应用经阴道三维超声与宫腔声学造影对绝经后不规则出血患者内膜病变的早期诊断

目的 探讨经阴道三维超声(3D-TVS)与宫腔造影(2D-HSG)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阴道超声枪查.用3D-TVS测量子宫内膜容积.经2D-TVS测量内膜厚度≥5 mm者32例行2D-HSG.以子宫内膜病理学结果为标准评价3D-TVS、2D-HSG诊断符合率.结果 3D-TVS以子宫内膜容积10 ml为临界值诊断子宫内膜病理性改变的敏感性、假阳性率分别为95.4%、21.2%;预测子宫内膜癌和癌前病变分别为100%、18.2%;2D-HSG诊断子宫内膜病变及子宫内膜癌和癌前病变的准确率分别为96.8%和100%.造影剂注入宫腔子宫内膜变化和子宫肌壁顺应性在内膜良恶性病变间差异有统计学意义(P<0.05).结论 3D-TVS和2D-HSG是筛查子宫内膜病变的可靠方法.2D-HSG是诊断和鉴别绝经后不规则出血原因的有效方法,造影剂注入宫腔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.

Early diagnosis of endometrial disorder in women with postmenopausal bleeding by three-dimensional transvaginal sonography and hysterosonography

Objective To evaluate the value of three-dimensional transvaginal sonography and hysterosonography in the diagnosis of endometrial lesion in women with postmenopausal bleeding. Methods A total of 74 patients with postmenopausal bleeding were prospectively studied by two-and three-dimensional transvaginal sonography. Endometrial thickness and volume were measured by 2D and 3D ultrasound respectively. Endometrial thickness was found by hysterosonography at greater than 5 mm in 32 cases.Changes of endometrium and compliance of muscularis uteri were observed. The results were correlated with histopathological findings. Results When 10 ml of endometrial volume was set as the cut-off point of endometrial abnormalities in postmenopausal women with bleeding, the sensitivity and false positive rate were 95.4%, 21.2% whereas 100%, 18.2% were obtained respectively when it was used to predict endometrial malignancy and premalignancy. The accurate rate of 2D-HSG diagnosing endometrial disorders and endometrial malignancy and pre-malignancy was 96.8% and 100% respectively. Changes of endometrium and compliance of muscularis uteri showed a significant difference between the groups of benign and malignancy after the injection of fluid into uterine cavity (P<0.05). Conclusion 3D-TVS and 2D-HSG are reliable methods in screening endometrial lesions. 2D-HSG should be regarded as an important tool in diagnosing and differentiating endometrial lesions especially in early stages of this malignant disease.Changes of endometrium and compliance of muscularis uteri may help to differentiate benign disorders from endometrial cancer.