不同超声联合诊断在不同严重程度宫腔粘连中的应用

目的:研究不同超声联合诊断在不同严重程度宫腔粘连中的应用价值(阴道超声、三维超声及能量超声)。方法:回顾性分析2018年3月—2020年4月我院收治的63例临床诊断为宫腔粘连已婚妇女。根据宫腔镜检查结果将患者分为宫腔正常对照组及宫腔粘连组,分析两组超声图像特征。并分析阴道超声联合三维超声的准确率。根据宫腔镜检查结果及宫腔粘连严重程度将宫腔粘连组分为轻度粘连组、中度粘连组、重度粘连组。分析各组超声参数差异。结果:63例患者中有11例宫腔正常,52例宫腔粘连者(31例轻度粘连、15例中度粘连、6例重度粘连)。宫腔正常组:阴道超声示子宫内膜回声连续均匀,三维超声宫腔呈倒三角形,形态规则,边界清晰;宫腔粘连组:阴道超声示子宫内膜薄,形态欠规则,局部内膜回声不连续,宫腔线显示欠清或不清晰,局部与肌层分界不清。三维冠状面可见子宫腔内膜回声局部缺损。阴道、三维、能量超声诊断宫腔粘连总准确率分别为68.25%、77.78%、79.37%;阴道联合三维超声、阴道联合能量、三维联合能量超声诊断总准确率分别为77.78%、79.37%、82.54%;联合诊断确诊宫腔粘连49例,宫腔镜证实有48例,其中轻度粘连28例(90.32%),中度粘连14例(93.33%),重度粘连6例(100.00%);漏诊4例。联合诊断敏感性92.31%,特异性90.91%,总准确率92.06%。对照组、轻度组、中度组、重度组ED、EV、VI、VFI值差异有统计学意义(P<0.05)。结论:三者联合诊断更能全面、准确、直观的诊断宫腔粘连,有助于提高疾病诊断率,提高临床诊断价值。

Application of different ultrasound based methods in diagnosis of different severity of intrauterine adhesions

Objective:To investigate the value of different ultrasound based methods in diagnosis of different severity of intrauterine adhesions.Methods:Sixty-three cases of married women with intrauterine adhesions treated in our hospital from March 2018 to April 2020 were retrospectively analyzed.Women were divided into two groups according to hysteroscopy results:control group and intrauterine adhesion group,and the ultrasonic image characteristics of two groups were compared.The accuracy of vaginal ultrasound combined with three-dimensional ultrasound was also analyzed.Intrauterine adhesion group was further divided into three groups according to the severity degrees:mild adhesions group,moderate adhesions group and severe adhesions group.The difference of ultrasonic parameters among each group was analyzed.Results:Among the 63 patients,11 had normal uterine cavity and 52 had intrauterine adhesion,including 31 cases of mild adhesion,15 cases of moderate adhesion and 6 cases of severe adhesion.In control group,vaginal ultrasound showed continuous and uniform endometrial echo,and three-dimensional ultrasound showed that uterine cavity was inverted triangle with clear regular boundary.In intrauterine adhesions group:vaginal ultrasound showed thin endometrium,irregular shape,local discontinuous endometrial echo,unclear endometrial line,and unclear boundary between local endometrial line and muscular layer,three dimensional ultrasound showed local echo defects in endometrium.The total accuracy rates of vaginal ultrasound,three-dimensional ultrasound,and Doppler ultrasound in the diagnosis of intrauterine adhesions were 68.25%,77.78%,and 79.37%,respectively,the total accuracy rates of vaginal ultrasound combined with three-dimensional ultrasound,vaginal ultrasound combined with Doppler ultrasound,and three-dimensional ultrasound combined with Doppler ultrasound in the diagnosis of intrauterine adhesions were 77.78%,79.37%,and 82.54%,respectively,49 cases of intrauterine adhesions were confirmed by combined diagnosis,and 48 cases were confirmed by hysteroscopy,including 28 cases of mild adhesion(90.32%),14 cases of moderate adhesion(93.33%),and 6 cases of severe adhesion(100.00%).Four cases were missed diagnosis.The sensitivity,specificity and total accuracy of combined diagnosis were 92.31%,90.91%and 92.06%,respectively.ED,EV,VI and VFI had significant differences among control group,mild group,moderate group and severe group(P<0.05).Conclusion:The combined diagnosis of the three can diagnose intrauterine adhesions more comprehensively,accurately and intuitively,which is helpful to improve the diagnosis rate and has high clinical diagnostic value.