经阴道二维超声联合三维超声容积成像技术在宫腔粘连诊断及其分型中的应用价值

Value of transvaginal two-dimensional ultrasound combined with three-dimensional ultrasound volume imaging in the diagnosis and classification of uterine adhesions

目的探讨采取经阴道二维超声联合三维超声容积成像技术在宫腔粘连(IUA)诊断及其分型中的应用价值。方法回顾性抽取2021年1月至2022年12月周口市中医院收治的IUA患者92例作为观察组,另抽取同期收治的经宫腔镜检查正常的女性50例作为对照组。两组对象均愿意配合研究,且观察组经宫腔镜检查确诊。两组均接受阴道二维超声、三维超声容积成像技术检查,将宫腔镜检查结果作为标准,比较两组超声检查宫腔血流指标情况,不同检查方法诊断IUA分型情况。结果(1)两组超声检查宫腔血流指标比较,观察组子宫内膜厚度(EMT)、子宫内膜容积(EV)、血管指数(VI)、血流指数(FI)、血管化血流指数(VFI)均低于对照组(P均<0.05)。(2)不同检查方法诊断IUA结果比较,二维超声诊断准确度、特异度、灵敏度分别为83.09%(118/142)、88.00%(44/50)、80.43%(74/92),三维超声容积成像技术诊断准确度、特异度、灵敏度分别为89.44%(127/142)、92.00%(46/50)、88.04%(90/92),二者联合诊断准确度、特异度、灵敏度分别为98.59%(140/142)、100.00%(50/50)、97.83%(90/92),差异有统计学意义(P<0.05)。(3)不同IUA程度宫腔血流指标比较,重度粘连者EMT、EV、VI、FI、VFI最低,而轻度粘连者最高(P<0.05)。(4)不同检查方法诊断IUA分型情况比较,三种检查方法对单一周围型、中央型、混合型的检出率差异未见统计学意义(P>0.05),但总检出率比较,二者联合检出率高于二维超声或三维超声容积成像技术(P<0.05)。结论应用阴道二维超声联合三维超声容积技术诊断IUA,能提高临床诊断准确度。

Objective To investigate the value of transvaginal two-dimensional ultrasound combined with three-dimensional volume imaging in the diagnosis and classification of intrauterine adhesion(IUA).Methods Ninety-two IUA patients admitted to Zhoukou Hospital of Traditional Chinese Medicine from January 2021 to December 2022 were retrospectively selected as the observation group,while 50 female patients who underwent hysteroscopy examination during the same period were selected as the control group.Both groups were willing to cooperate with the study,and the observation group was identify by hysteroscopy.The two groups were examined by vaginal two-dimensional ultrasound and three-dimensional ultrasound volume imaging technology.The result of hysteroscopy examination was used as the standard.The uterine blood flow indicators of the two groups were compared,and the IUA types diagnosed by different examination methods were compared.Results The endometrial thickness(EMT),endometrial volume(EV),vascular index(VI),blood flow index(FI),vascularized blood flow index(VFI)in the observation group were lower than those in the control group(P<0.05).Comparison of diagnostic results for IUA using different examination showed that the accuracy,specificity,and sensitivity of two-dimensional ultrasound were 83.09%(118/142),88.00%(44/50),and 80.43%(74/92),respectively.The accuracy,specificity,and sensitivity of three-dimensional ultrasound volume imaging were 89.44%(127/142),92.00%(46/50),and 88.04%(90/92),respectively.The diagnostic accuracy,specificity,and sensitivity of the combination of the two techniques were 98.59%(140/142),100.00%(50/50),and 97.83%(90/92),respectively;there were significant differences among the three examination methods(P<0.05).EMT,EV,VI,FI and VFI in patients with moderate and severe adhesion were the lowest,while the above indicators in patients with mild adhesion were the highest.There was no significant difference in the detection rate of single peripheral type,central type and mixed type of IUA among different examination methods(P>0.05),but the total detection rate of the combination of the two methods was significantly higher than that of two-dimensional ultrasound or three-dimensional ultrasound volume imaging technology(P<0.05).Conclusions Vaginal two-dimensional ultrasound combined with three-dimensional ultrasound volume technology can improve the accuracy of clinical diagnosis of IUA.