Predictive value of the trans-perineal three-dimensional ultrasound measurement of the pubic arch angle for vaginal delivery

BACKGROUND Numerous variables are linked to the success of vaginal delivery,including the subpubic arch angle(SPAA)during labor,the importance of which has not yet been fully elucidated.AIM To examine the SPAA distributional characteristics and to ascertain SPAA’s ability to predict the type and duration of labor.METHODS We determined the SPAA and analyzed the corresponding data.We also evaluated the relationship between the SPAA and the mode of delivery and the duration of labor by regression.The present study comprised a total of 301 pregnant women who had given birth at Beijing Tiantan Hospital of the Capital Medical University between January and December of 2021.RESULTS Our analysis of 301 pregnant women revealed that the SPAA measured using three-dimensional trans-perineal ultrasound had a minimum angle of 81°and a maximum angle of 122.2°.The angle in the normal vaginal delivery group was greater than that in the labor cesarean group(P=0.000).The SPAA was a highly significant positive predictor of normal vaginal delivery(P=0.000)with an area under the curve of 0.782(P=0.000;95%CI:0.717-0.848).We found the length of the second stage of labor to be positively influenced by the SPAA using linear regression analysis(P=0.045).CONCLUSION The SPAA was a highly significant positive predictor of normal vaginal delivery.The length of the second stage of labor and normal vaginal birth were predicted by SPAA.

Differentiation of focal liver lesions using three-dimensional ultrasonography: Retrospective and prospective studies

AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal liver lesions,including 168 hepatocellular carcinomas (HCCs),63 metastases,40 hemangiomas and 11 focal nodular hyperplasias (FNHs),were examined by 3D US with perflubutane-based contrast agent.Tomographic ultrasound images and sonographic angiograms were reconstructed.Among 282 lesions,enhancement patterns of 163 lesions between January 2007 and October 2007 were analyzed retrospectively.Then from November 2007 to May 2008,compared with contrast-enhanced (CE) 2D US,CE 3D US was performed on 119 lesions for prospective differential diagnosis.Sensitivity,specificity,area under receiver operating characteristic curve (Az) and inter-reader agreement were assessed.RESULTS: With the tridimensional view,dominant enhancement patterns were revealed as diffuse enhancement or peripheral ring-like enhancement,followed with washout change for HCCs or metastases,respectively,and peripheral nodular enhancement or diffuse enhancement with spoke-wheel arteries,followed by persistent enhancement for hemangiomas or FNHs,respectively.At CE 3D US,the prospective differentiation of lesions showed sensitivity 92% (mean for two readers),specificity 91% and Az value 0.95 for HCCs,84%,97%,and 0.95 for metastases,91%,98%,and 0.98 for hemangiomas and 80%,99%,and 0.99 for FNHs,respectively,while good to excellent inter-reader agreement was achieved.No significant difference exists between prospective diagnosis accuracy at CE 3D US and that at CE 2D US.CONCLUSION: CE 3D US provides a spatial perspective for liver tumor enhancement,and could help in differentiating focal liver lesions.

Prenatal assessment of normal fetal pulmonary grey-scale and lung volume by three-dimensional ultrasonography

Objective To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound(3-D US)and evaluate the feasibility of fetal lung maturity.Methods A total of 732 women with normal singleton pregnancies between 28 and 42 weeks of gestation underwent ultrasound examination.The 3-D US equipment with a 3.5-5 MHz transabdominal transducer was used for the fetal biometric measurement.The echogenicity ratio between fetal lung and liver was compared.The fetal lung volume was calculated by the rotational multiplanar technique for volume measurement(VOCAL).Results The right fetal lung volume increased with the increase of gestational age with a linear positive correlation(r=0.884,P<0.01).After 34 weeks,the echogenicity ratio of fetal lung to liver was more than 1.1.Conclusion The echogenicity of lung/liver and fetal lung volume could be used as normal fetal predictable indicators for fetal lung maturity.

