彩色多普勒超声对剖宫产腹壁子宫内膜异位症的诊断价值

Research of diagnostic effect of color Doppler ultrasound in abdominal wall endometriosis after caesarean section

目的探讨彩色多普勒超声对剖宫产术后腹壁子宫内膜异位症(AWE)的临床诊断价值。方法回顾性分析2012年1月至2015年6月西昌市人民医院46例经病理证实为剖宫产术后AWE患者的临床资料与彩色多普勒超声表现。结果彩色多普勒超声对AWE诊断准确率为97.83%,彩色多普勒超声表现:无钙化灶,肿块形态及大小不规则,横纵比≤1,内部不均匀低回声,病灶边界不清晰,CDFI可见内部及外周无或少量血流信号,动脉血流呈"高阻低速"型,肿块大小及回声可随月经周期变化而变化。肿块直径<3 cm的潜伏期较短、位置表浅、病灶多呈卵圆形或椭圆形,病灶多无血流或少血流;直径≥3 cm病灶潜伏期较长、位置较深,病灶多为不规则形态,且血流信号较为丰富;直径<3 cm潜伏期(2.52±0.98)年、病灶直径(1.61±0.54)cm、病灶形态不规则(68.75%)、病灶深度(22例腹直肌前鞘及皮下脂肪层,10例腹横筋膜/全层腹壁)、CDFI血流(10例无,19例少量,3例丰富);直径≥3 cm分别为(3.90±1.43)年、(4.35±1.42)cm、89.47%形态不规则、病灶深度(4例腹直肌前鞘及皮下脂肪层,15例腹横筋膜/全层腹壁)、CDFI血流(3例无,8例少量,8例丰富),组间比较差异有统计学意义(P<0.05)。结论彩色多普勒超声结合病史及临床表现可对剖宫产术后AWE做出准确定位及定性诊断,是一种简便可靠的AWE诊断方法。

Objective To investigate the diagnostic value of color Doppler ultrasound for abdominal wall endometriosis （AWE）after caesarean section. Methods The clinical data and manifestation of color Doppler ultrasoundof 46 AWE patients confirmed by surgery and pathologywere retrospectively analyzed. Results The diagnostic accuracy of color Doppler ultrasound for AWEwas 97.83%. Withcolor Doppler ultrasonography,threre was no calcification,irregularmorphology and size,with aspect ratio ≤1,uneven and low echoes inside, blurred margins,and the CDFI showed no or a small amount offlow signals,whose artery displayed ＂low speed and high resistance＂,and tumor size and echo might vary with the menstrual cycle changes.Compared with ≥3 cm group,the latent period of 〈3 cm groupnodules were shorter,the locationwas more superficial,the shapewas round or oval,and there was no or few vascularity;the latent period of ≥3 cm group was longer,location wasdeeper,the shape was irregular,and the vascularity was abundant.In the tumor diameter〈3 cm group,the latent period was （2.52±0.98） years, lesion diameter was （1.61±0.54）cm,irregularmorphology was 68.75%,with location （22 cases of rectus abdominis sheath and subcutaneous fat layer and 10 cases of abdominal transverse fascia/full-thickness abdominal wall）and CDFI blood flow（no in 10 cases, poor in 19 cases, and rich in 3 cases）as listed in brackets;thosein the tumor diameter ≥3 cm group were （3.90±1.43） years,（4.35±1.42） cm, 89.47%irregularmorphology, location （4 cases of rectus abdominis sheath and subcutaneous fat layer and 15 cases of abdominal transverse fascia/full-thickness abdominal wall）, CDFI blood flow（no in 3 cases,poor in 8 cases, and rich in 8 cases）, respectively, and the differences between the groups were significantstatistically（P〈0.05）. Conclusion Color Doppler ultrasound,whenproperly combined with the illness history and clinical manifestations, can make an accurate diagnosis of localization and characterization,which may be a simple and reliable method in the diagnosis of AWE.