经阴道三维超声在宫腔粘连诊断及粘连程度评估中的应用

Application of transvaginal three-dimensional ultrasound in the diagnosis and evaluation of intrauterine adhesions

目的:探讨经阴道三维超声(3D-TVS)在宫腔粘连(IUA)诊断及粘连程度评估中的应用价值。方法:抽取2017年7月至2019年7月郑州大学第二附属医院收治的因怀疑IUA并经宫腔镜确诊的患者110例作为观察组,并选取同期在医院经宫腔镜检查的正常女性35例作为对照组。所有研究对象均行经阴道二维超声(2D-TVS)和阴道三维超声(3D-TVS)检查,比较两组检查方法对IUA患者的诊断率;分析观察组与对照组的3D-TVS检查所示子宫内膜容积(EV)及子宫内膜血流变化,并比较观察组不同粘连程度的EV及血流变化情况。结果:3D-TVS对IUA诊断的总准确率明显高于2D-TVS的诊断准确率(P<0.01),对轻、中度IUA的准确率也高于2D-TVS的诊断准确率(P<0.01),而对重度IUA的准确率二者比较差异未见统计学意义(P>0.05);观察组轻、中、重度IUA患者EV低于对照组(P<0.05);观察组中度和重度IUA患者的血管指数(VI)、血流指数(FI)及血管血流综合指数(VFI)等参数低于对照组(P<0.05),观察组各不同程度IUA的EV和血流变化比较差异有统计学意义(P<0.05或P<0.01)。结论:3D-TVS对IUA的诊断准确率明显高于2D-TVS,3D-TVS定量测量EV和子宫内膜血流信号,其有效提高了IUA的诊断准确性,能对宫腔的粘连程度进行客观评价,具有较高的临床应用价值。

Objective To explore and analyze the clinical diagnosis and severity of transvaginal three-dimensional ultrasound(3D-TVS)in patients with intrauterine adhesions(IUA).Methods From July 2017 to July 2019,110 patients with suspected IUA and diagnosed by hysteroscopy in the Second Affiliated Hospital of Zhengzhou University were selected as the observation group,and 35 normal women who were examined by hysteroscopy in our hospital in the same period were selected as the control group.All subjects were examined by transvaginal two-dimensional ultrasound(2D-TVS)and transvaginal three-dimensional ultrasound(3D-TVS),and the diagnostic rates of the two groups in patients with IUA were compared.The changes of endometrial volume(EV)and endometrial blood flow in the observation group and the control group after 3D-TVS examination were analyzed,and the changes of EV and blood flow in the observation group with different degrees of adhesion were compared.Results The total accuracy of 3D-TVS in the diagnosis of IUA was significantly higher than that of 2D-TVS,and the accuracy of mild and moderate IUA was also significantly higher than that of 2D-TVS,but there was no significant difference in the accuracy of severe IUA between the two groups.EV in patients with mild,moderate and severe IUA in the observation group were significantly lower than those in the control group.The parameters such as vascular index(VI),blood flow index(FI)and vascular blood flow comprehensive index(VFI)in moderate and severe IUA patients in the observation group were significantly lower than those in the control group.The EV and blood flow changes of different degrees of IUA in the observation group were significantly different(P<0.05 or P<0.01).Conclusions The diagnostic accuracy of 3D-TVS in IUA is significantly higher than that of 2D-TVS quantitative measurement of EV,and endometrial blood flow signals in 3D-TVS and effectively improves the diagnostic accuracy of IUA and objectively evaluates the degree of intrauterine adhesion,which has high clinical application value.