经阴道三维超声及能量多普勒诊断宫腔粘连及预测严重程度效果

The effect of transvaginal three-dimensional ultrasound and energy Doppler for diagnosing and predicting the severity of intrauterine adhesion

目的:分析经阴道三维超声(3D-TVS)成像及三维能量多普勒超声(3D-PDUS)内膜血流检测对宫腔粘连(IUA)的诊断及其严重程度的预测价值。方法:选取2017年1月—2019年12月本院临床疑诊IUA的患者90例及子宫内膜正常女性100例(对照组)为研究对象。分析3D-TVS与宫腔镜(HS)检查的一致性,比较轻度、中度、重度宫腔粘连与对照组间子宫内膜容积(V)及血流指数的差异,分析其对宫腔粘连程度的预测价值。结果:2D-TVS诊断IUA与宫腔镜的符合率为70.0%,灵敏度74.3%,特异度50.0%;3D-TVS诊断IUA宫腔镜的符合率为91.1%,灵敏度91.9%,特异度87.5%。宫腔粘连重度组子宫内膜V、血管指数(VI)、血管血流指数(VFI)小于对照组、轻度粘连组、中度粘连组(P<0.05),对照组、轻度粘连组、中度粘连组子宫内膜VI无差异(P>0.05),中度宫腔粘连V、VFI小于对照组和轻度粘连组(P<0.05),对照组与轻度粘连组子宫内膜V无差异(P>0.05),轻度粘连组子宫内膜VFI小于对照组(P<0.05),重度粘连组、中度粘连组、轻度粘连组、对照组之间血流指数(FI)无差异(P>0.05)。结论:内膜血流VFI可以有效鉴别轻度粘连与中度粘连、中度粘连与重度粘连,3D-TVS对IUA有较高的诊断价值,检测内膜血流有助于评估宫腔粘连程度。

Objective:To analyze the value of endometrial blood flow examination by transvaginal three-dimensional ultrasound(3 D-TVS)imaging and three-dimensional energy Doppler ultrasound(3 D-PDUS)for diagnosing the women with intrauterine adhesion(IUA),and to study its value for predicting the severity of IUA.Methods:90 women with suspected IUA were selected in study group,and 100 women with normal endometrium were selected in control group from January 2017 to December 2019.The consistency of endometrial blood flow examined by 3 D-TVS and by hysteroscopy(HS)was analyzed.The differences of endometrial volume and blood flow index were compared among the women with mild IUA,the women with moderate IUA,the women with severe IUA,and the women in the control group.The values of the examinations by 3 D-TVS and3 D-PDUS for predicting the severity of IUA were analyzed.Results:The diagnosis coincidence rate of 2 D-TVS examination of IUA compared with that of hysteroscope was 70.0%,which’s sensitivity and specificity were 74.3%and 50.0%.The diagnosis coincidence rate of 3 D-TVS examination of IUA compared with that of hysteroscope was 91.9%,which’s sensitivity and specificity were 91.9%and 87.5%.The values of endometrial volume,vascular index(VI),vessels and blood flow index(VFI)of the women with severe IUA were significant less than those of the women with mild or moderate IUA,and those of the women in the control group(P<0.05).There was no significant difference in value of VI among the women in the control group,and the women with mild and moderate IUA(P>0.05).The values of endometrial volume and VFI of the women with moderate IUA were significant less than those of the women with mild IUA and that of the women in the control group(P<0.05).There was no significant difference in the value of endometrial volume between the women in the control group and the women with mild IUA(P>0.05).The value of endometrial VFI of the women with mild IUA was significant less than that of the women in the control group(P<0.05).There was no significant difference in value of endometrial blood flow index(FI)among the women in the control group,and the women with mild,moderate,and severe IUA(P>0.05).The endometrial VFI value of the women could effectively distinguish mild IUA from moderate IUA,and could effectively distinguish moderate IUA from severe IUA(P<0.05).Conclusion:3 D-TVS has high diagnostic value for IUA,and the endometrial blood flow detection by 3 D-TVS is helpful to evaluate the degree of intrauterine adhesion.