三维超声对先天性子宫畸形的诊断价值
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摘要
目的探讨三维超声对先天性子宫畸形的诊断价值。方法对临床320例可疑先天性子宫畸形经阴道、直肠或经腹行二、三维超声成像,以宫、腹腔镜或手术结果为金标准,比较各种类型的子宫畸形二、三维超声诊断结果的差异。结果经宫、腹腔镜或手术确诊子宫畸形318例,子宫形态正常2例,经二维超声诊断符合率90.3%,经三维超声诊断符合率约96.9%。二、三维超声与金标准的一致性检验Kappa值分别为0.88、0.96,一致性检验二者与金标准一致性好,且三维具有更好的一致性。单角子宫二、三维阳性预测值均为100.0%,假阴性率分别为22.8%、8.6%;双子宫二、三维阳性预测值分别为87.5%、100.0%,假阴性率均为0;双角子宫二、三维阳性预测值分别为68.0%、89.5%,假阴性率均为0;完全纵隔子宫二、三维阳性预测值分别为94.4%、100.0%,假阴性率均为0;不完全纵隔子宫二、三维阳性预测值均为100.0%,假阴性率分别为8.7%、4.8%;弓形子宫二、三维阳性预测值分别为85.0%、91.1%,假阴性率均为0;特殊类型二、三维阳性预测值均为100.0%,假阴性率分别为54.5%、9.1%。结论三维超声在部分先天性子宫畸形的诊断及分型中优于二维超声,对二维超声是有益的补充。
Objective To investigate the clinical effectiveness of application of three-dimensional ultrasound(3 D US) in diagnosis of congenital uterine anomalies.Methods For 320 clinical suspicious of congenital uterine malformation were scanned by transvaginal ultrasound,Transrectal Ultrasound or Transabdominal ultrasound of two-dimensional ultrasound(2 D US) and 3 D US,and the ultrasonic results were compared with hysteroscopy,laparoscopy or operation so as to make a comparison of the differences in the various types of uterine malformation between two methods.Results As a consequence,318 patients were diagnosed as uterine anomalies and 2 patients were diagnosed as normal uterus by ultrasound combined with hysteroscopy,laparoscopy and operation in the study.The diagnostic accordance rate of 2 D-US was 90.3% and of 3 D-US was 96.9%.By the consistency check,2 D-US and 3 D-US were highly consistent with the gold standard(kappa value was 0.88,0.96,respectively),and 3 D-US has better consistency.In unicornuate uterus,the positive predictive value of 2 D-US and of 3 D-US both were 100.0%,and the false negative rate was 22.8% and8.6%.In uterus duplex,the positive predictive value of 2 D-US and of 3 D-US was 87.5% and 100.0%,and the false negative rate all was 0.In uterus bicornis,the positive predictive value of 2 D-US and of 3 D-US was 68.0% and 89.5%,and the false negative rate all was 0.In complete septate uterus,the positive predictive value of 2 D-US and of 3 D-US was 94.4% and 100.0%,and the false negative rate all was 0.In incomplete septate uterus,the positive predictive value of 2 D-US and of 3 D-US both were 100.0%and the false negative rate was 8.7% and 4.8%.In uterus arcuatus,the positive predictive value of 2 D-US and of 3 D-US was 85.0% and 91.1%,and the false negative rate all was0.In special type uterus,the positive predictive value of 2 DUS and of 3 D-US both were 100.0%,and the false negative rate was 54.5% and 9.1%.Conclusion 3 D-US was more accurate on diagnosis of diversified congenital uterine anomalies,and also it was a further supplement of 2 D-US.
Objective To investigate the clinical effectiveness of application of three-dimensional ultrasound(3 D US) in diagnosis of congenital uterine anomalies.Methods For 320 clinical suspicious of congenital uterine malformation were scanned by transvaginal ultrasound,Transrectal Ultrasound or Transabdominal ultrasound of two-dimensional ultrasound(2 D US) and 3 D US,and the ultrasonic results were compared with hysteroscopy,laparoscopy or operation so as to make a comparison of the differences in the various types of uterine malformation between two methods.Results As a consequence,318 patients were diagnosed as uterine anomalies and 2 patients were diagnosed as normal uterus by ultrasound combined with hysteroscopy,laparoscopy and operation in the study.The diagnostic accordance rate of 2 D-US was 90.3% and of 3 D-US was 96.9%.By the consistency check,2 D-US and 3 D-US were highly consistent with the gold standard(kappa value was 0.88,0.96,respectively),and 3 D-US has better consistency.In unicornuate uterus,the positive predictive value of 2 D-US and of 3 D-US both were 100.0%,and the false negative rate was 22.8% and8.6%.In uterus duplex,the positive predictive value of 2 D-US and of 3 D-US was 87.5% and 100.0%,and the false negative rate all was 0.In uterus bicornis,the positive predictive value of 2 D-US and of 3 D-US was 68.0% and 89.5%,and the false negative rate all was 0.In complete septate uterus,the positive predictive value of 2 D-US and of 3 D-US was 94.4% and 100.0%,and the false negative rate all was 0.In incomplete septate uterus,the positive predictive value of 2 D-US and of 3 D-US both were 100.0%and the false negative rate was 8.7% and 4.8%.In uterus arcuatus,the positive predictive value of 2 D-US and of 3 D-US was 85.0% and 91.1%,and the false negative rate all was0.In special type uterus,the positive predictive value of 2 DUS and of 3 D-US both were 100.0%,and the false negative rate was 54.5% and 9.1%.Conclusion 3 D-US was more accurate on diagnosis of diversified congenital uterine anomalies,and also it was a further supplement of 2 D-US.
