子宫有蒂粘膜下肌瘤的超声鉴别诊断、病理基础及临床意义

目的 探讨有蒂子宫粘膜下肌瘤的超声鉴别诊断要点，以期为临床选择治疗方案提供准确信息。方法 对140例经手术病理证实的有蒂子宫粘膜下肌瘤、内膜息肉、内膜癌及内膜增生进行经腹或经阴道超声检查，观察病灶大小、形态、位置、回声、边界、结节表面及基底与子宫内膜的关系，子宫内膜轮廓的完整性及结节血供情况。结果 全部病灶为不同程度高回声，其中粘膜下肌瘤40例，内膜息肉54例，内膜癌及内膜增生各23例。粘膜下肌瘤的声像图特征为：圆形，有包膜，周边多有无回声区，内部回声均匀，蒂部子宫内膜中断，结节表面被膜与子宫内膜相延续。子宫内膜息肉常呈舌形或椭圆型，无被膜，蒂部子宫内膜连续，结节内常见有小无回声区。内膜癌形态多不规则。良性增生内膜轮廓完 整，能观察到居中的宫腔线。结论 子宫腔内病变的组织形态学基础构成了超声图像上的特征，可作为相互间鉴别诊断的依据。

Ultrasonographic differential diagnosis for submucous myoma:pathology background and clinical significance

Objective To look for the characteristics in ultrasonographic differential diagnosis of submucous myoma in order to offer information for clinicians choice of managements.Methods One hundred and forty patients with uterine lesions were examined by ultrasound in via abdominal or transvaginal way.The histopathology diagnosis was obtained from all cases through surgical or hysteroscope section.The dimension,figure,location,echo and the margin of lesions were recorded.The relationship between the surface of lesions and the endometrium was observed.The blood supply of lesions was detected by color Doppler.Results Of 140 cases,40 were submucous myoma,54 were endometrium,polyp proliferated endometrium and endometrial carcinoma were 23 cases respectively.All the lesions appeared hyperecho.The characters of ultrasonographic for diagnosis of submucous myoma were that the lesion was round with capsule and dark halo around lesion and homogeneous internal echo was detected,the capsule connected with the endometrium at the base of lesion,and the endometrium at the base of lesion was not connected.The endometrium polyp appeared like a tongue or band,without capsule,the endometrium at the base was continuous and small area without echo could be observed within lesion.The figure of endomerial carcinoma was irregular.The endometrium was continuous at benign proliferated endometrium and the high echo line in the middle of uterine cavity could be seen.Conclusions The morphology and histopathology changes of lesions in uterine cavity were the base of the characters for ultrasonographic differential diagnosis,according to that could tell submucous myoma from other disorder.