二维联合三维超声在腹壁子宫内膜异位症诊断中的应用
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摘要
目的探讨二维超声联合三维超声对腹壁子宫内膜异位(AWE)的临床诊断价值。方法选择具有剖宫产史的患者66例,年龄22～44岁,平均年龄30.6岁。对其进行二维超声、三维超声诊断,观察病灶处肿块的位置、形态、大小、边界、内部回声、血流速、血流阻力等参数。以病理诊断为"金标准",比较二者诊断准确率。结果经病理确诊AWE患者45例,非AWE患者21例。经二维超声诊断为AWE的患者59例,非AWE患者7例,其中诊断正确50例,诊断错误16例。经二维联合三维超声诊断为AWE的患者为52例,非AWE患者14例,其中诊断正确57例,诊断错误9例。通过二维超声诊断准确率为75.76%;而通过二维联合三维超声诊断的准确率为86.36%。二维联合三维超声诊断准确率大于二维诊断准确率(χ2=4.00,P=0.039)。通过二维联合三维观察AWE,于病灶处肿块的边界不清晰,形态不规则,内部低回声且不均匀,随月经周期性有变化。通过二维超声可见AWE的病灶内部血流无特异性改变,有稀疏血流信号,动脉频谱呈现低速高阻的主要特征。经彩色多普勒血流显像(CDFI)检查AWE的病灶处,可见散例点状血流、线带状或短线带状信号,动脉血流速范围为Vmax=8.6～32.0 cm/s,Vmin=2.8～16.2 cm/s,RI=0.66～0.84。20例AWE患者的腹壁切口处肿块内部未见明显血流信号。结论二维超声联合三维超声诊断的应用,较大提高了AWE的超声诊断率,同时其无创伤、无辐射、价格低,较易为患者接受,为AWE的及早发现与治疗,提供了较高价值的临床诊断依据。
Objective To investigate the clinical value of two-dimensional(2 D) combined with three-dimensional(3 D) ultrasonography in diagnosis of abdominal wall endometriosis(AWE). Methods A total of 66 patients with cesarean section were enrolled, which aged 22-44 years old with mean age of 30.6 years old. The 2 D ultrasonography and 3 D ultrasonography were performed to observe the parameters such as position, shape, size, boundary, internal echo, blood flow velocity and blood flow resistance of tumor. The pathological diagnosis was used as gold standard, and the diagnostic accuracy of 2 methods was compared. Results The pathological diagnosis confirmed 45 patients with AWE and 21 patients without AWE. There were 59 patients with AWE and 7 patients with non-AWE diagnosed by 2 D ultrasonography, in which 50 cases were correct and 16 were incorrect. There were 52 patients with AWE and 14 patients with non-AWE by 2 D combined with 3 D ultrasonography, in which 57 cases were correctly and 9 were incorrectly. The diagnosis accuracy rate was 75.76 % by 2 D ultrasonography and86.36 % by 2 D combined with 3 D ultrasonography. The diagnostic accuracy rate of 2 D combined 3 D ultrasonography was significantly higher than that of 2 D ultrasonography(χ2= 4.00,P = 0.039). The 2 D combined with 3 D ultrasonic was performed to observe AWE, data indicated that the boundaries were not clear, shape was irregular, internal was hypoechoic and uneven, and periodic changed with menstruation. The 2 D ultrasonography showed that there were no specific change in blood flow inside of AWE, and there were sparse blood flow signals. The arterial spectrum exhibited the main characteristics of low velocity and high resistance. The scattered blood flow, line-band or short-line-band signal in nidus of AWE were observed by color Doppler flow imaging, The range of arterial blood flow rate were Vmax= 8.6-32.0 cm/s, Vmin= 2.8-16.2 cm/s, resistance index(RI) = 0.66-0.84. There was no obvious blood flow signal inside tumor of abdominal wall in 20 AWE patients. Conclusion It is demonstrated that 2 D combined with 3 D ultrasonography could greatly improve the ultrasound diagnosis rate of AWE. It is non-invasive, non-radiative, low-price and more acceptable for patients. It provides a valuable clinical diagnosis basis for early detection and early treatment of AWE.
