三维阴道超声对子宫内膜-肌层结合带的观察在不孕不育及妇科疾病诊断中的应用价值

Application value of three-dimensional vaginal ultrasound in the diagnosis of infertility and gynecological diseases by observing the endometrial-myometrial junction zone

目的探讨三维阴道超声对子宫内膜-肌层结合带(JZ)的观察能否提高超声对子宫内膜息肉的诊断准确性及在不孕不育妇科疾病诊断中的应用价值。方法选取152例怀疑子宫内膜息肉的患者,用三维阴道超声进行容积成像,进行JZ的观察,测量体外受精后不同妊娠结果患者交界区从基底子宫内膜到外子宫肌层内层平均交界区(AJZ)和最大交界区(MJZ)厚度。比较AJZ阀值7 mm(AJZ<7 mm/AJZ≥7 mm)、MJZ阀值10 mm(MJZ<10 mm/MJZ≥10 mm)、AJZ≥7 mm和MJZ≥10 mm及所有其他AJZ、MJZ阀值组合检查的妊娠结果。统计152例不孕症的亚型分布(子宫内膜异位症、男性不育症、输卵管、排卵障碍、原因不明等)及不同不孕症的亚型患者采用不同AJZ、MJZ阀值组合检查的妊娠结果。结果82例怀孕患者AJZ为(5.15±1.20)mm、MJZ为(6.25±1.42)mm,小于未孕患者的(6.76±1.35)、(9.84±1.61)mm,差异有统计学意义(P<0.05)。AJZ≥7 mm患者的未孕率71.8%(28/39)高于AJZ<7 mm的37.2%(42/113),差异有统计学意义(P<0.05)。MJZ≥10 mm患者的未孕率86.2%(25/29)高于MJZ<10 mm的36.6%(45/123),差异有统计学意义(P<0.05)。AJZ≥7 mm和MJZ≥10 mm患者的未孕率95.8%(23/24)高于所有其他AJZ、MJZ阀值组合的36.7%(47/128),差异有统计学意义(P<0.05)。152例不孕症的亚型分布:子宫内膜异位症54例(35.5%)、男性不育症36例(23.7%)、输卵管23例(15.1%)、排卵障碍11例(7.2%)、原因不明28例(18.4%)。不同亚型不孕症患者采用不同AJZ、MJZ阀值组合检查的妊娠结果比较,差异有统计学意义(P<0.05)。结论三维阴道超声诊断子宫异常的效果显著,大多数先天性子宫异常在子宫解剖结构的三维重建冠状面中能够得出确凿且可靠的诊断,子宫腔的全景也改善了JZ的可视化,能显着改善早期子宫腺肌病的诊断,并可能有助于引入治疗措施来阻止早期子宫腺肌病。

Objective To investigate whether the observation of endometrial-myometrial junction zone(JZ)by three-dimensional vaginal ultrasound can improve the accuracy of ultrasound in endometrial polyps and its application value in the diagnosis of infertility gynecological diseases.Methods A total of 152 patients with suspected endometrial polyps were selected for volumetric imaging by three-dimensional vaginal ultrasound to observe JZ.In patients with different pregnancy results after in vitro fertilization,the average junction zone(AJZ)and maximum junction zone(MJZ)thickness of the junction area from the basal endometrium to the outer myometrium inner layer was measured.The pregnancy outcomes of AJZ threshold 7 mm(AJZ<7 mm/AJZ≥7 mm),MJZ threshold 10 mm(MJZ<10 mm/MJZ 10≥mm),AJZ≥7 mm and MJZ≥10 mm and all other combinations of AJZ and MJZ threshold were compared.The subtype distribution(endometriosis,male infertility,fallopian tube,ovulation disorders,unknown reasons,etc.)and the pregnancy results of different subtypes of infertility patients with different combinations of AJZ and MJZ thresholds examination were counted.Results AJZ(5.15±1.20)mm and MJZ(6.25±1.42)mm of 82 pregnant patients were less than those of non-pregnant patients(6.76±1.35)and(9.84±1.61)mm,and the difference was statistically significant(P<0.05).The non-pregnancy rate of patients with AJZ≥7 mm was 71.8%(28/39),which was higher than 37.2%(42/113)of patients with AJZ<7 mm,and the difference was statistically significant(P<0.05).The nonpregnancy rate of patients with MJZ≥10 mm was 86.2%(25/29),which was higher than 36.6%(45/123)of patients with MJZ<10 mm,and the difference was statistically significant(P<0.05).The subtype distribution of 152 cases of infertility:endometriosis in 54 cases(35.5%),male infertility in 36 cases(23.7%),fallopian tube in 23 cases(15.1%),ovulation disorders in 11 cases(7.2%),unknown causes in 28 cases(18.4%).There was statistically significant difference in pregnancy outcomes of different subtypes infertility patients with different combination of AJZ and MJZ threshold examination(P<0.05).Conclusion Three-dimensional vaginal ultrasound is effective in diagnosing uterine abnormalities.In most cases of congenital uterine abnormalities,a conclusive and reliable diagnosis can be obtained in the three-dimensional reconstruction of the coronal plane of the uterine anatomy.The panoramic view of the uterine cavity also improves the visualization of JZ,which can significantly improve the diagnosis of early adenomyosis,and may help to introduce therapeutic measures to prevent early adenomyosis.