经阴道三维超声诊断子宫畸形的价值

Superiority of real-time three-dimensional transvaginal ultrasonography in diagnosing uterine congenital malformations

目的探讨经阴道三维超声对子宫畸形的诊断价值。方法选择已临床确诊的130例子宫畸形患者,年龄26~42岁,平均年龄33岁。单角和/或残角子宫均经过宫腔镜和/或腹腔镜检查确诊,双子宫、双角子宫、鞍形子宫均经过MRI检查确诊,纵隔子宫经过宫腔镜检查确诊。回顾分析其经阴道二维和三维超声图像资料。结果经阴道三维超声诊断单角子宫和/或残角子宫11例,双子宫6例,双角子宫7例,纵隔子宫80例,鞍形子宫25例。经阴道二维超声诊断单角子宫和/或残角子宫5例,双子宫6例,双角子宫6例,纵隔子宫73例,鞍形子宫5例。经阴道三维超声诊断与宫腔镜结果符合率99.23%,显著高于二维超声诊断73.08%;两者相比,差异有统计学意义（P〈0.005）。结论经阴道三维超声图像可以显示不同子宫畸形的宫腔结构及宫底的外观形态,是诊断先天性子宫畸形的无创性可靠方法之一。

Objective To study superiority of real-time three-dimensional transvaginal uhrasonography in diagnosing uterine congenital malformations. Methods A total of 130 patients（aged 26 - 42 years old with mean age of 33 years old） were enrolled. The unicoruuate uterus and/or rudimentary horn of uterus were diagnosed by hysteroseopy and/or laparoscopy, double uterus, bicornuate uterus and arcuate uterus were diagnosed by MRI. Mediastinal uterus were diagnosed by hysteroscopy. All of two- dimensional or three-dimensional transvaginal ultrasonography images were analyzed. Results By three-dimensional transvaginal uhrasonography, 11 cases were unicornuate uterus and/or rudimentary horn of uterus, 6 of double uterus, 7 of bicornuate uterus, 80 of mediastinal uterus and 25 of arcuate uterus. By two-dimensional transvaginal ultrasonography, 5 cases were unicornuate uterus and/or rudimentary horn of uterus, 6 of double uterus, 6 of bicornuate uterus, 73 of mediastinal uterus and 5 of arcuate uterus. The diagnose accordance rate by three-dimensional transvaginal uhrasonography（99.23 %） was significant higher than that of two-dimensional transvaginal uhrasonography（73.08 %）. Both of them existed statistical significant difference（P 〈 0.005）. Conclusion It is demonstrated that three-dimensional transvaginal uhrasonography could display different morphology of uterine malformation and fundus structure, which is one of the non-invasive and reliable method in diagnosing congenital uterine malformations.