超声检查对子宫肉瘤和子宫肌瘤的鉴别诊断价值

目的分析二维和多普勒超声对子宫肉瘤(USM)和子宫肌瘤(UM)的鉴别诊断价值。方法回顾性分析2016年1月至2022年8月经病理学证实的50例子宫肉瘤(其中平滑肌肉瘤24例,子宫内膜间质肉瘤16例,腺肉瘤10例)及50例子宫平滑肌瘤患者的临床资料。比较两组发病年龄、临床症状、血清CA125、超声征象。结果子宫肉瘤组发病年龄明显高于子宫肌瘤组,临床症状以不规则阴道流血多见(P<0.05),血清CA125>35 U/mL较常见(P<0.05)。子宫肉瘤超声图像特征为:病灶直径较大且单发为主,可位于子宫肌层、宫腔内、宫颈等,病灶形态不规则,边界模糊,内部回声以不均质低回声和囊实混合回声多见,内部无明显声衰减,病灶内镶嵌样血流信号多见。两组在病灶大小、位置、病灶形态、内部回声、内部声衰减、血流信号丰富程度方面差异有统计学意义(P<0.05)。子宫肉瘤三种病理亚型超声征象比较,病灶位置差异有统计学意义(P<0.05)。结论超声可以通过分析子宫肉瘤和子宫肌瘤的二维及多普勒超声图像特点,给予临床恶性可能的提示,对临床治疗决策的制定及患者预后具有重要意义。

Objective To analyze the differential diagnosis value of two-dimensional and doppler ultrasonography in uterine sarcoma and uterine fibroids.Methods From January 2016-August 2022,50 cases of uterine sarcoma(including 24 cases of leiomyosarcoma,16 cases of endometrial stromal sarcoma,and 10 cases of adenosarcoma)in Hangzhou First People's Hospital affiliated to Zhejiang University School of Medicine were retrospectively analyzed and 50 cases of uterine leiomyoma were included as the control group.The age of onset,clinical symptoms,serum CA125 and ultrasonic signs of the two groups were compared,and the ultrasonic signs of the three pathological subtypes of uterine sarcoma were analyzed.Results The age of onset in uterine sarcoma group was significantly higher than that in uterine leiomyoma group.The most common clinical symptoms were irregular vaginal bleeding(P<0.05)and CA125>35U/mL(P<0.05).The lesions were large in diameter and mainly single,which could be located in myometrium,uterine cavity,cervix,etc.The lesions were irregular in shape and fuzzy in boundary.The internal echoes were mainly heterogeneous hypoecho and cyst-solid mixed echo,without obvious internal acoustic attenuation,and the internal blood flow signals of the lesions were abundant.There were significant differences between the two groups in the size,location,shape,internal echo,internal acoustic attenuation and blood flow signal richness(P<0.05).There was significant difference in the Lesion location only among the three pathological subtypes of uterine sarcoma(P<0.05).Conclusion Ultrasonography can provide clinical malignant hints by analyzing the image characteristics of uterine sarcoma and uterine fibroids by two-dimensional and doppler ultrasound,which is of great significance for clinical treatment decision-making and patient prognosis.