超声在Ⅱ型子宫黏膜下肌瘤患者术前评估中的价值
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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.
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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[2]林玉贤,杨宁波,曹立萍,等.探讨高强度聚焦超声技术在治疗子宫肌瘤中的应用.中国性科学,2017,26(6):45-47.
[3]杨淑英,向群,陈雪兰,等.腹腔镜子宫肌瘤切除手术难度评分系统在腹腔镜子宫肌瘤切除手术中应用评估.中国性科学,2015,24(1):24-26.
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[5]徐秋栋,徐丽萍,王磊,等.经阴道三维超声诊断子宫粘膜下肌瘤与肌壁间肌瘤临床分析.医学影像学杂志,2016,26(3):557-559.
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[7]朱莹莹,范盈盈.腹腔镜与B超监护在宫腔镜电切术治疗Ⅱ型子宫黏膜下肌瘤中应用的临床比较分析.现代实用医学,2015,27(3):370-371.
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[9]赵凯英,吴静,杨振华,等.超声造影在子宫肌瘤高强度聚集超声消融治疗术中的应用.临床超声医学杂志,2016,18(3):195-197.
[10]王李娜,于冰.经阴道三维超声宫腔声学造影对黏膜下子宫肌瘤的诊断价值.中国药物与临床,2017,17(1):52-54.
[11]黄永生,尹香花,苏悦,等.宫腔镜电切治疗Ⅱ型子宫黏膜下肌瘤的效果及安全性.实用临床医药杂志,2014,18(13):88-90.
[12]孙健,曾燕敏,陈军霞,等.超声引导下射频消融治疗子宫肌瘤临床价值研究.临床军医杂志,2017,45(7):664-667.
[13]李晶华,黄文燕,张瑞,等.Ⅱ型子宫黏膜下肌瘤术前超声评估MFM的临床意义.首都医科大学学报,2016,37(4):523-528.
[14]吴淑华,李威,颜亭.经腹部及经阴道超声在子宫黏膜下肌瘤诊断中的应用分析.医学影像学杂志,2017,27(3):570-573.
[15]Cogendez E,Eken MK,Bakal N,et al.The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions..Journal of Medical Ultrasonics,2015,42(4):533-533.
[16]孟璐,赵一婷,牛旺,等.实时超声弹性成像技术鉴别诊断子宫肌瘤和子宫腺肌瘤.中国医学影像技术,2016,32(6):919-922.
[17]何宗珊,邹秋果,黄燕.经腹及经阴道超声联合应用扫查子宫肌瘤对比分析.中国性科学,2016,25(4):48-50.
[18]周克松,朱军,徐晓茜,等.超声造影对子宫肌瘤子宫动脉栓塞患者术前筛查及术后疗效评估.中国超声医学杂志,2016,32(4):355-357.
[2]林玉贤,杨宁波,曹立萍,等.探讨高强度聚焦超声技术在治疗子宫肌瘤中的应用.中国性科学,2017,26(6):45-47.
[3]杨淑英,向群,陈雪兰,等.腹腔镜子宫肌瘤切除手术难度评分系统在腹腔镜子宫肌瘤切除手术中应用评估.中国性科学,2015,24(1):24-26.
[4]杨伟超,林紫晴,张婧.HIFU治疗子宫肌瘤应用超声与增强MRI评估临床意义分析.中国CT和MRI杂志,2016,14(12):99-102.
[5]徐秋栋,徐丽萍,王磊,等.经阴道三维超声诊断子宫粘膜下肌瘤与肌壁间肌瘤临床分析.医学影像学杂志,2016,26(3):557-559.
[6]曹泽毅.中华妇产科学.2版.北京:人民卫生出版社,2007:1454-1454.
[7]朱莹莹,范盈盈.腹腔镜与B超监护在宫腔镜电切术治疗Ⅱ型子宫黏膜下肌瘤中应用的临床比较分析.现代实用医学,2015,27(3):370-371.
[8]Ahmad RA,Sadek SM,Ragheb AS.Evaluation of the uterine cavity by magnetic resonance imaging,three dimensional hysterosonography and diagnostic hysteroscopy in women with pre-and post-menopausal bleeding.Middle East Fertility Society Journal,2015,20(2):70-78.
[9]赵凯英,吴静,杨振华,等.超声造影在子宫肌瘤高强度聚集超声消融治疗术中的应用.临床超声医学杂志,2016,18(3):195-197.
[10]王李娜,于冰.经阴道三维超声宫腔声学造影对黏膜下子宫肌瘤的诊断价值.中国药物与临床,2017,17(1):52-54.
[11]黄永生,尹香花,苏悦,等.宫腔镜电切治疗Ⅱ型子宫黏膜下肌瘤的效果及安全性.实用临床医药杂志,2014,18(13):88-90.
[12]孙健,曾燕敏,陈军霞,等.超声引导下射频消融治疗子宫肌瘤临床价值研究.临床军医杂志,2017,45(7):664-667.
[13]李晶华,黄文燕,张瑞,等.Ⅱ型子宫黏膜下肌瘤术前超声评估MFM的临床意义.首都医科大学学报,2016,37(4):523-528.
[14]吴淑华,李威,颜亭.经腹部及经阴道超声在子宫黏膜下肌瘤诊断中的应用分析.医学影像学杂志,2017,27(3):570-573.
[15]Cogendez E,Eken MK,Bakal N,et al.The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions..Journal of Medical Ultrasonics,2015,42(4):533-533.
[16]孟璐,赵一婷,牛旺,等.实时超声弹性成像技术鉴别诊断子宫肌瘤和子宫腺肌瘤.中国医学影像技术,2016,32(6):919-922.
[17]何宗珊,邹秋果,黄燕.经腹及经阴道超声联合应用扫查子宫肌瘤对比分析.中国性科学,2016,25(4):48-50.
[18]周克松,朱军,徐晓茜,等.超声造影对子宫肌瘤子宫动脉栓塞患者术前筛查及术后疗效评估.中国超声医学杂志,2016,32(4):355-357.