经阴道实时三维子宫输卵管超声造影的临床应用

目的 探讨经阴道实时三维超声造影评估子宫输卵管通畅性的准确性和临床应用价值.方法 对428例不孕症妇女行经阴道实时三维子宫输卵管超声造影,其中32例行腹腔镜下通染液检查.结果 428例患者846条输卵管超声造影显示输卵管通畅271条,输卵管通而不畅373条,输卵管不通畅202条,其中32例子宫输卵管超声造影与腹腔镜通液结果对照(Kappa值=0.788),经阴道实时三维超声造影评估输卵管通畅性的敏感性84.0％,特异性100％,阴性预测值87.5％,阳性预测值90.9％.结论 经阴道实时三维子宫输卵管超声造影可动态显示子宫输卵管、卵巢和盆腔显影顺序和伞端形态,有利于输卵管通畅性的评估以及对输卵管功能的研究.     

经阴道超声与宫腔注液造影评价宫腔内病变

目的　评价经阴道超声与宫腔注液造影对宫腔内病变的诊断价值。方法　应用经阴道超声与宫腔内注液造影结合检查月经不规则妇女２０ 例,宫腔造影插管采用更细、更方便的专用宫腔造影管,造影剂用无菌生理盐水。结果　粘膜下肌瘤７ 例,呈等回声或低回声、无蒂、基底较宽,基底处内膜强回声线中断;内膜息肉６ 例,呈中强回声,多有蒂,基底处内膜强回声线无中断;子宫内膜癌２ 例,为中强回声,基底宽广,形态、边缘不规则,回声不均;５ 例宫腔内未见病变。与最后诊断符合者１９ 例（１９／２０） 。结论　经阴道高频超声与宫腔注液造影检查是一项简便、准确、无创的宫腔内病变的诊断方法。     

经阴道超声和超声子宫造影对子宫腔内病变诊断的比较

目的：评价经阴道超声和超声子宫造影对子宫腔内病变的诊断作用。方法：经阴道超声诊断官腔内异常的44例患者，行超声子宫造影检查，以宫腔镜和病理结果为标准，计算两种方法诊断子宫内膜息肉、黏膜下肌瘤、内膜病变的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果：44例患者，经阴道超声诊断内膜息肉、黏膜下肌瘤、内膜病变的敏感性、特异性、准确性分别为65％、96％、82％；94％、96％、95％；100％、67％、77％；超声子宫造影诊断内膜息肉、黏膜下肌瘤、内膜病变的敏感性、特异性、准确性分别为85％、100％、93％；100％、85％、91％；100％、98％、98％。结论：与传统的经阴道超声相比，超声子宫造影对子宫腔内病变的诊断有很高的敏感性和特异性，是一种简便易行、疼痛少，无合并症的诊断方法。     

经阴道子宫输卵管三维超声造影评价输卵管通畅性

目的 探讨经阴道子宫输卵管三维超声造影(3D HyCoSy)评价输卵管通畅性的可行性和准确性.方法 对22例不孕症患者进行3D HyCoSy检查,评价所获得的三维图像质量,并以1周内的子宫输卵管碘油造影(HSG)图像为对照,评估3D HyCoSy判断输卵管通畅性的情况.结果 22例患者3DHyCoSy的图像质量评分为(2.8±0.5)分.与HSG相比,其判断输卵管通畅的符合率为88.9%(24/27),判断输卵管阻塞的符合率为94.1%(16/17),总体符合率为90.9%(40/44).两种方法判断输卵管通畅性的能力相当(P值=0.000,k值=0.812).所有患者均未出现与造影剂相关的不良反应.结论 经阴道3D HyCoSy是一种全新的输卵管影像学检查方法,能安全、有效地显示输卵管形态,并准确判断其通畅性.

Abstract：

Objective To assess the feasibility and accuracy of the transvaginal three-dimensional hysterosalpingo-contrast sonography(3D HyCoSy) on the fallopian tube patency. Methods 3D HyCoSy was performed in twenty-two cases with infertility. Image quality of 3D HyCoSy was evaluated. The estimate of the fallopian tube patency in 3D HyCoSy were compared with those of hysterosalpinography(HSG) in one week. Results The mean score of image quality of 3D HyCoSy in twenty-two cases was 2. 8 + 0. 5. The accuracy of the unobstructed and obstructed fallopian tube were 88.9% (24/27) and 94.1% (16/17) respectively, and the total accuracy was 90. 9% (40/44) , which was equal to the results of HSG (P = 0. 000,k = 0. 812). No adverse reactions of SonoVue occurred in the cases. Conclusions Transvaginal 3D HyCoSy which is a new imaging technique can safely and effectively display the morphological character of fallopian tube and assess the patency.     

