经阴道三维超声对先天性子宫畸形的诊断价值

Value of transvaginal three-dimensional sonography in diagnosing congenital uterine abnormalities

目的探讨三维超声在先天性子宫畸形诊断中的应用价值。方法对2014年1月至2017年12月在南京医科大学第一附属医院生殖医学科的不孕或不育患者行经阴道三维超声检查,采用OmniView成像获取满意的子宫冠状切面声像图,诊断出不同类型的子宫形态;将408例诊断为子宫畸形患者的三维超声诊断结果与宫(腹)腔镜手术结果进行一致性比较分析,以宫(腹)腔镜手术后的结果为诊断子宫畸形的金标准,评价三维超声诊断各种类型子宫畸形的敏感度、特异度、阳性预测值、阴性预测值及Kappa系数。结果 408例子宫畸形患者的三维超声诊断为弓形子宫29例(7.11%),不全纵隔子宫223例(54.66%),完全纵隔子宫114例(27.94%),双角子宫15例(3.68%),单角子宫19例(4.66%),双子宫6例(1.47%),Robert子宫1例(0.25%),阴道斜隔综合征1例(0.25%)。三维超声与宫(腹)腔镜诊断各种类型子宫畸形的Kappa系数分别为:弓形子宫0.94,不全纵隔子宫0.96,完全纵隔子宫0.97,双角子宫0.96,单角子宫、双子宫、Robert子宫、阴道斜隔综合征均为1.00。结论三维超声对不同类型先天性子宫畸形有较高的诊断准确率,可作为子宫畸形的首选诊断方法,在临床上推广应用。

Objective To evaluate the value of three-dimensional sonography for diagnosis of congenital uterine abnormalities.Methods Infertility patients underwent transvaginal three-dimensional sonography from January 2014 to December 2017 in the First Affiliated Hospital of Nanjing Medical University.By applying OmniView technique,satisfactory uterine coronal section images were obtained to diagnose the types of uterus.Three-dimensional sonography results of 408 cases of uterine malformation were compared with hysteroscopy and laparoscopy results.Hysteroscopy and laparoscopy results were taken as golden standard to evaluate the sensitivity,specificity,positive predictive value,negative predictive value and Kappa of three-dimensional sonography.Results Three-dimensional sonography revealed 29（7.11%）cases of arcuate uterus,223（54.66%）cases of subseptate uterus,114（27.94%）cases of complete septate uterus,15（3.68%）cases of bicornate uterus,19（4.66%）cases of single horn uterus,6（1.47%）cases of didelphia,1（0.25%）case of Robert uterus and 1（0.25%）case of oblique vaginal septum syndrome.The Kappa coefficients of three-dimensional sonography and hysteroscopy（laparoscopy）in the diagnosis of various types of uterine abnormality were 0.94 for arcuate uterus,0.96 for subseptate uterus,0.97 for complete septate uterus,0.96 for bicornate uterus,and 1.00 for single horn uterus,didelphia,Robert uterus and oblique vaginal septum syndrome,respectively.Conclusion Threedimensional sonography has high diagnostic accuracy for different types of congenital uterine abnormality.Because it is a noninvasive examination method,it can be used as one of the first diagnostic methods of uterine abnormality and is widely used in clinic.