经阴道三维超声对不孕不育患者宫腔病变的诊断价值

目的探讨三维超声在不孕不育患者宫腔病变中的诊断价值。 方法选取2017年1月至2018年12月在南京医科大学第一附属医院生殖医学中心的不孕不育患者行经阴道三维超声检查,将428例诊断为不同类型宫腔病变患者的三维超声结果与宫腔镜或病理组织学结果进行比较分析,以宫腔镜或病理组织学结果为"金标准",采用四格表计算三维超声诊断各类宫腔病变的敏感度、特异度、阳性预测值、阴性预测值及准确性。 结果三维超声诊断宫腔病变患者428例,其中包括宫腔粘连235例（54.9%）,子宫内膜息肉153例（35.7%）,子宫黏膜下肌瘤40例（9.4%）。将428例患者的三维超声结果与宫腔镜或病理组织学结果相比较,诊断结果一致为404例（94.4%）,误诊24例（5.6%）,其中,宫腔粘连误诊14例,子宫内膜息肉误诊7例,子宫黏膜下肌瘤误诊3例。三维超声与宫腔镜或病理组织学结果相比,其诊断各种类型宫腔病变的准确性分别为：宫腔粘连96.73%,子宫内膜息肉96.96%,子宫黏膜下肌瘤98.83%。 结论三维超声对各种宫腔病变有较高的诊断准确性,可作为不孕不育患者排除宫腔病变的首选检查方法。

Value of transvaginal three-dimensional ultrasound in diagnosing uterine cavity lesions in infertile patients

ObjectiveTo evaluate the diagnostic value of three-dimensional ultrasound for uterine cavity lesions in infertile patients. MethodsInfertility patients who underwent three-dimensional ultrasound from January 2017 to December 2018 at the First Affiliated Hospital of Nanjing Medical University were collected. Three-dimensional ultrasound results of 428 patients diagnosed with different types of uterine cavity lesions were compared with those of hysteroscopy or histopathology. The four grid table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of three-dimensional sonography. ResultsThree-dimensional ultrasound detected uterine cavity lesions in 428 patients, including 235 (54.9%) cases of intrauterine adhesion, 153 (35.7%) cases of endometrial polyps, and 40 (9.4%) cases of submucosal myoma. Compared with hysteroscopy or histopathology results, the three-dimensional ultrasound had consistent results in 404 cases (94.4%), and 24 (5.6%) cases were misdiagnosed, of which 14 were misdiagnosed as intrauterine adhesions, 7 misdiagnosed as endometrial polyp, and 3 as submucosal myoma. The accuracy of three-dimensional ultrasonography in diagnosing various types of uterine cavity lesions was 96.73% for intrauterine adhesion, 96.96% for endometrial polyps, and 98.83% for submucosal myoma. ConclusionThree-dimensional ultrasound has a high diagnostic accuracy for various types of uterine cavity lesions, which can be used as the first choice for infertile patients to exclude uterine cavity lesions.