Prenatal diagnosis of isolated lateral facial cleft by ultrasonography and three-dimensional printing:A case report

BACKGROUND Lateral facial clefts are atypical with a low incidence in the facial cleft spectrum.With the development of ultrasonography(US)prenatal screening,such facial malformations can be detected and diagnosed prenatally rather than at birth.Although three-dimensional US(3DUS)can render the fetus'face via 3D reconstruction,the 3D images are displayed on two-dimensional screens without field depth,which impedes the understanding of untrained individuals.In contrast,a 3D-printed model of the fetus'face helps both parents and doctors develop a more comprehensive understanding of the facial malformation by creating more interactive aspects.Herein,we present an isolated lateral facial cleft case that was diagnosed via US combined with a 3D-printed model.CASE SUMMARY A 31-year-old G2P1 patient presented for routine prenatal screening at the 22nd wk of gestation.The coronal nostril-lip section of two-dimensional US(2DUS)demonstrated that the fetus'bilateral oral commissures were asymmetrical,and left oral commissure was abnormally wide.The left oblique-coronal section showed a cleft at the left oral commissure which extended to the left cheek.The results of 3DUS confirmed the cleft.Furthermore,we created a model of the fetal face using 3D printing technology,which clearly presented facial malformations.The fetus was diagnosed with a left lateral facial cleft,which was categorized as a No.7 facial cleft according to the Tessier facial cleft classification.The parents terminated the pregnancy at the 24th wk of gestation after parental counseling.CONCLUSION In the diagnostic course of the current case,in addition to the traditional application of 2D and 3DUS,we created a 3D-printed model of the fetus,which enhanced diagnostic evidence,benefited the education of junior doctors,improved parental counseling,and had the potential to guide surgical planning.

Clinical Application of Surface Mode on Three-dimensional Ultrasonography: A Preliminary Study

To investigate the methodology and evaluate the clinical value of surface mode on three- dimensional ultrasonography (3DUS) in static anatomical structures, 62 patients with various diseases were studied. The equipment used here was Voluson 530D 3DUS imaging system and 3D volume trahsducer with frequency being 3. 0-5. 0 MHz. The 3DUS rendering method was surface mode. The results showed that: 1 ) Surface mode of 3DUS could demonstrate clearly the anatomical characteristics of the region-of-interest (ROI) and the inner wall of lesions or organs that contained fluid. The anatomic details, such as location, size, shape, and number of the ROI, could be visualized intuitively; 2) The outer anatomic features (e. g. contour, edge, configuration, etc. ) of some organs or lesions surrounded by fluid could be displayed clearly. It could be concluded that surface mode on 3DUS could provide more diagnostic information than two-dimensional ultrasonography (2DUS) in some cases and could served as a beneficial supplement to ZDUS in clinical practice.

TACC diagnosed by transoesophageal endoscopic ultrasonography:A case report

BACKGROUND Primary adenoid cystic carcinoma in the trachea(TACC)is a rare tumour.Tracheal bronchoscopy is always chosen as a routine approach to obtain a pathological diagnosis,but it can be associated with an increased risk of asphyxia.CASE SUMMARY We describe a case of TACC in a patient evaluated by chest computed tomography(CT)with three-dimensional reconstruction imaging and diagnosed by transoesophageal endoscopic ultrasonography.The pathological diagnosis confirmed tracheal adenoid cystic carcinoma.CONCLUSION We highlight the importance of CT and provide a successful exploration of transoesophageal biopsy as a safe alternative approach.

