经阴道三维超声在诊断宫腔病变中的应用价值资料.docVIP

经阴道三维超声在诊断宫腔病变中的应用价值 ????????[ 10-11-15 10:53:00 ]????编辑：studa20 ?????????????? 作者：范志华 林晓 李建卫 林宁 叶振盛 赵月明? 【摘要】? 　　目的 探讨经阴道三维超声（3DTVS）在诊断子宫腔病变中的临床应用价值。方法 分析56例宫腔内病变患者的3DTVS诊断资料，并与宫腔镜检查及临床病理结果进行对照研究。用Kappa检验评价经阴道三维超声与宫腔镜、病理检查的一致性。结果 病理结果为子宫内膜息肉25例，子宫黏膜下肌瘤15例，子宫内膜增生症11例，子宫内膜癌5例。对于子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜增生症的诊断，3DTVS与宫腔镜检查的一致性检验Kappa值分别为0.856、0.909和0.887，3DTVS与病理检查的一致性检验Kappa值分别为0.748、0.818和0.774。结论 3DTVS对宫腔病变的诊断与宫腔镜及病理结果有较好的一致性，在诊断宫腔病变中具有很高的临床价值。 【关键词】? 成像，三维； 诊断，鉴别； 子宫疾病； 超声检查，多普勒，彩色； 阴道??? 　　ABSTRACT:? Objective? To investigate the clinical value of threedimensional transvaginal sonography (3DTVS) in the diagnosis of Uterine cavity disease.? Methods? 56 patients with uterine cavity disease were examined by 3DTVS and compared with the results of hysteroscopy and pathology.? The consistency of? 3DTVS and hysteroscopy and pathology were analyzed by Kappa test.? Results? Pathological diagnosis showed 25 cases were endometrial polyps, 15 cases were submucous myoma, 11 cases were endometrial hyperplasia and 5 cases were endometrial cancer.? In the diagnosis of Endometrial polyps, submucous myoma and endometrial hyperplasia, the consistency test Kappa values were 0.856, 0.909 and 0.887 for 3DTVS and hysteroscopy，and 0.748, 0.818 and 0.774 for 3DTVS and pathology.? Conclusion? 3DTVS have good consistency with hysteroscopy and pathology and have higher clinical value in the diagnosis of uterine cavity disease.??? 　　KEY WORDS:? imaging, threedimensional; diagnosis, differential; uterine diseases; uterine diseases; ultrasonography, Doppler, color; vagina 　　常见的子宫腔病变包括子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜增生症和子宫内膜癌等。患者常因阴道不规则流血、经期延长、经量过多和绝经后阴道流血等症状就诊，年轻患者常合并不孕。早期确诊并及时治疗十分重要。3DTVS可以对子宫内膜和宫腔进行立体成像。本文旨在探讨3DTVS在诊断宫腔病变的临床应用价值。 　　1? 资料与方法 　　1.1? 临床资料? 　　2009年1-12月，在本院行常规妇科超声检查提示宫腔内可疑占位性病变的患者共56例，年龄（40.3±11.3）岁（27～63岁）。临床表现：月经过多23例、经期过长22例、绝经后出血5例、不孕症3例，无明显症状3例。患者均经3DTVS检查，再行宫腔镜检查加诊断性刮宫术或宫腔镜下赘生物摘除术。全部病例所取标本送病理组织学检查。 　　1.2? 仪器与方法? 　　采用美国生产的Philip IU22三维彩色超声诊断系统。腔内三维容积探头频率为3～9 MHz。患者排尿后取膀胱截石