育器形状,位置及其与子宫腔,子宫内膜、肌层、浆膜层的关系,储存图像,并与宫腔镜、腹腔镜或破腹取器术等手术结果对比分析。结果:75例患者均经手术证实,其中节育器异位至腹腔1例;节育器形状正常但位置下移21例;节育器位置下移(或变形)合并肌层嵌顿为32例,其中浅嵌顿22例,深嵌顿10例;节育器在宫腔内不同角度旋转19例;取环后残端嵌顿2例,经阴道三维超声诊断节育器异常准确率100.0%,经阴道二维超声诊断节育器异常准确率74.7%,两者相比差异有统计学意义(P<0.05),尤其是节育器在宫腔内肌层浅嵌顿,不同角度旋转的诊断,经阴道三维超声诊断准确率明显高于经阴道二维超声。结论:经阴道三维超声诊断节育器异常图像清晰,准确率高,明显优于经阴道二维超声及其他影像学诊断方法,有利于临床治疗方案的选择。

Objective:To discuss the clinical significance of transvaginal three-dimensional ultrasonography in the diagnosis of migration of intrauterine devices.Methods:75patients with such symptoms as abnormal bleeding,abdominal pain,leucorrhea abnormality,ring conception,highly suspected migration by the clinicians had been first examined by transvaginal two-dimensional ultrasound,and then by transvaginal three-dimensional ultrasound imaging.The shape and position of intrauterine devices had been observed in relation to the uterine cavity,endometria,muscular layer and serous layer.Then the images had been stored,and finally had been analyzed comparatively with the results of surgeries by hysteroscope,laparoscopy or torn abdominal extraction.Results:75patients were confirmed by surgery:one case of migration of the intrauterine device in the abdominal cavity;21cases of descending with normal shapes;32cases of descending(or deformation)with incarceration in muscular layer,among which 22 were shallow incarceration,10deep;19cases of circumgyration in the uterus;2cases of stump incarceration after the ring removing.As a result,the abnormity accuracy by transvaginal three-dimensional ultrasound diagnosis was 100%,two-dimensional ultrasound diagnosis 75%.There was statistical significance(P<0.05).Transvaginal three-dimensional ultrasound was much more accurate than two-dimensional ultrasound in the diagnosis of shallow incarceration in muscular layer and rotating in different angles.Conclusion:Images by three-dimensional ultrasonography is much clearer and more accurate than transvaginal two-dimensional ultrasound and other methods,and it is more useful for clinical treatment choices.