腔内彩色多普勒超声与二维超声对子宫内膜疾病患者诊断准确率的对比分析

Comparative Analysis of the Diagnostic Accuracy of Color Doppler Ultrasound and Two-dimensional Ultrasound in Patients with Endometrial Diseases

目的对比腔内彩色多普勒超声与二维超声诊断子宫内膜疾病患者的准确率。方法选择淇县人民医院2019年10月至2021年10月纳入的62例初步诊断为子宫内膜疾病的患者,收集并整理所有患者临床资料,分别开展腔内彩色多普勒超声与二维超声,分析二维超声、彩色多普勒超声与病理检验的结果,计算不同病变类型的诊断符合率,对比彩色多普勒超声与二维超声的诊断符合率,计算子宫内膜癌、子宫黏膜下肌瘤、单纯性内膜增生、子宫内膜息肉的阻力指数,观察各类病变类型患者的彩色多普勒超声的图像特征,对比两种检查的诊断结果。结果经彩色多普勒超声检查,结果中检出9例子宫内膜癌,诊断符合率77.78%;17例子宫黏膜下肌瘤,诊断符合率94.12%;12例单纯性内膜增生,诊断符合率91.67%;24例子宫内膜息肉,诊断符合率100.00%。经二维超声检查,结果中检出7例子宫内膜癌,诊断符合率42.86%;15例子宫黏膜下肌瘤,诊断符合率80.00%;10例单纯性内膜增生,诊断符合率60.00%;21例子宫内膜息肉,诊断符合率90.48;9例宫内积血,诊断符合率100.00%,其中彩色多普勒的诊断符合率(93.55%)高于二维超声(79.03%),差异有统计学意义(P<0.05)。经彩色多普勒超声检查,子宫内膜癌的阻力指数低于子宫黏膜下肌瘤、单纯性内膜增生、子宫内膜息肉;而单纯性内膜增生的阻力指数高于其他类型,差异有统计学意义(P<0.05)。经彩色多普勒检查,发现:(1)子宫内膜癌的大小1~5 mm,宫腔内存在不均质低回声,无包膜,形态不规则,边界不清,合并出血、坏死时显示不规则无回声,宫颈管无扩张。低回声内显示丰富血流信号。(2)子宫黏膜下肌瘤:大小1~2.5 mm,宫腔内存在低回声团,椭圆形,边界清楚,与子宫肌壁有裂隙,宫腔中团块蒂部显示条状丰富血流信号,些许血流信号。(3)单纯性内膜增生:肌壁回声均匀,边缘粗糙不光滑,内膜增厚,梭状强回声,内部散在无回声,椭圆形,与肌壁分界清楚,变厚的内膜层中无明显血流信号。(4)子宫内膜息肉:大小0.3~2 mm,宫腔内高回声团,椭圆形,边界清楚,回声内部及周边显示些许血流信号。结论腔内彩色多普勒超声对子宫内膜疾病的诊断价值较高,可为临床诊断、鉴别病变类型提供准确的参考依据。

Objective To compare the clinical accuracy of color Doppler ultrasound and two-dimensional ultrasound on the diagnosis of endometrial diseases.Methods A total of 62 patients with preliminary diagnosis of endometrial diseases were selected from October 2019 to October 2021 in Qi County People's Hospital,and the clinical data of all patients were collected and sorted out,and intracavitary color Doppler ultrasound and two-dimensional ultrasound were carried out respectively.The results of two-dimensional ultrasonography,color Doppler ultrasonography and pathological examination were analyzed,the diagnostic coincidence rate of different lesion types was calculated.The diagnostic coincidence rate of color Doppler ultrasound and two-dimensional ultrasound was compared,and the resistance index of endometrial cancer,uterine submucosal myoma,simple endometrial hyperplasia and endometrial polyps was calculated.The image characteristics of color Doppler ultrasound in patients with various types of lesions were observed,and the diagnostic results of the two examinations were compared.Results Nine cases of endometrial carcinoma were detected by color Doppler ultrasonography,and the diagnostic coincidence rate was 77.78%.There were 17 cases of submucosal myoma of uterus,and the diagnostic coincidence rate was 94.12%.There were 12 cases of simple intimal hyperplasia,and the diagnostic coincidence rate was 91.67%.There were 24 cases of endometrial polyps,and the diagnostic coincidence rate was 100.00%.Seven cases of endometrial carcinoma were detected by two-dimensional ultrasonography,and the diagnostic coincidence rate was 42.86%.15 cases of submucosal myoma of uterus,the diagnostic coincidence rate was 80.00%;Ten cases had simple intimal hyperplasia,and the diagnostic coincidence rate was 60.00%.21 cases of endometrial polyps,the diagnostic coincidence rate was 90.48;The diagnostic coincidence rate of 9 cases of intrauterine hemorrhage was 100.00%.The diagnostic coincidence rate of color Doppler(93.55%)was higher than that of two-dimensional ultrasound(79.03%),and the difference was statistically significant(P<0.05).Color Doppler ultrasonography showed that the resistance index of endometrial cancer was lower than that of submucosal myoma,simple endometrial hyperplasia and endometrial polyps.The resistance index of simple intimal hyperplasia was higher than that of other types,and the difference was statistically significant(P<0.05).Color doppler examination showed that:(1)the size of endometrial carcinoma was 1~5 mm,the intrauterine cavity was heterogeneous and hypoechoic,without capsule,irregular shape and unclear boundary,irregular and anechoic when complicated with hemorrhage and necrosis,and cervical canal was not dilated.Abundant blood flow signal was shown in the hypoechoic area.(2)Uterine submucosal fibroids:1~2.5 mm in size,hypoechoic masses in the uterine cavity,oval shape,clear boundary,cleft with the uterine muscle wall,and the pedicle of the mass in the uterine cavity showed a string of rich blood flow signals,some blood flow signals.(3)Simple intimal hyperplasia:the muscle wall echo is uniform,the edge is rough and not smooth,the intima is thickened,fusiform strong echo,the internal scattered echogenic,elliptical,and the boundary with the muscle wall is clear,and there is no obvious blood flow signal in the thickened intima layer.(4)Endometrial polyp:0.3~2 mm in size,hyperechoic mass in the intrauterine cavity,oval shape,clear boundary,and some blood flow signal in and around the echo.Conclusion Color Doppler ultrasound has high diagnostic value for endometrial diseases,which can provide accurate reference for clinical diagnosis and differentiation of the types of lesions.