经阴道三维超声容积成像与断层超声显像技术对宫腔粘连的诊断及漏诊分析  

Analysis of the diagnosis and missed diagnosis of intrauterine adhesions by three-dimensional transvaginal sonography Render and tomographic ultrasound imaging

作　　者：叶琴[1] 薛恩生[1] 梁荣喜[1] 郭晶晶[1] 林学英[1] 王艳[1] Ye Qin;Xue Ensheng;Liang Rongxi;Guo Jingjing;Lin Xueying;Wang Yan(Department of Ultrasound,Union Hospital,Fujian Medical University,Fujian Institute of Ultrasonic Medicine,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院超声科,福建省超声医学研究所,福州350001

出　　处：《中华超声影像学杂志》2020年第3期255-259,共5页Chinese Journal of Ultrasonography

摘　　要：目的探讨经阴道三维超声(3D-TVS)检查对宫腔粘连(intrauterine adhesions,IUA)的诊断价值并分析漏诊原因。方法对2017年1月至2019年7月在福建医科大学附属协和医院就诊的47例IUA患者行3D-TVS检查3D容积成像(Render成像)与断层超声显像(TUI成像),记录和分析内膜异常回声数据,并将超声诊断结果与宫腔镜手术结果进行分析。结果3D-TVS诊断准确39例,符合率为83.0%(39/47),超声表现为子宫内膜回声厚薄不均,宫腔线均有不同程度的回声连续性中断。Render成像显示7例内膜局部回声不均匀呈"蜂窝状"改变,28例局部回声缺失呈不规则低回声区或低回声带,4例一侧宫角消失;TUI成像显示该39例内膜均出现不同程度局部变薄、回声连续性中断呈低回声条带状改变。8例漏诊的IUA患者中3例内膜纤细呈丝状或膜状粘连,5例为IUA合并内膜息肉患者。结论3D-TVS Render成像与TUI成像技术可显示立体图像,方便临床医生阅图,有利于对患者进行术前诊断与术后复查,为临床治疗提供更多的信息和治疗依据。检查过程中仍需注意可能引起漏诊的问题。Objective To investigate the value of three-dimensional transvaginal sonography(3D-TVS)in the diagnosis of intrauterine adhesions(IUA)and to analyze the causes of the missed diagnosis.Methods Forty-seven patients with IUA were examined by three-dimensional transvaginal sonography(3D-TVS),3D volume imaging(Render imaging)and tomographic ultrasound imaging(TUI imaging)in the Union Hospital of Fujian Medical University from January 2017 to July 2019.The abnormal echo data of the endometrium were recorded and analyzed,and the ultrasound diagnosis and hysteroscopic diagnosis were compared.Results 3D-TVS correctly diagnosed IUA was accurate in the 39 cases whose ultrasound imaging showed an uneven thickness of endometrial echo with the uterine cavity line having different degrees of echo continuity interruption.The diagnostic accuracy rate was 83.0%(39/47).In the Render imaging,7 cases showed endometrial echo with honeycomb change,28 cases showed partial echo loss with irregular low echo zone or low echo,and 4 cases showed corneal disappearance of one side.In TUI imaging,the endometrium was partly thinned in varying degrees where echo continuity was interrupted with hypoechoic band-like changes in all 39 cases.Three of the 8 missed IUA cases showed slender endometrium with filiform or membranous adhesions,and the other 5 were patients with uterine endometrial polyps.Conclusions 3D-TVS,Render imaging and TUI imaging technology can display stereo images,which contributes to the better preoperative diagnosis and postoperative follow-up.Care should be taken to avoid missed diagnosis and to improve the diagnostic accuracy for IUA by the techniques.

关 键 词：超声检查 经阴道 三维 宫腔粘连 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711[医药卫生—诊断学]