盆腔单纯囊性肿物超声定性诊断与穿刺治疗病例选择

Ultrasonic differential diagnosis of pelvic cysts and the value for respiration therapy

目的 探讨女性盆腔囊性肿物的超声定性诊断及其对超声引导穿刺抽吸治疗病例选择的指导意义。方法 分析 5 2 6个有病理结果的女性盆腔囊性肿物的声像图表现及 14 4个病变超声引导介入治疗效果。结果 5 2 6个肿物中超声定性诊断与病理诊断总符合率为 95 .6 % (5 0 3/ 5 2 6 )。部分卵巢囊性畸胎瘤、黏液性囊腺瘤、输卵管积脓、卵巢出血性囊肿或交界性浆液性囊腺瘤可有与子宫内膜异位囊肿或卵巢冠囊肿相似的声像图表现。超声介入治疗后复发者多为子宫内膜异位囊肿中囊壁厚、囊内或囊壁有中等回声块状物或酒精凝固时间短者。包裹性积液和绝经后卵巢囊肿抗炎治疗或随访观察中可完全消失。结论 超声对盆腔囊性肿物的定性诊断率较高 ,但部分不典型病例仍有误诊可能。超声引导穿刺抽吸治疗前应观察 2～ 3个月经周期。

Objective To evaluate the sonography features of different pelvic cysts and the value for guiding cases choice of ultrasound-guided respiration therapy. Methods The sonographic features of 526 pelvic cysts and their pathological diagnosis and the results of ultrasound-guided respiraion therapy in 144 lesions were analyzed. Results The total coincidence rate between sonographic and pathological diagnosis was 95.6% (503/526).Parts of cystic teratoma, mucinous cystadenoma, hyosalpinx, hemorrhagic ovarian cysts and serous cystadenoma have a sonographic appearance similar to that of endometriosis cysts or parovarian cysts.The most of recurrent cases after ultrasound guidancerespiration therapy are endometriosis cysts with thick wall, internal block echoes or the time is shorter than 3 minutes for ethanol coagulation. Encapsulation cysts and postmenopausal cysts can disappear after anti-inflammatory therapy or during the period of following up. Conclusion The accurate rate of ultrasonic differential diagnosis for pelvic cysts was high. However, some lesions without typical ultrasonic features could be misdiagnosised. It is necessary to follow up for 2-3 menstrual cycles with ultrasonography before ultrasound-guidance aspiration therapy is performed.