子宫输卵管三维造影在分析诊断女性子宫异常出血因素中的价值  

The value of three-dimensional hysterosalpingo-contrast sonography in analyzing the factors of abnormal uterine bleeding in women

作　　者：蒋美平 骆迎春[1] 侯丽琼[1] 张美香 符元春 JIANG Meiping;LUO Yingchun;HOU Liqiong;ZHANG Meixiang;FU Yuanchun(Department of Ultrasound,Hunan Maternal and Child Health Hospital,Hunan 410008,Changsha,China)

机构地区：[1]湖南省妇幼保健院超声科,长沙410008

出　　处：《中国性科学》2021年第9期87-90,共4页Chinese Journal of Human Sexuality

基　　金：湖南省出生缺陷协同防治科技重大专项(2019SK1010);湖南省科技创新计划项目(2018SK50504);湖南省卫生健康委科研计划课题项目(202109020809)。

摘　　要：目的探究子宫输卵管三维造影(3D-HyCoSy)在分析诊断女性子宫异常出血(AUB)因素中的应用价值。方法选择2018年4月至2020年4月湖南省妇幼保健院诊治的96例AUB患者作为研究对象。分别采用3D-HyCoSy和病理检查进行诊断,根据3D-HyCoSy诊断结果,将病理诊断为阳性(n=70)的患者分为阳性组(n=57)和阴性组(n=13)。统计3D-HyCoSy误诊和漏诊情况,计算符合率;分析3D-HyCoSy对AUB不同病因诊断的灵敏度;比较两组的临床特征;采用Logistic回归分析影响3D-HyCoSy诊断准确性的因素,构建森林图预测模型,评价模型预测的准确度。结果3D-HyCoSy的误诊率、漏诊率、诊断符合率分别为4.17%、13.54%和82.29%;诊断出的病因包括子宫内膜息肉、子宫内膜增生、子宫内膜癌、子宫黏膜下肌瘤和内膜非特异性病变,3D-HyCoSy对不同病因诊断的灵敏度分别为92.86%、88.89%、66.67%、50.00%、86.36%。宫腔手术史、附件区包块、子宫肌层对比剂逆流、中位子宫、子宫内膜厚度<9mm均是影响3D-Hy-CoSy诊断准确性的因素,构建的预测3D-HyCoSy诊断准确性森林图模型的准确度较高。结论3D-HyCoSy诊断AUB病因的符合率较好,整体上诊断的灵敏度较高,可作为诊断AUB病因的辅助检查手段,但对于子宫内膜癌、子宫黏膜下肌瘤诊断的灵敏度相对较低,需联合其他检查手段进行诊断。Objective To explore the value of three-dimensional hysterosalpingo-contrast sonography(3D-HyCoSy)in the analysis and diagnosis of abnormal uterine bleeding(AUB)factors in women.Methods 96 AUB patients treated in Hunan Maternal and Child Health Hospital from April 2018 to April 2020 were selected as the research subjects.3D-HyCoSy and pathological examination were used for diagnosis,respectively.According to 3D-HyCoSy diagnosis results,patients with positive pathological diagnosis(n=70)were divided into positive group(n=57)and negative group(n=13).The misdiagnosis and missed diagnosis of 3D-HyCoSy were counted,and the coincidence rate was calculated.The sensitivity of 3D-HyCoSy in the diagnosis of different causes of AUB was analyzed.The clinical characteristics of the two groups were compared.The factors affecting the accuracy of 3D-HyCoSy diagnosis were analyzed by Logistic regression,and the forest plot predictive model was constructed to evaluate the accuracy of the model prediction.Results The misdiagnosis rate,missed diagnosis rate and diagnosis coincidence rate of 3D-HyCoSy were 4.17%,13.54% and 82.29%,respectively.The diagnosed etiologies included endometrial polyps,endometrial hyperplasia,endometrial cancer,submucosal fibroids and endometrial non-specific lesions.The sensitivity of 3D-HyCoSy for the diagnosis of different etiologies was 92.86%,88.89%,66.67%,50.00% and 86.36%,respectively.Uterine surgery history,adnexal mass,myometrial contrast agent reflux,median uterus,and endometrial thickness<9 mm were all factors affecting the accuracy of 3D-HyCoSy diagnosis.the forest plot predictive model was constructed,the accuracy of the model is high.Conclusions 3D-HyCoSy has a good coincidence rate in diagnosing the cause of AUB,and the overall sensitivity of diagnosis is high.It can be used as an auxiliary examination method to diagnose the cause of AUB,but it has relatively low sensitivity for the diagnosis of endometrial cancer and submucosal fibroids,so it should be combined with other examination methods

关 键 词：子宫输卵管三维造影 子宫异常出血 病理检查 符合率 灵敏度 

分 类 号：R711[医药卫生—妇产科学]