Objective To investigate the clinical value of two-dimensional(2 D) combined with three-dimensional(3 D) ultrasonography in diagnosis of abdominal wall endometriosis(AWE). Methods A total of 66 patients with cesarean section were enrolled, which aged 22-44 years old with mean age of 30.6 years old. The 2 D ultrasonography and 3 D ultrasonography were performed to observe the parameters such as position, shape, size, boundary, internal echo, blood flow velocity and blood flow resistance of tumor. The pathological diagnosis was used as gold standard, and the diagnostic accuracy of 2 methods was compared. Results The pathological diagnosis confirmed 45 patients with AWE and 21 patients without AWE. There were 59 patients with AWE and 7 patients with non-AWE diagnosed by 2 D ultrasonography, in which 50 cases were correct and 16 were incorrect. There were 52 patients with AWE and 14 patients with non-AWE by 2 D combined with 3 D ultrasonography, in which 57 cases were correctly and 9 were incorrectly. The diagnosis accuracy rate was 75.76 % by 2 D ultrasonography and86.36 % by 2 D combined with 3 D ultrasonography. The diagnostic accuracy rate of 2 D combined 3 D ultrasonography was significantly higher than that of 2 D ultrasonography(χ2= 4.00,P = 0.039). The 2 D combined with 3 D ultrasonic was performed to observe AWE, data indicated that the boundaries were not clear, shape was irregular, internal was hypoechoic and uneven, and periodic changed with menstruation. The 2 D ultrasonography showed that there were no specific change in blood flow inside of AWE, and there were sparse blood flow signals. The arterial spectrum exhibited the main characteristics of low velocity and high resistance. The scattered blood flow, line-band or short-line-band signal in nidus of AWE were observed by color Doppler flow imaging, The range of arterial blood flow rate were Vmax= 8.6-32.0 cm/s, Vmin= 2.8-16.2 cm/s, resistance index(RI) = 0.66-0.84. There was no obvious blood flow signal inside tumor of abdominal wall in 20 AWE patients. Conclusion It is demonstrated that 2 D combined with 3 D ultrasonography could greatly improve the ultrasound diagnosis rate of AWE. It is non-invasive, non-radiative, low-price and more acceptable for patients. It provides a valuable clinical diagnosis basis for early detection and early treatment of AWE.
引文
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[5]HU Shang-ying.MRI features and clinical value in high intensity focused ultrasound ablation of abdominal wall endometriosis[D].Chongqing:Chongqing Medical University,2015:10-10.[胡尚英.MRI在超声消融腹壁子宫内膜异位症中的临床应用评价[D].重庆:重庆医科大学,2015:10-10.]
[6]Kang J,Baek JH,Lee WS,et al.Clinical manifestations of abdominal wall endometriosis:a single center experience[J].Arch Gynecol Obstet,2013,287(2):301-305.
[7]HU Shang-ying.Progress in diagnosis and treatment of abdominal wall endometriosis[J].Chinese Journal of Minimally Invasive Surgery,2015,15(2):182-184.[胡尚英.腹壁子宫内膜异位症的诊疗进展[J].中国微创外科杂志,2015,15(2):182-184.]
[8]Busard MP,Mijatovic V,van Kuijk C,et al.Appearance of abdominal wall endometriosis on MR imaging[J].Eur Radiol,2010,20(5):1267-1276.
[9]WEI Yu-hua.The diagnosis of super sound to endometriosis in the abdominal wall of uterine-incision delivery[J].Guide of China Medicine,2013,11(7):415-416.[魏玉华.剖宫产后腹壁子宫内膜异位症的超声诊断[J].中国医药指南,2013,11(7):415-416.]