宫腔声学造影在子宫不规则出血诊断中的应用

目的　为提高超声对子宫内膜病变的诊断价值。方法　对４３ 例子宫不规则出血患者进行宫腔声学造影研究,并与诊刮结果对照。结果　造影前宫腔处于闭合状态,前后壁宫内膜贴近,有些宫腔内异常不易发现。宫腔扩开后以水作透声窗对内膜病变的显示程度明显提高。随着宫腔充盈程度的不同,病灶从显示不满意到清楚显示,并对其大小、形态、起源等可准确判断。结论　宫腔声学造影能直观显示内膜病变。诊刮与宫腔造影结合起来,则会提高诊断的准确性。但如确定内膜的功能状态,必须参照病史。     

三维经阴道超声宫腔造影在子宫内膜息肉诊断中的临床价值

目的:探讨三维经阴道超声宫腔造影对子宫内膜息肉的诊断价值。方法:对58例子宫不规则出血,月经量增多的患者行经阴道三维超声检查后,对这些患者再行三维超声宫腔造影检查。将宫腔造影的结果与病理检查结果进行比较对照。结果:本次研究的58例患者中,42例诊断为子宫内膜息肉,7例诊断为子宫内膜增生,9例诊断为其他子宫内膜病变。三维超声宫腔造影诊断子宫内膜息肉的敏感度100%,特异度88%。结论:宫腔造影可以准确诊断子宫内膜息肉,特别是三维超声宫腔造影,在表面模式下可使诊断率进一步提高。     

经阴道超声子宫输卵管声诺维造影的应用价值

目的探讨经阴道超声子宫输卵管声诺维(SonoVue)造影对判断输卵管通畅程度的临床应用价值。方法对68例临床诊断为不孕症的妇女经阴道超声行子宫输卵管SonoVue造影,实时动态观察SonoVue造影剂通过输卵管的情况。结果根据SnoVue造影的超声图像特点,68例不孕症患者中,双侧输卵管通畅43例(63.2%),双侧输卵管阻塞6例(8.8%),双侧输卵管通而不畅11例(16.2%),单侧不全梗阻或完全梗阻8例(11.8%)。结论经阴道超声行子宫输卵管SonVue造影能准确诊断输卵管是否通畅,同时具有简单、安全和实用的特点,可作为评价输卵管通畅程度的有效检查方法。     

经阴道三维超声诊断子宫畸形

目的 探讨经阴道三维超声成像诊断子宫畸形的应用价值.方法 对可疑子宫畸形的病例行经阴道二维扫查及经阴道三维成像,并对两者结果 进行分析.结果 132例明确诊断子宫畸形的病例中,仅利用经阴道二维能明确诊断的有56例,行三维后明确诊断的有76例.结论 经阴道三维超声对子宫畸形诊断具有重要价值,弥补了以往二维超声难以获取冠状面信息的不足.     

经阴道三维超声宫腔造影诊断先天性子宫畸形

目的 评价经阴道三维超声宫腔造影对先天性子宫畸形的诊断价值。方法 应用经阴道三维超声对35例疑似子宫畸形患者进行官腔内生理盐水灌注后扫查，并与宫腔镜和腹腔镜检查结果对照。结果 6例诊断为完全纵隔子宫，19例诊断为不完全纵隔子宫，10例诊断为双角子宫。经阴道三维超声宫腔造影的准确度为100％。结论 经阴道三维超声宫腔造影方法简便、易行，准确度高，是诊断先天性子宫畸形的可行方法。     

宫腔声学造影与经阴道超声诊断子宫内膜息肉的ROC曲线分析

目的:用受试者操作特性分析(ROC)方法评价经阴道超声(TVS)、宫腔声学造影(SHG)对子宫内膜息肉的检查价值。方法:临床怀疑内膜病变的患者47例,行TVS、SHG检查,检查完毕后所有患者均行宫腔镜检查。用ROC for Windows 0.90软件对数据进行分析。结果:ROC分析显示,TVS曲线下面积为0.620,SHG曲线下面积为0.978。两种方法的ROC曲线及曲线下面积明显不同,两者的差别有显著性意义(P<0.01)。结论:SHG在诊断子宫内膜息肉方面明显优于TVS。     

