女性尿道憩室和阴道壁囊肿的超声鉴别诊断分析

Ultrasonic differential diagnosis analysis of female urethral diverticulum and vaginal wall cyst

目的探讨女性尿道憩室(UD)和阴道壁囊肿的临床和超声图像特征及鉴别诊断要点。方法回顾性分析2017年1月至2021年5月北京协和医院收治并经手术病理证实的12例女性UD患者(UD组)、30例经手术病理及临床随访证实的阴道壁囊肿患者(阴道壁囊肿组)的临床和超声图像特征,分析总结两者鉴别诊断要点。结果UD组与阴道壁囊肿组年龄、病灶最大径差异无统计学意义(均P>0.05)。8例(66.7%)女性UD患者有泌尿系症状,5例(16.7%)阴道壁囊肿患者有泌尿系症状,两者差异有统计学意义(P<0.05);10例(83.3%)女性UD病灶位于盆底中上部,23例(76.7%)阴道壁囊肿病灶位于盆底中下部,两者病灶位置差异有统计学意义(P<0.05)。超声图像特征方面,UD病灶形态多不规则,包绕尿道,边界不清,囊壁厚度>0.1 cm,内壁不光滑伴钙化,内部可见分隔,部分可见与尿道相通,周边血流信号丰富;阴道壁囊肿多呈类圆形,不包绕尿道,边界清,壁薄光滑,内部分隔较少见,不与尿道相通,周边血流信号不丰富,两者比较差异有统计学意义(均P<0.05);病灶内部透声是否良好方面两者差异无统计学意义(P>0.05)。结论合并泌尿系症状、病灶的位置、超声特征(形态、是否包绕尿道、边界、囊壁厚度、内壁钙化、内部分隔、是否与尿道相通、血流分布)可作为鉴别UD与阴道壁囊肿的参考依据,病灶内部透声是否良好不能作为二者鉴别诊断的依据。

Objective To explore the clinical and ultrasound image characteristics and differential diagnosis of female urethral diverticulum(UD)and vaginal wall cysts.Methods A retrospective analysis of the clinical and ultrasound image features of 12 female patients with UD were collected as UD group and 30 patients with vaginal wall cysts confirmed by surgical pathology and clinical follow-up were collected as vaginal wall cysts group in Peking Union Medical College Hospital from January 2017 to May 2021.Ultrasound image characteristics,and the main points of the differential diagnosis of the two were analyzed and summarized.Results There were no significant differences in the age of the patients and the maximum diameter of the lesions between UD group and vaginal wall cysts group(all P>0.05).Eight cases(66.7%)of female patients with UD had urinary system symptoms,5 cases(16.7%)of vaginal wall cysts had urinary system symptoms,the difference was statistically significant(P<0.05);In 10 cases(83.3%)the UD lesions were located in the upper middle and upper pelvic floor,and vaginal wall cyst lesions in 23 cases(76.7%)were located in the lower middle and lower pelvic floor,the difference was statistically significant(P<0.05).In terms of ultrasound image characteristics,UD lesions were often irregular in shape,surrounding the urethra,with unclear borders,cyst wall thickness>0.1 cm,internal wall not smooth along with calcification,internal visible separation,partly visible to the urethra,and peripheral blood flow signals were abundant.Vaginal wall cysts were mostly round-shaped,not surrounding the urethra,clear borders,thin and smooth walls,less internal partitions,not communication with the urethra,and the peripheral blood flow signals were not abundant.The differences between the two group were statistically significant(all P<0.05).Whether the sound transmission inside the lesion was not statistically significant(P>0.05).Conclusions Combined with urinary system symptoms,lesion location,ultrasound characteristics(morphology,whether surrounding the urethra,boundary,cyst wall thickness,inner wall calcification,internal separation,whether it is connected to the urethra,blood flow distribution)can be used to distinguish between UD and vaginal wall cysts,whether the sound transmission inside the lesion cannot be used as the basis for the differential diagnosis of the two.