经阴道二维、三维超声联合应用在宫腔粘连诊断中的价值

Combined application of transvaginal two-dimensional&three-dimensional ultrasonography in the diagnosis of intrauterine adhesions

目的探讨经阴道二维超声(2D-TVS)、三维超声(3D-TVS)检查联合应用在宫腔粘连(intrauterine adhesion,IUA)诊断中的价值。方法选取2017年1月至2019年12月就诊疑似为IUA的患者168例,分别行2D-TVS、3D-TVS及联合检查,检查结果以宫腔镜检查结果为标准,对比三种检查方案结果与宫腔镜检查结果的符合率,并计算检查灵敏度、特异度及Youden指数,以判定不同检查方案对IUA检查的准确性。结果2D-TVS检查诊断为IUA患者116例,与宫腔镜检查结果符合110例,符合率为72.3%,误诊6例,漏诊42例。经3D-TVS检查诊断为IUA患者126例,与宫腔镜检查结果符合124例,诊断符合率为81.5%,误诊2例,漏诊28例;联合检查诊断为IUA患者148例,与宫腔镜检查结果符合144例,符合率为94.7%,误诊4例,漏诊8例;联合检查诊断结果的灵敏度、Youden指数及与宫腔镜诊断结果符合率均体现了较高的诊断价值,与两种单独检查方案结果比较差异有统计学意义(P<0.05)。结论2D-TVS联合3D-TVS可提高IUA诊断的准确率,且无创、高效,可作为临床筛查IUA的首选方案。

Objective To explore the value of transvaginal two-dimensional ultrasound(2D-TVS)and three-dimensional ultrasonography(3D-TVS)in the diagnosis of intrauterine adhesion(IUA).Methods A total of 168 patients with suspected IUA from January 2017 to December 2019 were selected,and 2D-TVS,3D-TVS and combined examination were performed,respectively.The examination results were based on results of hysteroscopy.The coincidence rates between three examination protocols were compared referenced hysteroscopy indexes.The sensitivity,specificity and Youden indexes were calculated to determine the accuracy of various IUA examinations.Results Totally 116 with diagnosed IUA was found by 2D TVs,110 cases with a coincidence rate of 72.3%was coincided with hysteroscopy results,6 cases were misdiagnosed,and 42 cases were missed diagnosis;126 patients with diagnosed IUA were found by 3D TVs,124 patients with a coincidence rate of 81.5%coincided with hysteroscopy results,2 cases were misdiagnosed,and 28 cases were missed diagnosis;148 cases were diagnosed by combined examinations,144 cases with a coincidence rate of 94.7%coincided with hysteroscopy results,4 cases were misdiagnosed,and 8 cases were missed.The sensitivity,Youden index and coincidence rate of combined examinations showed high diagnostic value,and the difference was statistically significant between it and two separate examination protocols(P<0.05).Conclusion The 2D TVS combined with 3DTVS can improve the accuracy of IUA diagnosis,and it is non-invasive and efficient,being worthy of the preferred protocol for clinical screening of IUA.