经阴道三维超声诊断子宫内膜病变的临床应用

目的 探讨经阴道三维超声诊断子宫内膜病变的价值。方法 对经阴道二维超声检查疑似宫腔内病变的46例已婚妇女进行经阴道三维超声检查，其结果与宫腔镜及病理相对照。结果 46例患者中子宫内膜增生16例，子宫内膜息肉12例．黏膜下子宫肌瘤9例，子宫内膜癌3例．余6例为正常子宫内膜分泌期改变；二维经阴道超声、三维经阴道超声诊断子宫内膜增生的特异性、敏感性、准确性分别为66．7%、93．7%、76．1%和90．0%、100％、93.5%；诊断内膜．息肉的特异性、敏感性、准确性分别为88．2%，58．3%、80．4%和100%、83．3％、95.7％，结论 三维经阴道超声提高了子宫内膜病变的诊断水平．与二维经阴道超声结合是诊断子宫内膜病变的首选方法。     

经阴道超声宫腔声学造影在宫腔病变中的应用价值

目的：探讨经阴道超声宫腔声学造影（Sonohysterography,SHG）对宫腔内病变的应用价值。方法：101例不孕症患者经阴道超声（Transvaginal sonography,TVS）检查疑有宫腔病变,随后行SHG检查,结果与宫腔镜检查（Hystemscopy,HS）和病理诊断相对照,估价SHG对宫腔病变的诊断价值。结果：通过与HS和病理检查结果相比,TVS检查对疾病的诊断符合率为54.46％（55?蛐101）,SHG检查对疾病的诊断符合率为91.09％（92?蛐101）,二者疾病诊断符合率相比差异具有显著统计学意义（P<0．05）。结论：SHG是诊断宫腔内病变的有效方法,对临床选择治疗方式有指导意义。     

三维超声生理盐水宫腔声学造影与宫腔镜检查对子宫黏膜下肌瘤分型对比

目的 评估三维超声生理盐水宫腔声学造影(3D-SIS)对子宫黏膜下肌瘤术前分型的临床价值。 方法 选择因不规则阴道出血并经阴道超声检查(TVS)诊断为子宫黏膜下肌瘤的患者62例,用3D-SIS与宫腔镜(HS)检查按照欧洲宫腔镜学会对黏膜下肌瘤的分型标准,分别对子宫黏膜下肌瘤进行分型并与术后分型结果比较。 结果 62例患者共检出子宫黏膜下肌瘤73个,均经手术证实,3D-SIS及HS检查对子宫黏膜下肌瘤分型的一致性分别为:0型100%(13/13);Ⅰ型92.31%(24/26);Ⅱ型82.35%(28/34),总一致性为89.04%(65/73)。 结论 通过术前对子宫黏膜下肌瘤的分型,3D-SIS对选择合适的手术方式具有重要的临床价值。     

Reproducibility of the measurement of submucous fibroid protrusion into the uterine cavity using three-dimensional saline contrast sonohysterography.

OBJECTIVE: To determine the intraobserver and interobserver reproducibility of measurement of the percentage of protrusion of submucous fibroids into the uterine cavity using three-dimensional saline contrast sonohysterography (3D-SCSH). METHODS: Women diagnosed with submucous uterine fibroids on B-mode two-dimensional (2D) ultrasound scan were invited to join the study and 3D-SCSH was carried out. 3D volume datasets were stored digitally and were examined later using the technique of planar reformatted sections. The reproducibilities of the measurement of fibroid diameter and protrusion ratio into the uterine cavity (ratio of the size of the segment of the fibroid protruding into the cavity to the total diameter of the fibroid) were examined by two independent observers who were unaware of the initial 2D scan findings. Interobserver reproducibility was assessed by calculating the difference between measurements taken by the two operators (limits of agreement) and interclass correlation coefficient. Intraobserver repeatability was assessed by calculating the difference between two measurements for each variable (limits of agreement) and further expressed as an intraclass correlation coefficient. RESULTS: Thirty-three 3D ultrasound volumes were examined. There was a good agreement between the observers in classifying the fibroids as greater or less than 50% confined to the myometrium (Cohen's kappa 0.81). There was no bias in measurements for both variables either between observers or with repeated measurements by each observer. For fibroid diameter and protrusion ratio the inter- and intraclass correlation coefficients were high (0.984-0.995), with narrow limits of agreement. CONCLUSION: 3D-SCSH is a reproducible method for the quantification of the percentage of a submucous fibroid protruding into the uterine cavity.     