360°腔内三维超声在阴道周围囊性病变诊断中的价值

目的:探讨经阴道360°腔内三维超声在阴道周围囊性病变中的应用价值。方法:常规经阴道超声检查发现阴道周围囊性病变42例,先利用二维超声观察阴道周围囊性病变大小、位置及与阴道、尿道和直肠的关系,再利用经阴道360°腔内三维超声获取矢状切面、横切面、冠状切面、任意切面图像,不同视角观察阴道周围囊性病变的空间关系,从而进行定位诊断。结果:常规经阴道超声检查发现阴道周围囊性病变42例,经手术病理、尿道镜、肾盂输尿管造影证实阴道壁囊肿21例、尿道旁腺囊肿13例、尿道憩室3例、先天性输尿管异位开口2例、骶尾部囊性畸胎瘤3例。经阴道360°腔内三维超声检查诊断符合率为95.23%(40/42),经阴道常规二维超声检查诊断符合率为71.42%(30/42),经阴道360°腔内三维超声检查与经阴道常规二维超声检查诊断符合率比较,差异具有统计学意义(P<0.05)。结论:经阴道360°腔内三维超声是准确、方便、快捷诊断阴道周围囊性病变的影像学手段,具有重要的应用价值。

腔内三维超声联合临床指标对剖宫产术后子宫切口憩室致子宫异常出血的价值

目的 探讨腔内三维超声联合临床指标在剖宫产术后子宫切口憩室致子宫异常出血的价值。方法 收集2017年1月~2023年4月在石河子市人民医院行阴道超声检查的126例剖宫产术后合并子宫切口憩室的患者资料。根据患者剖宫产术后出血情况分为组1(无异常出血,n=72)、组2(异常出血,n=54),所有患者均行阴道超声(二维超声及三维超声)检查。分析比较两组间临床特征(子宫位置、剖宫产次数以及剖宫产缝线方式等)以及子宫切口憩室超声特征(憩室形态、憩室容积、憩室长度、憩室深度以及残余肌层厚度等)的差异,建立基于临床及超声特征的预测模型,探索剖宫产术后合并子宫切口憩室患者子宫异常出血的独立危险因素,并评价此模型的预测价值。结果 两组间剖宫产次数、子宫位置、子宫内膜厚度、憩室深度、憩室长度、憩室容积、憩室比以及残余肌层厚度的差异均有统计学意义(P<0.05);多因素回归分析显示,子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是子宫异常出血的独立危险因素(OR=0.087、10.385、4.658、12.892、0.001,P<0.05),与各单因素相比,此模型预测子宫异常出血的AUC为0.936,高于各单因素(AUC=0.567、0.705、0.836、0.895、0.870,P<0.05),该联合预测模型以-6.28为截断值时,敏感度为87.04%,特异性为91.67%,准确度为89.68%,且与临床诊断结果有良好一致性(Kappa=0.789,P<0.001)。结论 子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是剖宫产术后子宫切口憩室合并子宫异常出血的独立危险因素,超声及临床特征对预测剖宫产术后子宫切口憩室致子宫异常出血有重要预测价值。

经直肠双平面超声诊断儿童先天性阴道尿道瘘1例

女性患儿,14岁,不自主漏尿10余年、憋尿后明显,近半年症状加重;无特殊家族史。查体及实验室检查均未见明显异常。下腹部纵切面超声:膀胱充盈,双侧输尿管均开口于膀胱三角区,膀胱与阴道、宫颈间未见异常通道;阴道内见5.63cm×1.85cm梭形无回声区。

早期经阴道彩超检查子宫内膜厚度联合血清β-HCG检测在宫外孕临床诊断中的应用

目的:探讨早期经阴道彩超检查子宫内膜厚度联合血清β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)检测在宫外孕临床诊断中的应用。方法:选取2018年3月至2021年3月收治的156例宫外孕患者作为宫外孕组,另同期选取在本院行体检的健康孕妇156例作为对照组。收集两组的临床资料,两组均行早期经阴道彩超检查记录子宫内膜厚度、收缩期最大血流速度(Peak systolic velocity,VS)、舒张末期流速(Enddiastolic velocity,VD)和阻力指数(Resistance index,RI),采用化学发光免疫法检测血清β-HCG水平。对比两组上述指标差异,并采用受试者工作曲线(Receiver operating characteristic,ROC)分析上述指标联合检测对宫外孕的诊断价值。结果:宫外孕组患者VS、VD和RI水平均高于对照组(P<0.05),子宫内膜厚度和血清β-HCG水平均低于对照组(P<0.05)。ROC分析显示,子宫内膜厚度、VS、VD、RI、血清β-HCG及其联合检测的曲线下面积(Receiver operating characteristic,AUC)分别为0.780、0.743、0.733、0.746、0.793和0.934,(P均<0.05)。结论:早期经阴道彩超检查子宫内膜厚度联合血清β-HCG检测可以提高宫外孕诊断的准确度,有助于及时发现异常并治疗。

