经阴道三维宫腔输卵管超声造影联合宫腔水造影对宫腔粘连的诊断价值  

Diagnosis of intrauterine adhesions by transvaginal three-dimensional hysterosalpingo-contrast sonography combined with hydrohysterography

作　　者：陈意玲 林金淼 黄珊珊 郭静宜[1] 吕国荣 CHEN Yiling;LIN Jinmiao;HUANG Shanshan;GUO Jingyi;LYU Guorong(Department of Ultrasound Medicine,Jinjiang Municipal Hospital(Shanghai Sixth People's Hospital Fujian Hospital),Quan-zhou 362200,China;Department of Ultrasound Medicine,Second Affiliated Hospital of Fujian Medical University,Quanzhou 362200,China)

机构地区：[1]福建省晋江市医院(上海市第六人民医院福建医院)超声医学科,福建泉州362200 [2]福建医科大学附属第二医院超声医学科,福建泉州362000

出　　处：《医学影像学杂志》2024年第10期96-99,共4页Journal of Medical Imaging

摘　　要：目的探讨经阴道三维宫腔输卵管超声造影(TVS 3D-HyCoSy)联合宫腔水造影(SIS)对宫腔粘连(IUA)的诊断价值及分析误诊原因。方法选取47例临床疑似IUA的不孕症患者,采用二维经阴道超声检查(2D-TVS)及TVS 3D-HyCoSy联合SIS进行检查。以宫腔镜(HS)检查结果作为IUA的诊断金标准,比较2D-TVS和TVS 3D-HyCoSy联合SIS诊断IUA的一致性及诊断效能,并分析IUA超声检查误诊的原因。结果TVS 3D-HyCoSy联合SIS诊断宫腔粘连确诊35例,误诊3例(内膜炎症、内膜增生、内膜息肉),漏诊2例,诊断准确率(89.36%)优于2D-TVS(63.83%),差异有统计学意义(P<0.05);TVS 3D-HyCoSy联合SIS诊断IUA的灵敏度及阴性预测值优于2D-TVS,差异有统计学意义(P<0.05),且kappa值(0.67)大于2D-TVS(0.21)的kappa值。结论TVS 3D-HyCoSy联合SIS诊断宫腔粘连优于2D-TVS,可以为临床提供相对全面的诊断信息及治疗依据,但也存在一定误诊。误诊原因包括内膜慢性炎症造成假性粘连带、内膜息肉造成宫腔充盈缺损等。Objective To investigate the diagnostic value of transvaginal three-dimensional hysterosalpingo-contrast sonography(TVS 3D-HyCoSy)combined with intrauterine hydrography(SIS)in intrauterine adhesions(IUA)and the causes of misdiagnosis.Methods Forty-seven infertile patients with clinically suspected IUA were examined by transvaginal two-dimensional ultrasound(2D-TVS)and TVS 3D-HyCoSy combined with SIS.The results of hysteroscopy(HS)were used as the gold standard for the diagnosis of IUA.The consistency and diagnostic efficacy of 2D-TVS and TVS 3D-HyCoSy combined with SIS in the diagnosis of IUA were compared,and the causes of ultrasonic misdiagnosis of IUA were analyzed.Results 1)TVS 3D-HyCoSy combined with SIS was accurate in the diagnosis of intrauterine adhesions in 35 cases,in which 3 cases were misdiagnosed(endometrial inflammation,endometrial hyperplasia,endometrial polyps)and 2 cases were missed.The diagnostic accuracy(89.36%)was better than 2D-TVS,and the difference was statistically significant(63.83%,P<0.05);2)The sensitivity and negative predictive value of TVS 3D-HyCoSy combined with SIS in the diagnosis of IUA were better than those of 2D-TVS,the difference was statistically significant(P<0.05),and the kappa value(0.67)was greater than that of 2D-TVS(0.21).Conclusion TVS 3D-HyCoSy combined with SIS is superior to 2D-TVS in the diagnosis of IUA,which can provide relatively comprehensive diagnostic information and treatment basis for clinical practice,but there are also some misdiagnoses.The causes of misdiagnosis include pseudo adhesions caused by chronic inflammation of the endometrium,filling defects of the uterine cavity caused by endometrial polyps,etc.

关 键 词：宫腔粘连 宫腔水造影 三维输卵管超声造影 

分 类 号：R711.75[医药卫生—妇产科学] R445.1[医药卫生—临床医学]