实时三维超声在子宫内膜蠕动评价中的应用

Real-time three-dimensional ultrasound in the evaluation of endometrial peristalsis

目的探讨经阴道实时三维(RT-3D)超声在评价子宫内膜蠕动方向和频率中的应用价值。方法2021年12月至2022年5月在南京中医药大学附属医院招募122位未绝经的女性志愿者,在非经期行经阴道RT-3D超声检查,获得174个2 min的子宫矢状面和冠状面动态视频,以8倍速播放后由两位观察者对子宫内膜蠕动的方向和频率进行评估。结果两位观察者对矢状面上前壁、后壁以及冠状面上左侧壁、右侧壁、宫底蠕动方向的评估具有高度的一致性(Kappa值分别为0.739、0.768、0.670、0.687和0.614,P<0.01)。两位观察者之间在矢状面和冠状面上观察到的各壁蠕动频率的差异无统计学意义(P>0.05);两位观察者对各壁蠕动频率评估的一致性较好(矢状面上前壁、后壁以及冠状面上左侧壁、右侧壁和宫底的组内相关系数分别为0.888、0.899、0.828、0.853、0.858,P<0.01)。结论RT-3D超声可在冠状面上观察子宫的蠕动情况,评估子宫宫底蠕动方向是否朝向排卵侧,技术重复性高,为评价子宫内膜蠕动的方向和频率提供了一种新的、可靠的技术和方法。

Objective To investigate the value of real-time 3-dimensional(RT-3D)transvaginal ultrasound in evaluating the direction and frequency of endometrial peristalsis.Methods Transvaginal RT-3D ultrasound was conducted in 122 non-menopausal female volunteers recruited in the Affiliated Hospital of Nanjing University of Chinese Medicine from December 2021 to May 2022.A total of 174 dynamic videos(2 min)of sagittal and coronal planes of the uterus were obtained,which were played at 8-time speed and then evaluated by two observers for the direction and frequency of endometrial peristalsis.Results There was a high degree of agreement between two observers in the assessment of peristaltic direction of the anterior and posterior walls on the sagittal plane and the left wall,right wall and uterine fundus on the coronal plane,with kappa values of 0.739,0.768,0.670,0.687 and 0.614,respectively(P<0.01).There was no significant difference in the peristaltic frequency among the walls on the sagittal and coronal planes(P>0.05).There was a good agreement between two observers for the evaluation of peristaltic frequency at each wall,with intra-group correlation coefficients of 0.888,0.899,0.828,0.853 and 0.858,respectively for the anterior and posterior walls in the sagittal plane and the left wall,right wall and uterine fundus in the coronal plane(P<0.01).Conclusion RT-3D ultrasound can emerge the uterine peristalsis on the coronal plane and judge the peristaltic direction of the uterine fundus.The technique is highly reproducible and is a new and reliable method for evaluating the direction and frequency of uterine peristalsis.