三维超声成像术前评价卵巢肿物的临床价值

The preoperative evaluation value of three-dimensional ultrasound imaging for ovarian masses

目的探讨三维超声成像图显示卵巢肿物大体解剖结构的临床价值。方法选择2008年1月至2009年12月因囊实性或实性卵巢肿物在首都医科大学附属北京妇产医院行二维及三维超声检查及手术治疗的患者47例,术前1周内对卵巢肿物行二维及三维超声检查,每例患者均行三维超声成像及断层超声成像(TUI),并与术后大体标本及其解剖结构进行比较。结果 47例卵巢肿物均经病理检查证实,其中良性23例,恶性24例(交界性6例)。术后大体标本与术前卵巢肿物三维超声成像和(或)断层超声成像对比,超声能准确反映其解剖结构42例(42/47,89.4%)。5例分别因不能显示肿物表面小突起及内部小囊腔、肿物内部受挤压后的结构显示不清、将畸胎瘤肿物内壁的牙齿误认为形态类似的乳头样结构,另将位置相近的双侧卵巢肿物成像误认为单侧条形卵巢肿物。结论与病理大体标本及其解剖结构对照,术前三维超声成像技术能较准确地显示卵巢肿物的解剖结构,对临床术前判断肿瘤良恶性和制订手术方案有重要参考价值。

Objectives To explore the clinical value of preoperative three-dimensional ultrasound imaging for ovarian tumors for reflecting the anatomy postoperatively. Methods Forty-seven patients with ovarian cystic-solid or solid masses from Beijing Obstetrics and Gynecology Hospital, Capital Medical University were evaluated by two-dimensional （2D） and three-dimensional （3D） ultrasound examination within one week before surgery from January 2008 to December 2009. Every ovarian mass was examined by three-dimensional ultrasound and tomographic ultrasound imaging （TUI） and the results was compared with the specimen postoperatively. Results Forty-seven ovarian masses were confirmed by pathology, including 23 benign masses and 24 malignant masses （six borderline tumors）. Compared with the postoperative specimens, the accuracy of preoperative 3D ultrasound imaging of ovarian tumors for the anatomical structures was 89.4% （42/47）. The misdiagnosis causes in 5 cases included failure to detect tiny papillae on the surface and small cysts in the mass, failure to display the compressed structures accurately, wrongly believe the teeth on the tumor wall as papillae and wrongly believe two adjacent ovarian tumors as one unilateral mass. Conclusions Compared with postoperative specimens, the anatomy of ovarian tumors could be reflected accurately by 3D ultrasound imaging preoperatively. It could be helpful for differential diagnosis between benign and malignant ovarian tumors and the decision of surgical plan.