经阴道超声检查在宫腔粘连中的诊断价值

The value of transvaginal untrasound in diagnosing intrauterine adhesions in the primary-level hospital

目的探讨基层医院经阴道超声检查在宫腔粘连中的诊断价值。方法对疑诊为宫腔粘连的87例行经阴道超声和宫腔镜检查,以宫腔镜检查结果为金标准,评价经阴道超声检查诊断宫腔粘连结果。结果87例患者经宫腔镜检查确诊为宫腔粘连者76例,76例宫腔粘连患者中,经阴道超声检查提示为宫腔粘连者56例,与宫腔镜检查相比较,经阴道超声检查诊断宫腔粘连的敏感度为73.68%,特异度为81.82%,准确度为74.71%,ROC曲线下面积为0.638,95%CI=0.506-0.770。经阴道超声检查诊断轻度、中度、重度粘连检出率分别为50.00%（17/34）、71.43%（20/28）、85.71%（12/14）,中央型、周围型、混合型检出率分别为67.57%（25/37）、50.00%（8/16）、82.61%（19/23）。结论经阴道超声检查可作为宫腔粘连的常规筛查方法,具有较高的临床价值,值得在基层医院推广应用。

Objective To explore the value of transvaginal untrasound in diagnosing intrauterine adhesions in the primary-level hospital. Methods Eighty-seven patients with suspicious intrauterine adhesions were examined by transvaginal ultrasound and hysteroscopy. Hysteroscopic results were used as a gold standard to evaluate the diagnositic results of intrauterine adhesions by transvaginal ultrasound. Results Seventy-six cases with intrauterine adhesions were verified by hysteroscopy. Intrauterine adhesions were confirmed by transvaginal ultrasound in 56 cases out of 76 cases. Compared with those by hysteroscopy,the detection rates of mild,moderate and severe intrauterine adhesions by transvaginal ultrasound were 50. 00%( 17 /34),71. 43%( 20 /28) and 85. 71%( 12 /14) respectively. The detection rates of central,marginal and mixed intrauterine adhesions by transvaginal ultrasound were 67. 57%( 25 /37),50. 00%( 8 /16),82. 61%( 19 /23) respectively. The sensitivity,specificity and accuracy of transvaginal ultrasound in diagnosing intrauterine adhesions were 73. 68%,81. 82% and 74. 71% respectively,the area under the receiver operating characteristic( ROC) curve was 0. 638,95% CI = 0. 506 ~ 0. 770. Conclusion Transvaginal ultrasound may be a routine screening method for diagnosing intrauterine adhesions in a primary-level hospital.