引文
[1]Saravelos SH,Cocksedge KA,Li TC.Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure:a critical appraisal[J].Hum Reprod Update,2008,14(5):415-429.
[2]佘义梅,杨喜惠.三维超声成像对先天性子宫畸形的诊断价值[J].中国处方药,2016,14(9):108-109.
[3]丘媚妮,侯涛,李境,等.宫腔镜结合腹腔镜诊治先天性子宫畸形的临床价值[J].中国现代药物应用,2013,7(20):19-20.
[4]刘炜,蔡爱露.三维超声诊断先天性子宫畸形的应用价值[J].中国医学工程,2014,22(4):48.
[5]刘海杰.三维超声C平面在先天性子宫畸形诊断及分型中的应用[J].中国医药指南,2015,13(26):62-63.
[6]Patton PE.Anatomic uterine defects[J].Clin Obstet Gynecol,1994,37(3):705-721.
[7]谢红宁,朱云晓,李丽娟,等.三维超声成像对特殊类型子宫畸形的诊断研究[J].中国超声医学杂志,2006,22(3):221-223.
[8]姜蓓蓓.132例先天性子宫发育异常的临床分析[D].河北医科大学,2015.
[9]于利利,张璇,王泽华.经阴道三维超声新技术Omniview对先天性子宫畸形的诊断价值[J].华中科技大学学报(医学版),2014,43(3):328-330.
[10]周曦,陈忠东,文佩燕.宫腹腔镜联合诊治先天性子宫畸形的临床分析[J].中国内镜杂志,2010,16(1):82-84.
[11]卢祥章.经阴道三维超声对先天性子宫畸形的诊断价值[J].中国医疗设备,2015,30(12):76-78.
[12]李莉,禤庆山,胡悦林,等.子宫输卵管碘油造影在先天性子宫畸形诊断及分型中的临床应用[J].中国优生与遗传杂志,2013,21(8):103-104.
[13]王海,蔡菊芳,曾茂平,等.三维超声与碘油造影用于先天性子宫畸形诊断临床对比研究[J].中国继续医学教育,2015,7(12):35-36.
[14]Mueller GC,Hussain HK,Smith YR,et al.Müllerian duct anomalies:comparison of MRI diagnosis and clinical diagnosis[J].AJR Am J Roentgenol,2007,189(6):1294.
[15]杨益刚,王忠,郭娴吟,等.先天性子宫畸形的三维超声和MRI诊断价值对照[J].赣南医学院学报,2015,35(2):243-244.
[16]李鸿利,韦嘉,袁媛,等.超声在监测兔酒精性脂肪肝模型建立中的应用[J].医学研究生学报,2015,28(5):486-490.
[17]Bocca SM,Oehninger S,Stadtmauer L,et al.A study of the cost,accuracy,and benefits of 3-dimensional sonography compared with hysterosalpingography in women with uterine abnormalities[J].J Ultrasound Med,2012,31(1):81-85.
[18]黄维,刘莉萍,陈光勇,等.经阴道彩色多普勒超声诊断宫外孕57例[J].东南国防医药,2009,11(6):541-542.
[19]Grimbizis GF,Gordts S,Di Spiezio Sardo A,et al.The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies[J].Hum Reprod,2013,28(8):2032-2044.
[20]Gergolet M,Campo R,Verdenik I,et al.No clinical relevance of the height of fundal indentation in subseptate or arcuate uterus:a prospective study[J].Reprod Biomed Online,2012,24(5):576-582.
[21]Practice Committee of the American Society for Reproductive Medicine.Uterine septum:a guideline[J].Fertil Steril,2016,106(3):530.
[22]Kupesi CS,Kurjak A,Skenderovic S,et al.Screening for uterine abnormalities by three-dimensional ultrasound improves perinatal outcome[J].J Perinat Med,2002,30(1):9-17.
