摘要
目的:分析超声在Ⅱ型子宫黏膜下肌瘤患者术前评估中的价值。方法:118接受手术治疗的子宫黏膜下肌瘤患者术前均进行经腹超声和经阴道超声检查,评估图像质量,分析不同超声子宫黏膜下肌瘤及分型的诊断效能,重点分析Ⅱ型子宫黏膜下肌瘤患者的超声表现以指导手术治疗。结果:118例患者经腹、经阴道超声检查图像质量评分依次为(3. 22±0. 41)分、(3. 16±0. 47)分,差异无统计学意义(P <0. 05)。经腹超声、经阴道超声漏诊率、误诊率及诊断准确率比较,差异无统计学意义(P> 0. 05),经腹、经阴道超声联合误诊率为2. 54%,明显低于经腹超声、经阴道超声的10. 17%、8. 47%;诊断准确率为97. 46%,明显高于经腹超声、经阴道超声的88. 14%、90. 68%,差异具有统计学意义(P <0. 05)。经腹、经阴道超声联合诊断Ⅱ型子宫黏膜下肌瘤的灵敏度、特异度、准确率为93. 75%、94. 29%、94. 07%,明显高于经腹超声诊断的87. 50%、92. 86%、90. 67%和经阴道超声诊断的85. 42%、92. 86%、85. 83%。0型或Ⅰ型与Ⅱ型子宫黏膜下肌瘤超声表现差异具有统计学意义(P <0. 05),Ⅱ型子宫黏膜下肌瘤的超声表现以多发肌瘤、肌瘤直径>5cm为主,肌瘤除继发囊性变外,纤维化、钙化较为常见,CDFI信号丰富。结论:经腹和经阴道超声检查有助于提高诊断Ⅱ型子宫黏膜下肌瘤的诊断效能,且有助于术前探清肌瘤情况,为手术方式和手术途径的选择提供重要的判断依据。
Objective:To analyzed the value of ultrasound in preoperative evaluation of patients with type Ⅱ submucosal myoma of uterus. Methods: 118 patients with submucous myoma of uterus who underwent surgical treatment were examined by transabdominal ultrasound and transvaginal ultrasound. The image quality was evaluated and the efficiencies of different types of ultrasound in the diagnosis of submucous myoma of uterus were analyzed.Ultrasonic findings of patients with type Ⅱ submucous myoma of uterus were analyzed to guide surgical treatment.Results:Image quality scores of 118 patients undergoing transabdominal and transvaginal ultrasound examination were(3. 22 ± 0. 41) points and(3. 16 ± 0. 47) points,respectively( P < 0. 05). There was no significant difference between transabdominal ultrasound and transvaginal ultrasound in the missed diagnosis rate,misdiagnosis rate and diagnostic accuracy( P > 0. 05). The misdiagnosis rate of transabdominal ultrasound combined with transvaginal ultrasound( 2. 54%) was significantly lower than that of transabdominal ultrasound or transvaginal ultrasound(10. 17%,8. 47%),and the diagnostic accuracy(97. 46%) was higher than that of transabdominal ultrasound or transvaginal ultrasound(88. 14% or 90. 68%)( P < 0. 05). The sensitivity,specificity and accuracy of transabdominal ultrasound combined with transvaginal ultrasound in diagnosis of type Ⅱ submucosal myoma of uterus(93. 75%,94. 29%,94. 07%) were significantly higher than those of transabdominal ultrasound(87. 50%,92. 86%,90. 67%) or those of transvaginal ultrasound( 85. 42%,92. 86%,85. 83%). There were significant differences in ultrasound findings between type 0 or type I and type Ⅱ submucosal myoma of uterus( P < 0. 05). Ultrasound findings of type Ⅱ submucosal myoma of uterus mainly included multiple myomas and the diameter of myo-ma > 5 cm. Except the secondary cystic degeneration of myoma,fibrosis and calcification were common and CDFI signal was abundant. Conclusions:Transabdominal ultrasound and transvaginal ultrasound examinations is helpful to improve the diagnostic efficiency of type Ⅱ submucosal myoma of uterus,which helps the preoperative exploration of myoma,providing important bases for the choice of operation mode and operation approach.
引文
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