经阴道二维超声与三维超声诊断纵隔子宫的临床价值

Clinical value of transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography in diagnosis of uterus septus

目的比较经阴道二维超声(2D-TVS)与三维超声(3D-TVS)诊断纵隔子宫的价值。方法选取佛山市第一人民医院2011-2016年收治的经宫腔镜确诊的纵隔子宫患者197例为研究对象,67例患者采用2D-TVS检查,130例采用3D-TVS检查,比较两组患者超声检查的敏感性、误诊率及与宫腔镜检查结果是否一致。结果 3D-TVS总检出率为(89.43%)高于2D-TVS的总检出率(64.06%),两组误诊率为(14.29%vs.66.67%),与宫腔镜的一致性为(0.74%vs.0.23%)。而对于不同纵隔子宫分型的比较表明:弓形子宫2D-TVS的灵敏度优于3D-TVS,误诊率明显低,与宫腔镜检查具有更高一致性,但是完全性纵隔子宫与不完全性纵隔子宫的检查结果则完全相反。结论 3D-TVS在诊断纵隔子宫的总检出率方面包括灵敏度、误诊率、与MRI的一致性明显优于2D-TVS,但对于美国生育协会(AFS)不同分型的诊断价值,则各有优势。鉴于目前大多数B超均可兼顾2D及3D诊断,两者联用能提高诊断的可靠性。

Objective To compare the diagnostic value of transvaginal two-dimensional ultrasonography（ 2D-TVS） and three-dimensional ultrasonography（ 3D-TVS） in diagnosis of uterus septus. Methods A total of 197 patients diagnosed as uterus septus by hysteroscopy and treated in the hospital from 2011 to 2016 were selected as research objects. A total of 67 patients were examined by 2D-TVS and130 patients were examined by 3D-TVS. The sensitivity,misdiagnostic rate and consistency of hysteroscopic results were compared between the two groups. Results The total detection rate of 3D-TVS（ 89. 43%） was higher than that of 2D-TVS（ 64. 06%）; the misdiagnostic rates in the two groups were 14. 29% and 66. 67%,respectively; the consistency of hysteroscopis results were 0. 74% and 0. 23%,respectively. The comparison of different uterus septus types showed that the sensitivity of 2D-TVS for arc-shaped uterus was better than that of3D-TVS,and the misdiagnostic rate was lower,and it was more consistent with hysteroscopic results. However,the results of complete uterus septus and incomplete uterus septus were opposite. Conclusion The total detection rate of 3D-TVS in diagnosing uterus septus includes sensitivity,misdiagnostic rate; MRI consistency of 3D-TVS is superior to 2D-TVS,but they have their own advantageous for diagnosis of different types in American Fertility Association（ AFS） classification. In view of the fact that most B-mode ultrasound can take into account both 2D and 3D diagnosis,it is recommended that the combination of them can improve the reliability of diagnosis.