[23]Tomazevi C T,Ban-Frange6 H,Virant-Klun I,et al.Septate,subseptate and arcuate uterus decrease pregnancy and live birth rates in IVF/ICSI[J].Reprod Biomed Online,2010,21(5):700-705.
[24]江添.经阴式三维超声成像诊断先天性子宫畸形的临床价值分析[J].中外医学研究,2015,13(16):65-66.
[25]罗应德.三维超声对先天性子宫畸形的诊断价值[J].中国现代药物应用,2014,8(4):83-84.
[2]佘义梅,杨喜惠.三维超声成像对先天性子宫畸形的诊断价值[J].中国处方药,2016,14(9):108-109.
[3]丘媚妮,侯涛,李境,等.宫腔镜结合腹腔镜诊治先天性子宫畸形的临床价值[J].中国现代药物应用,2013,7(20):19-20.
[4]刘炜,蔡爱露.三维超声诊断先天性子宫畸形的应用价值[J].中国医学工程,2014,22(4):48.
[5]刘海杰.三维超声C平面在先天性子宫畸形诊断及分型中的应用[J].中国医药指南,2015,13(26):62-63.
[6]Patton PE.Anatomic uterine defects[J].Clin Obstet Gynecol,1994,37(3):705-721.
[7]谢红宁,朱云晓,李丽娟,等.三维超声成像对特殊类型子宫畸形的诊断研究[J].中国超声医学杂志,2006,22(3):221-223.
[8]姜蓓蓓.132例先天性子宫发育异常的临床分析[D].河北医科大学,2015.
[9]于利利,张璇,王泽华.经阴道三维超声新技术Omniview对先天性子宫畸形的诊断价值[J].华中科技大学学报(医学版),2014,43(3):328-330.
[10]周曦,陈忠东,文佩燕.宫腹腔镜联合诊治先天性子宫畸形的临床分析[J].中国内镜杂志,2010,16(1):82-84.
[11]卢祥章.经阴道三维超声对先天性子宫畸形的诊断价值[J].中国医疗设备,2015,30(12):76-78.
[12]李莉,禤庆山,胡悦林,等.子宫输卵管碘油造影在先天性子宫畸形诊断及分型中的临床应用[J].中国优生与遗传杂志,2013,21(8):103-104.
[13]王海,蔡菊芳,曾茂平,等.三维超声与碘油造影用于先天性子宫畸形诊断临床对比研究[J].中国继续医学教育,2015,7(12):35-36.
[14]Mueller GC,Hussain HK,Smith YR,et al.Müllerian duct anomalies:comparison of MRI diagnosis and clinical diagnosis[J].AJR Am J Roentgenol,2007,189(6):1294.
[15]杨益刚,王忠,郭娴吟,等.先天性子宫畸形的三维超声和MRI诊断价值对照[J].赣南医学院学报,2015,35(2):243-244.
[16]李鸿利,韦嘉,袁媛,等.超声在监测兔酒精性脂肪肝模型建立中的应用[J].医学研究生学报,2015,28(5):486-490.
[17]Bocca SM,Oehninger S,Stadtmauer L,et al.A study of the cost,accuracy,and benefits of 3-dimensional sonography compared with hysterosalpingography in women with uterine abnormalities[J].J Ultrasound Med,2012,31(1):81-85.
[18]黄维,刘莉萍,陈光勇,等.经阴道彩色多普勒超声诊断宫外孕57例[J].东南国防医药,2009,11(6):541-542.
[19]Grimbizis GF,Gordts S,Di Spiezio Sardo A,et al.The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies[J].Hum Reprod,2013,28(8):2032-2044.
[20]Gergolet M,Campo R,Verdenik I,et al.No clinical relevance of the height of fundal indentation in subseptate or arcuate uterus:a prospective study[J].Reprod Biomed Online,2012,24(5):576-582.
[21]Practice Committee of the American Society for Reproductive Medicine.Uterine septum:a guideline[J].Fertil Steril,2016,106(3):530.
[22]Kupesi CS,Kurjak A,Skenderovic S,et al.Screening for uterine abnormalities by three-dimensional ultrasound improves perinatal outcome[J].J Perinat Med,2002,30(1):9-17.
[23]Tomazevi C T,Ban-Frange6 H,Virant-Klun I,et al.Septate,subseptate and arcuate uterus decrease pregnancy and live birth rates in IVF/ICSI[J].Reprod Biomed Online,2010,21(5):700-705.
[24]江添.经阴式三维超声成像诊断先天性子宫畸形的临床价值分析[J].中外医学研究,2015,13(16):65-66.
[25]罗应德.三维超声对先天性子宫畸形的诊断价值[J].中国现代药物应用,2014,8(4):83-84.