对照分析阴式与腹部彩色多普勒超声对子宫切口妊娠的诊断价值

目的 比较阴式与腹部彩色多普勒超声在子宫切口妊娠诊断中的应用价值。方法 选取102例疑似子宫切口妊娠患者作为研究对象,患者均接受阴式与腹部彩色多普勒超声检查。以手术病理检查结果作为金标准,观察阴式与腹部彩色多普勒超声对于子宫切口妊娠的诊断结果 ,比较阴式与腹部彩色多普勒超声诊断子宫切口妊娠的敏感度、特异度、符合率,以及不同子宫切口妊娠分型诊断准确率。结果 102例疑似子宫切口妊娠患者经手术病理检查诊断阳性75例(73.53%),其中混合型28例(37.33%)、单纯妊娠囊型32例(42.67%)、嵌入型15例(20.00%);阴式彩色多普勒超声检出阳性75例(73.53%),腹部彩色多普勒超声检出阳性74例(72.55%)。阴式彩色多普勒超声对子宫切口妊娠诊断敏感度98.67%、特异度96.30%与符合率98.04%均高于腹部彩色多普勒超声的86.67%、66.67%、81.37%(P<0.05)。阴式与腹部彩色多普勒超声对混合型、单纯妊娠囊型、嵌入型子宫切口妊娠的诊断准确率对比,结果未见差异性(P>0.05)。结论 相较于腹部彩色多普勒超声,阴式彩色多普勒超声对子宫切口妊娠的诊断价值更高,为临床诊疗工作提供了可靠的参考依据。

经阴道彩超用于宫外孕破裂及卵巢黄体破裂鉴别诊断的临床价值

目的:分析阴道彩超的诊断价值。方法:选取2020年2月到2023年8月90例宫外孕破裂患者以及90例卵巢黄体破裂患者,均行阴道彩超检查,分析阴道彩超检查的鉴别诊断价值,并比较两组超声检查结果的差异。结果:(1)阴道超声在宫外孕破裂与卵巢黄体破裂诊断准确率的差异无意义(P>0.05);(2)两组血流表现、血流频率特征相比,差异有意义(P<0.05);(3)两组血流动力学指标相比,差异有意义(P<0.05)。结论:阴道超声在宫外孕破裂与卵巢黄体破裂的鉴别诊断准确率高,可推广使用。

Endoanal ultrasonography in fecal incontinence: Current and future perspectives

Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.

基于彩超动态观察经阴道分娩后盆腔组织器官解剖参数变化及与盆底功能障碍的关联性

目的 基于彩超动态观察经阴道分娩后盆腔组织器官解剖参数变化,并进一步分析超声参数与盆底功能障碍(PFD)的关联性。方法 选取2020年7月—2022年5月收治的120例经阴道分娩初产妇,根据产后是否发生PFD分为PFD组50例、无PFD组70例。比较2组人口学资料、临床特征、超声参数,采用Pearson相关性分析超声参数与盆底功能障碍问卷(PFDI-20)评分的关系,采用受试者工作特征曲线分析超声参数对PFD的诊断价值,采用RR危险度分析超声参数与PFD的关系。结果 PFD组阴道撕裂较无PFD组严重(P<0.01);PFD组膀胱颈至耻骨联合后下缘的距离、宫颈至耻骨联合后下缘的距离、缩肛时缩短率短于或低于无PFD组,膀胱下降度、宫颈下移、尿道旋转度、静息肛提肌裂孔前后径、缩肛肛提肌裂孔前后径、最大Valsalva动作肛提肌裂孔前后径、最大Valsalva动作伸长率以及PFDI-20评分长于或高于无PFD组(P<0.01)。缩肛时缩短率与PFDI-20评分呈负相关(r=-0.756,P<0.001),膀胱下降度、宫颈下移、尿道旋转度、最大Valsalva动作伸长率与PFDI-20评分呈正相关(r=0.723、0.813、0.734、0.835,P<0.001)。膀胱下降度、宫颈下移、尿道旋转度、缩肛时缩短率、最大Valsalva动作伸长率联合诊断PFD的曲线下面积为0.916,上述指标所致的RR值分别为3.643、3.742、2.511、0.308、3.144。结论 膀胱下降度、宫颈下移、尿道旋转度、缩肛时缩短率、最大Valsalva动作伸长率与PFDI-20评分联系密切,可反映产妇阴道分娩后盆底功能,对PFD的早期诊断、干预具有指导作用。

