三维断层超声显像联合三维超声综合评分法诊断宫腔粘连价值

Value of three dimensional tomography ultrasonography imaging combined with three dimensional ultrasound comprehensive score for diagnosing intrauterine adhesions

目的:探讨三维断层超声显像(TUI)联合三维超声综合评分法诊断宫腔粘连(IUA)临床价值。方法:选取2021年4月-2022年6月本院就诊疑似宫腔粘连的182例患者临床资料,均采用TUI、三维超声综合评分法诊断,以宫腔镜病理诊断为金标准,分析TUI联合三维超声综合评分法与宫腔镜检查的一致性;比较轻度、中度、重度宫腔粘连患者TUI特征。结果:186例经宫腔镜诊断IUA 92例,其中轻度粘连32例、中度粘连34例、重度粘连26例,随患者粘连程度加重TUI子宫内膜边缘不光整率增加(P<0.05),其他特征如缺损、内聚及钙化比较无差异(P>0.05)。以宫腔镜检查结果为金标准,三维超声综合评分诊断IUA的灵敏度、特异度、符合率、阳性预测值、阴性预测值分别为95.7%、92.6%、94.1%、92.6%和95.6%,Kappa值为0.882;TUI诊断IUA的灵敏度、特异度、符合率、阳性预测值、阴性预测值分别为97.8%、94.7%、96.2%、94.7%和97.8%,Kappa值为0.925;三维超声综合评分联合TUI诊断IUA的灵敏度、特异度、符合率、阳性预测值、阴性预测值分别为94.6%、100.0%、97.3%、100.0%和95.0%,Kappa值为0.946。结论:TUI联合三维超声综合评分法临床诊断宫腔粘连有较高价值。

Objective:To investigate the clinical value of three-dimensional tomography ultrasonography imaging(TUI)combined with three-dimensional ultrasound comprehensive scoring for diagnosing intrauterine adhesions(IUA).Methods:The clinical data of 182 with suspected IUA from April 2021 to June 2022 were selected in the study.These patients had been diagnosed by TUI combined with three-dimensional ultrasound comprehensive scoring.Based on the hysteroscopy pathological diagnosis as the gold standard,the consistency of TUI combined with three-dimensional ultrasound comprehensive scoring for diagnosing IUA was analyzed.The characteristics of TUI were compared among the patients with mild IUA,the patients with moderate IUA,and the patients with severe IUA.Results:There were 92 patients with IUA diagnosed by hysteroscopy in the 186 patients,which including 32 cases with mild IUA,34 cases with moderate IUA,and 26 cases with severe IUA.With the increase of the degree of IUA,the unsmoothness rate of endometrial edge of the patients in TUI examination increased(P<0.05),but there were no significant differences in the other features,such as defects,cohesion,and calcification in TUI examination among the patients with different degree of IUA(P>0.05).The hysteroscopy results as the gold standard,the sensitivity,the specificity,the coincidence rate,the positive predictive value,the negative predictive value,and Kappa value of three-dimensional ultrasonic comprehensive scoring for diagnosing IUA were 95.7%,92.6%,94.1%,92.6%,95.6%,and 0.882,respectively,and the sensitivity,the specificity,the coincidence rate,the positive predictive value,the negative predictive value,and Kappa value of TUI for diagnosing IUA were 97.8%,94.7%,96.2%,94.7%97.8%,and 0.925,respectively.The sensitivity,the specificity,rate,the positive predictive value,the negative predictive value,and Kappa value of three-dimensional ultrasound combined with TUI for diagnosing IUA were 94.6%,100.0%,97.3%,100.0%,95.0%,and 0.946,respectively.Conclusion:TUI combined with three-dimensional ultrasonic comprehensive scoring method for IUA has high diagnostic value.