多途径超声联合检查在先天性阴道闭锁诊断中的应用价值  

Role of multipath ultrasonography in diagnosing congenital vaginal atresia

作　　者：王慧芳[1] 胡守容 郭蓉 张丹丹[1] 曾娜君 贺玉梅 张蕾[1] 郄建英 林燕秋 蔡阿乔 Wang Huifang;Hu Shourong;Guo Rong;Zhang Dandan;Zeng Najun;He Yumei;Zhang Lei;Qie Jianying;Lin Yanqiu;Cai Aqiao(Department of Ultrasound,Shenzhen Luohu People's Hospital,the Third Affiliated Hospital of Shenzhen University,Shenzhen 518001,China)

机构地区：[1]深圳大学第三附属医院深圳市罗湖区人民医院超声科,518001

出　　处：《中华医学超声杂志（电子版）》2022年第10期1065-1070,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的分析先天性阴道闭锁超声影像学特征,探讨多途径超声联合检查在诊断及鉴别诊断先天性阴道闭锁中的临床应用价值。方法回顾性分析2021年3月至2022年5月在深圳市罗湖区人民医院经手术证实的22例先天性阴道闭锁患者的临床资料,所有患者均行经腹部超声、经会阴超声、经直肠腔内超声和经直肠双平面高频超声联合检查,总结多途径超声联合检查诊断不同类型阴道闭锁的超声影像学特征,并与手术结果进行对比分析。结果本组22例先天性阴道闭锁患者接受经腹腔镜下阴道成形术或经会阴闭锁阴道切开成形术,其中13例为Ⅰ型阴道闭锁,12例术前超声检查结果与手术结果一致,符合率为92.3%;9例为Ⅱ型阴道闭锁,术前超声检查结果均与手术结果一致,符合率为100%。13例Ⅰ型阴道闭锁患者行经腹部、经会阴和经直肠腔内超声检查均可见阴道中上段积血;经直肠双平面高频超声检查在阴道积血下方、膀胱尿道后壁与直肠前壁之间未见正常阴道结构显示,仅见中等回声的结缔组织间隙,为闭锁的阴道下段,闭锁阴道长度<3 cm者4例,≥3 cm者9例。Ⅱ型阴道闭锁患者行经腹部、经会阴和经直肠腔内超声检查可见子宫颈发育异常,膀胱尿道后壁与直肠前壁之间的阴道走行区域未见积血;经直肠双平面高频超声检查在膀胱尿道后壁与直肠前壁之间未见正常阴道结构,仅见中等回声的结缔组织间隙,于尿道内口水平测量此间隙厚度为1.2~7.8(2.81±1.01)mm。术中诊断子宫内膜异位症的发生率为59.1%(13/22),其中腹膜型子宫内膜异位症占比为92.3%(12/13)。结论多途径超声联合检查能够准确诊断先天性阴道闭锁并分型,为临床个性化手术方式的选择提供可靠的影像学诊断依据。Objective To analyze the ultrasound features of congenital vaginal atresia and to discuss the practical value of multipath ultrasonography in the diagnosis and differential diagnosis of this disease.Methods The ultrasound records of 22 patients with congenital vaginal atresia confirmed by surgery at Shenzhen Luohu District People's Hospital from March 2021 to May 2022 were retrospectively analyzed.All the patients had images obtained through transabdominal ultrasound,transperineal ultrasound,transrectal ultrasound,and transrectal biplanar high-frequency ultrasound before surgery.The features of different types of vaginal atresia were summarized and compared with the surgical outcomes.Results The 22 patients with congenital vaginal atresia underwent transvaginal laparoscopic vaginoplasty or transperineal vaginoplasty.Among them,13 cases were confirmed with type I vaginal atresia by surgery,12 of which obtained a correct diagnosis by preoperative ultrasound,with a consistency rate of 92.3%.The other 9 cases were confirmed with type II vaginal atresia,and all of them obtained a correct diagnosis by ultrasound before surgery,with a consistency rate of 100%.Patients with type I vaginal atresia showed hematocele in the middle and upper vagina on transabdominal,transperineal,and transrectal ultrasound.No normal vaginal anatomy was visualized inferior to the hematocele or between the posterior urethovesical wall and the anterior rectal wall on transrectal biplanar high-frequency ultrasound.And merely an isoechonic connective tissue gap was seen,which was the lower part of the atresic vagina.The length of atresia was<3 cm in 4 cases and≥3 cm in 9 cases.As for patients with type II vaginal atresia,abnormal cervix development could be observed by transabdominal,transperineal,and transrectal ultrasound,and no hematocele was found in the vagina area between the posterior urethovesical wall and the anterior rectal wall.An isoechonic connective tissue gap could also be visualized by transrectal biplanar high-frequency ultraso

关 键 词：先天性阴道闭锁 梗阻性生殖道畸形 子宫颈发育异常 经直肠 双平面高频超声 

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]