孕妇阴道尤因肉瘤超声表现1例

患者女,21岁,孕2产1,孕20周;腹胀伴肛门坠胀2月余,外院超声提示盆腔囊肿,未接受任何治疗。产科查体:于阴道壁左侧处女膜缘1cm至左穹窿下0.5cm处触及较大包块,位置固定,质硬,无压痛。经腹超声:孕妇阴道内87mm×74mm×73mm囊实性混合占位,形态尚规整,边界尚清晰,实性部分以不均匀稍高回声为主、囊性部分透声尚可,后方回声增强;CDFI于其实性部分探及短条状血流信号;脉冲多普勒(pulsed wave Doppler,PWD)示阻力指数(resistance index,RI)0.71(图1A);胎儿未见明显异常。

阴道三维宫腔超声造影诊断宫腔粘连的价值及准确性分析

目的:研究阴道三维宫腔超声造影诊断宫腔粘连的价值及准确性。方法:研究对象为2020年12月—2021年12月深圳市中西医结合医院收治的50例疑似宫腔粘连患者,开展阴道三维超声和阴道三维宫腔超声造影检查后,再进行宫腔镜检查,并以宫腔镜检查结果作为诊断金标准,观察不同检查方法宫腔粘连检查诊断结果差异,分析误诊率、漏诊率、准确率、敏感度、特异度及检查满意度。结果:宫腔镜检查结果显示,阳性42例,阴性8例,阴道三维宫腔超声造影检查阳性预测值高于阴道三维超声,差异有统计学意义(P<0.05)。阴道三维超声和阴道三维宫腔超声造影检查误诊率对比,差异无统计学意义(P>0.05);阴道三维宫腔超声造影检查漏诊率低于阴道三维超声,准确率、敏感度、特异度及检查满意度均高于阴道三维超声,差异均有统计学意义(P<0.05)。结论:在宫腔粘连疾病的临床诊断中,阴道三维宫腔超声造影诊断价值高,不仅可有效提高患者检查满意度,而且还具有较高的诊断准确性,可有效减少漏诊,诊断敏感度及特异度高,值得推广。

经阴道彩色多普勒超声与二维超声检查对子宫内膜癌的诊断价值

目的探究经阴道彩色多普勒超声与二维超声检查对子宫内膜癌的诊断价值。方法选取2019年3月至2021年3月本院收治的120例经病理检查确诊为子宫内膜癌的患者作为研究对象,患者均同时给予二维超声、经阴道彩色多普勒超声检查,比较两种检查方式对子宫内膜癌患者血流情况检查结果、对子宫内膜癌患者病灶测值及诊断价值。结果经阴道彩色多普勒超声血流情况Ⅰ级占比低于二维超声,Ⅱ级占比高于二维超声,差异有统计学意义(P<0.05)。经阴道彩色多普勒超声病灶上下径、前后径、左右径均大于二维超声,差异有统计学意义(P<0.05)。经阴道彩色多普勒超声灵敏度、特异度均高于二维超声(P<0.05),两种检查方式准确率比较差异无统计学意义。结论经阴道彩色多普勒超声与二维超声检查对子宫内膜癌患者均有良好的鉴别诊断效果,经阴道彩色多普勒超声在帮助医生掌握后续治疗方案中的临床应用价值更高,值得临床推广应用。