生理盐水灌注宫腔造影在子宫内膜及宫腔病变诊断与治疗中的应用

子宫内膜和宫腔病变近年来发病率有上升趋势,常导致不规则阴道出血、不孕,故早期诊断尤为重要.生理盐水灌注宫腔造影以生理盐水为透声窗,可提高图像质量和分辨率,更好地评价子宫内膜、内膜下及宫腔内病变,对其诊断、鉴别诊断及制定合理的治疗方案有重要作用.本文就生理盐水灌注宫腔造影对子宫内膜及宫腔内病变的诊断与治疗进展做一综述.     

经腹及经阴道超声、宫腔超声造影和宫腔镜诊断宫内病变

目的 评价经腹、经阴道超声及官腔超声造影、官腔镜对宫内病变的诊断价值。方法 常规经腹部、经阴道超声及生理盐水灌注官腔后经阴道超声观察宫内病变，官腔镜检查治疗宫内病变。结果 88例经腹超声，45例经阴道超声，39例官腔超声造影，23例行官腔镜检查治疗，数种方法结果比较：官腔超声造影和官腔镜的敏感性、准确性和阳性预测值最高，分别为94．29％、90．24％、94．29％和95、65％、91、67％、95．65％，两者差异无显著性意义。结论 经阴道超声、官腔超声造影是诊断官腔内病变的一种简便、经济、无痛苦无损伤、诊断率高的方法。     

Sonohysterography of the uterine cavity: Preliminary investigations

Objective: To compare sonohysterography (SH), in the exploration of the uterine cavity, with classical transvaginal sonography (TVS), hysterography (HSG), and hysteroscopy. Study design: 104 consecutive patients evaluated for uterine disorders underwent both TVS and SH. SH was obtained by distension of the uterine cavity with the instillation of an isotonic saline solution; 36 patients also underwent HSG; 82 women underwent surgery. Histologic findings were considered as gold standard. The criteria used to compare these methods were sensitivity, specificity, and negative and positive predictive values (NPV, PPV) for identifying pathology. Results: 3 instillation failures occurred. SH was found to be more effective (sensitivity 94%, specificity 98%) than HSG (sensitivity 67%, specificity 94%). The difference between TVS and SH was less marked, SH showing some superiority (sensitivity 88%, specificity 98%) to TVS (sensitivity 77%, specificity 93%). Conclusion: SH represents an improvement over conventional TVS and is fully capable of replacing HSG for the study of the uterine cavity. © 1995 John Wiley & Sons, Inc.     

宫腔水造影后子宫内膜带蒂息肉断裂脱出1例北大核心CSCD

患者女,31岁,超声发现子宫腔中下段0.9 cm×0.8 cm×0.5 cm等回声结节半年;平素月经规律,经量适中,无痛经;孕2产0,接受2次早期人工流产术,继发性不孕2年。查体未见明显异常。行子宫输卵管四维超声造影检查,将造影管水囊固定于宫颈内口,注入生理盐水充盈后观察宫腔,宫腔中上段未见明显异常;缓慢缩小水囊,同时向宫腔内缓慢推注生理盐水,退出造影管,宫腔下段随即显影,见0.8 cm×0.6 cm×0.4 cm等回声结节;加大造影管水囊并固定于宫颈管,再次注入生理盐水,见结节以一细蒂连于宫腔前壁(图1A),并随水流大幅摆动;检查结束后撤出造影管时,结节向宫颈外口摆动,细蒂断裂,结节随生理盐水脱出宫腔外;即时再行宫腔水造影,见原结节附着处仅残留一短蒂(图1B)。病理:大体标本为0.8 cm×0.5 cm×0.5 cm卵圆形粉红色脱出物,质软有弹性;光镜下见其表面被覆柱状上皮细胞,见间质纤维组织增生及部分不规则增生的厚壁血管,散在淋巴细胞浸润(图1C)。病理诊断:子宫内膜息肉。     

Sonographic investigation of the uterus during artificial uterine cavity distention

The improvement of sonographic examination of the uterus during artificial uterine cavity distention was studied in 30 consecutive patients in whom a hysteroscopy was indicated. In 10 of 21 patients with a normal sonographic appearence of the uterus, after filling the uterine cavity with Hyskon, various pathologic conditions became visible. In 5 of 9 patients with abnormal sonographic appearance of the uterus, the procedure enabled a more precise diagnosis concerning localization of abnormal echoes in the uterus. The advantage of this method was clearly demonstrated in cases of central echogenic structures, congenital uterine anomalies, myoma's, synechiae, and corpora aliena.