三维阴道超声与宫腔造影术对绝经后子宫内膜病变的诊断价值

首都医科大学学报 ›› 2005, Vol. 26 ›› Issue (5): 630-633.

三维阴道超声与宫腔造影术对绝经后子宫内膜病变的诊断价值

侯东敏¹, 何文²

1. 首都医科大学附属北京妇产医院超声科;2. 首都医科大学附属北京天坛医院超声科

收稿日期:2005-08-20 修回日期:1900-01-01 出版日期:2005-10-24 发布日期:2005-10-24

The Clinical Study of Endometrial Pathological Changes in Postmenopausal Women with Three-dimensional Transvaginal Sonography and Hysterosonography

Hou Dongmin¹, He Wen²

1. Department of Ultrasound, Beijing Obstetric and Gynecology Hospital, Capital University of Medical Sciences;2. Department of Ultrasound, Beijng Tiantan Hospital, Capital University of Medical Sciences

Received:2005-08-20 Revised:1900-01-01 Online:2005-10-24 Published:2005-10-24

摘要/Abstract

摘要：

目的探讨三维阴道超声(3D-TVS)与宫腔造影(2D-SHG)对绝经后子宫内膜病变的早期诊断价值。方法 74例绝经后阴道出血患者接受3D-TVS检查,测量子宫内膜容积;内膜厚度≥5 mm的32例行2D-SHG,观察内膜变化。以子宫内膜病理结果为标准评价3D-TVS、2D-SHG的诊断符合率。结果以子宫内膜容积10 mL为临界值,3D-TVS诊断子宫内膜病理性改变的敏感性、特异性、阳性预测值和阴性预测值分别为95.4%、78.8%、67.7%和97.6%;预测子宫内膜癌和癌前病变的以上各值分别为100%、66.7%、41.2%和100%;2D-SHG诊断子宫内膜病理性改变的敏感性、特异性、阳性预测值和阴性预测值分别为100%、96.9%、95.0%和100%,预测子宫内膜癌和癌前病变的以上各值分别100%、88.2%、86.7%和100%。造影剂注入宫腔,良性病变组和恶性病变组的子宫内膜变化和子宫肌壁顺应性比较差异均有统计学意义(P<0.05)。结论 3D-TVS和2D-SHG是诊断绝经后内膜病变的有效方法。2D-SHG是诊断和鉴别绝经后不规则出血原因的较好方法,注入造影剂时子宫内膜变化和子宫肌壁顺应性是鉴别内膜良恶性病变的重要指标。

关键词: 三维阴道超声, 宫腔造影, 子宫内膜病变, 绝经后出血

Abstract:

Objective To investigate the values of three-dimensional transvaginal sonograpphy and hysterosonography in early diagnosis of the endometrial diseases.Methods 74 patients with postmenopausal bleeding were studied prospectively.Endometrial thickness and volume were measured with 2D and 3D ultrasound respectively,endometrial thickness greater than 5 mm were found in 32 cases with hysterosonography.The changes of the endometrium and compliance of muscularis uteri were observed.The results were compared with histopathologic findings.Results When 10 mL of endometrial volume was set as the criticalor cut off-point of the endometrial abnormalities in postmenopausal women with bleeding,the sensitivity,specificity,positive predictive values and negative predictive value were 95.4%,78.8%,67.7%,97.6% respectively whereas 100%,66.7%,41.2%,100% were obtained respectively when it was used to predict endometrial malignancy and premalignancy.To identify endometrial disorders with 2D-SHG,the values above-mentioned were 100%,96.9%,95.0%,100% respectively whereas 100%,88.2%,86.7%,100% were obtained respectively for predicting endometrial malignancy and premalignancy.The changes of endometrium and compliance of muscularis uteri were significantly different between the groups of benign and malignant pathological changes when contrast medium was injected into uterine cavity(P<(0.05)).Conclusion 3D-TVS and 2D-SHG were reliable methods to diagnose endometrial disorders in postmenopausal women.2D-SHG should be viewed as an important tool in diagnosis and differentiation of endometrial pathological changes especially in the early stages of the malignant diseases.The changes of endometrium and compliance of muscularis uteri may serve as an effective diagnostic method for differentiation of benign endometrial disorders from endometrial cancer.

Key words: three-dimensional transvaginal sonography, hysterosonography, endometrial disorders, postmenopausal bleeding

中图分类号:

R711.74

侯东敏;何文. 三维阴道超声与宫腔造影术对绝经后子宫内膜病变的诊断价值[J]. 首都医科大学学报, 2005, 26(5): 630-633.

Hou Dongmin;He Wen. The Clinical Study of Endometrial Pathological Changes in Postmenopausal Women with Three-dimensional Transvaginal Sonography and Hysterosonography[J]. Journal of Capital Medical University, 2005, 26(5): 630-633.

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