阴道超声检查联合腹部超声检查在诊断宫外孕中的价值分析

目的探讨阴道超声检查联合腹部超声检查在宫外孕诊断中的应用价值。方法随机选取2020年2月—2022年8月山东国欣颐养集团枣庄中心医院的80例疑似宫外孕患者进行诊断研究。临床对所有宫外孕患者合理展开腹部超声检查操作、阴道超声检查操作以及阴道超声检查+腹部超声检查,将临床最终诊断作为金标准,比较3种方法的诊断效能、各种疾病类型检出率。结果金标准检出阳性70例、阴性10例,阴道超声检出阳性60例、阴性20例,腹部超声检出阳性50例、阴性30例,联合检出阳性71例、阴性9例。与阴道超声诊断效能以及腹部超声诊断效能比较,联合检测诊断效能提升程度明显,差异有统计学意义(P<0.05)。同阴道超声以及腹部超声各种疾病类型检出率对比,联合检测各种疾病类型检出率提升程度明显,差异有统计学意义(P<0.05)。结论在宫外孕患者临床诊断期间,经阴道超声检查以及经腹部超声检查的单一应用效果有限,在此种情形下,将经阴道超声检查以及经腹部超声检查进行充分结合,在提升患者诊断效能方面,获得的效果明显。并且可明显提升各种疾病类型检出率,可促进宫外孕患者的顺利诊治。

阴道超声联合腹部B超在异位妊娠诊断上的应用分析

目的探讨对异位妊娠患者给予阴道超声+腹部B超诊断后获得临床效果。方法选取2020年2月—2022年5月贵州省纳雍县人民医院的64例疑似异位妊娠患者为研究对象,对所有患者合理展开阴道超声检查、腹部B超检查以及阴道超声+腹部B超检查,临床最终诊断结果为金标准,对3种方法诊断异位妊娠的敏感度、特异度及准确度展开对比。结果临床最终诊断结果显示,阳性结果患者40例,阴性结果患者24例。阴道超声+腹部B超检查异位妊娠的特异度(91.67%)、敏感度(97.50%)以及准确度(95.31%)较阴道超声检查、腹部B超检查均高,差异有统计学意义(P<0.05)。结论临床针对异位妊娠患者在实施疾病诊断期间,阴道超声+腹部B超检查方式的联合应用,同两项单独诊断异位妊娠结果比较,敏感度、特异性以及准确度显著提高,从而提升异位妊娠患者的诊治效果,确保疾病患者获得有效、针对性治疗。

经腹部超声与经阴道超声检查在子宫腺肌瘤中的诊断效能

目的:分析经腹、经阴道超声检查在子宫腺肌瘤中的诊断效能.方法:选取2022年3月至2023年3月本院收治的88例疑似子宫腺肌瘤的患者作为研究对象,将其纳入疑似子宫腺肌瘤组.另选取同期本院收治的80例子宫肌瘤患者,纳入子宫肌瘤组.所有患者均采用经腹部超声检查和经阴道超声检查.以病理学检查结果作为诊断的"金标准",分析经腹、经阴道超声检查在子宫腺肌瘤诊断及鉴别诊断中的诊断效能.结果:疑似子宫腺肌瘤组患者经病理学诊断后,77例证实为子宫腺肌瘤.经阴道超声检查诊断子宫腺肌瘤的灵敏度、特异度、准确度、阳性预测值及阴性预测值均高于经腹部超声检查,差异均有统计学意义(P<0.05).子宫腺肌瘤患者病灶周围血流阻力指数(RI)及波动指数(PI)均显著大于子宫肌瘤患者,差异均有统计学意义(P<0.05).结论:经阴道超声检查应用于子宫腺肌瘤中的诊断效能更高,且病灶周围RI、PI值有助于与子宫肌瘤进行鉴别诊断.