经阴道二维和三维超声检查对宫腔异常的临床诊断价值

Clinical value of transvaginal two-dimensional ultrasound and three-dimensional ultrasound in diagnosing uterine anomalies

目的探讨经阴道二维超声和三维超声对宫腔异常的临床诊断价值。方法对在山东中医药大学附属医院生殖与遗传中心就诊患者,以宫腔镜或者宫腹腔镜证实宫腔异常者为观察对象,回顾分析其有创检查前的二维和三维超声检查结果,探讨不同超声检查方式对宫腔异常的临床诊断价值。结果 83例怀疑子宫畸形患者,宫腔镜检查证实弓形子宫44例,二维超声检查漏诊6例,三维超声检查全部诊断正确;经宫腹腔镜检查证实不全纵隔子宫23例,二维超声检查误诊5例(均误诊为弓形子宫),三维超声检查全部诊断正确;经宫腹腔镜检查证实完全纵隔子宫4例,二维及三维超声检查全部诊断正确;经宫腔镜检查证实单角子宫12例,二维及三维超声检查全部诊断正确。123例怀疑宫腔病变患者,经宫腔镜及病理结果证实宫腔占位68例,其中粘膜下肌瘤4例,子宫内膜息肉64例,二维超声检查漏诊9例内膜息肉,三维超声检查漏诊5例内膜息肉,二维及三维超声检查正确诊断所有粘膜下肌瘤;经宫腔镜证实宫腔粘连55例,二维超声检查漏诊23例,三维超声检查漏诊18例。结论三维超声检查对子宫畸形的诊断准确率可达100%;三维超声检查对宫腔病变的诊断存在一定的漏诊率,但漏诊率低于二维超声检查;三维超声检查对宫腔异常的诊断准确率高于二维超声检查。

Objective To discuss the clinical value of transvaginal two-dimensional ultrasound and three-dimensional ultrasound in the diagnosis of uterine anomalies. Methods Patients were selected from the reproductive and genetic center of integtated traditional and western medicine affiliated hospital of TCM university. Patients with abnormal uterine cavity who had been confirmed by hysteroscopy were setected as the research object. We reviewed the results of two-dimensional and three-dimensional ultrasonography before invasive examination, and explored the clinical diagnostic value of different ways of ultrasonography. Results In 83 cases of suspected uterine malformation, 44 cases of arcuate uterus were confirmed by hysteroscopy, 6 cases of arcuate uterus were missed by two-dimensional ultrasound and all arcuate uterus were correctly diagnosed by three-dimensional ultrasound. 23 cases of incomplete mediastinal uterus were confirmed by hysteroscopy, 5 cases of incomplete mediastinal uterus were misdiagnosed as arcuate uterus by two-dimensional ultrasound and all incomplete mediastinal uterus were correctly diagnosed by three-dimensional ultrasound. 4 cases of complete mediastinal uterus were confirmed by hysteroscopy, all complete mediastinal uterus were correctly diagnosed by two-dimensional and three-dimensional ultrasonography. 12 cases of unicornis uteruses were confirmed by hysteroscopy, all unicornis uteru were correctly diagnosed by two-dimensional and three-dimensional ultrasonography. There are 123 cases of suspected Uterine cavity lesion, 68 cases lesions of uterus were confirmed by hysteroscopy and pathological results. There were 4 cases of submucous myoma and 64 cases of endometrial polyp. 9 cases of endometrial polyps were missed by two dimensional ultrasound examination and 5 cases of endometrial polyps were missed by three dimensional ultrasound examination, and all submucous myomas were correctly diagnosed by two-dimensional and three-dimensional ultrasound. 55 cases of Intrauterine adhesions were confirmed by hysteroscopy. Two-dimensional ultrasound examination missed 23 cases of intrauterine adhesions and three-dimensional ultrasound examination missed 18 cases of intrauterine adhesions. Conclusion The diagnostic accuracy of three-dimensional ultrasound for uterine malformation is 100%;Three dimensional ultrasound has a certainmissed diagnosis rate for the diagnosis of uterine cavity lesions, but the rate of missed diagnosis is lower than that of two-dimensional ultrasound. The accuracy of three-dimensional ultrasound in diagnosing uterine anomalies is higher than that of two-dimensional ultrasound.