[10]CHEN Xiao-yan,WU Xing-mei,REN Xiao-xiao.Analysis of ultrasound characteristics of abdominal wall after cesarean section scar endometriosis[J].Journal of Medical Imaging,2015,25(2):368-370.[陈小燕,吴兴妹,任晓晓.剖宫产后腹壁瘢痕子宫内膜异位症的超声特征分析[J].医学影像学杂志,2015,25(2):368-370.]
[11]JIANG Xiao-yan.Ultrasound diagnosis of endometriosis in abdominal incision after cesarean section[J].Journal of Imaging Research and Medical Applications,2018,2(22):144-146.[蒋小燕.剖宫产后腹壁切口子宫内膜异位症的超声诊断[J].影像研究与医学应用,2018,2(22):144-146.]
[2]HE Xing-yun.Ultrasonic diagnosis and clinical analysis of abdominal wall endometriosis by cesarean section[J].China Modern Doctor,2010,48(6):71-71,73-73.[何兴云.剖宫产腹壁切口子宫内膜异位症的超声诊断及临床分析[J].中国现代医生,2010,48(6):71-71,73-73.]
[3]HAN Shu-juan,SHAO Lan.Clinical discussion on 27 cases of abdominal wall endometriosis after cesarean section[J].Clinical Misdiagnosis&Mistherapy,2014,27(6):28-30.[韩淑娟,邵岚.破宫产术后腹壁切口子宫内膜异位症27例临床讨论[J].临床误诊误治,2014,27(6):28-30.]
[4]ZHANG Ping,SUN Ya-bing,CHEN Zheng-yun,et al.Clinical study on 121 cases of abdominal wall endometriosis[J].Journal of Shanghai Jiao Tong University:Medical Science,2016,36(10):1463-1466.[张平,孙亚兵,陈正云,等.腹壁子宫内膜异位症121例临床研究[J].上海交通大学学报:医学版,2016,36(10):1463-1466.]
[5]HU Shang-ying.MRI features and clinical value in high intensity focused ultrasound ablation of abdominal wall endometriosis[D].Chongqing:Chongqing Medical University,2015:10-10.[胡尚英.MRI在超声消融腹壁子宫内膜异位症中的临床应用评价[D].重庆:重庆医科大学,2015:10-10.]
[6]Kang J,Baek JH,Lee WS,et al.Clinical manifestations of abdominal wall endometriosis:a single center experience[J].Arch Gynecol Obstet,2013,287(2):301-305.
[7]HU Shang-ying.Progress in diagnosis and treatment of abdominal wall endometriosis[J].Chinese Journal of Minimally Invasive Surgery,2015,15(2):182-184.[胡尚英.腹壁子宫内膜异位症的诊疗进展[J].中国微创外科杂志,2015,15(2):182-184.]
[8]Busard MP,Mijatovic V,van Kuijk C,et al.Appearance of abdominal wall endometriosis on MR imaging[J].Eur Radiol,2010,20(5):1267-1276.
[9]WEI Yu-hua.The diagnosis of super sound to endometriosis in the abdominal wall of uterine-incision delivery[J].Guide of China Medicine,2013,11(7):415-416.[魏玉华.剖宫产后腹壁子宫内膜异位症的超声诊断[J].中国医药指南,2013,11(7):415-416.]
[10]CHEN Xiao-yan,WU Xing-mei,REN Xiao-xiao.Analysis of ultrasound characteristics of abdominal wall after cesarean section scar endometriosis[J].Journal of Medical Imaging,2015,25(2):368-370.[陈小燕,吴兴妹,任晓晓.剖宫产后腹壁瘢痕子宫内膜异位症的超声特征分析[J].医学影像学杂志,2015,25(2):368-370.]
[11]JIANG Xiao-yan.Ultrasound diagnosis of endometriosis in abdominal incision after cesarean section[J].Journal of Imaging Research and Medical Applications,2018,2(22):144-146.[蒋小燕.剖宫产后腹壁切口子宫内膜异位症的超声诊断[J].影像研究与医学应用,2018,2(22):144-146.]