经阴道二维超声、三维容积超声及血流显像在脱出型黏膜下肌瘤诊断中应用价值

陈晓艺; 王金萍; 王琴

doi:10.13898/j.cnki.issn.1000-2200.2021.12.032

经阴道二维超声、三维容积超声及血流显像在脱出型黏膜下肌瘤诊断中应用价值

Application value of two-dimensional transvaginal ultrasonography, three-dimensional ultrasonography volumetric imaging and three-dimensional Doppler ultrasound in the diagnosis of prolapsed submucosal myoma

摘要

摘要:
目的探讨经阴道二维超声（2D-TVS）、三维超声（3D-TVS）容积成像及血流显像（3D-DUS）在脱出型黏膜下肌瘤诊断及起始部定位中的价值。
方法临床可疑脱出型黏膜下肌瘤并决定手术治疗病人57例，均行2D-TVS检查，术前再行3D-TVS检查。以手术病理结果为金标准，比较2种方法的诊断准确率。并根据手术结果，将脱出型黏膜下肌瘤病人作为确诊组，非肌瘤性病变病人作为疑似组，比较2组病人的"低回声为主""Ⅰ形蒂部结构"等声像图特点。
结果经手术病理确诊脱出型黏膜下肌瘤34例，宫颈息肉20例，宫颈癌、子宫内膜癌、宫颈肌瘤各1例。2D-TVS和3D-TVS诊断灵敏度分别为88.2%、94.1%，差异无统计学意义（P > 0.05）；特异度分别为54.5%、86.4%，3D-TVS特异度高于2D-TVS（P < 0.05）；一致性百分率分别为75%、91%。在2D-TVS的低回声为主、"Ⅰ"形蒂部结构、丰富条状血流和3D-TVS的"梨形"团块及3D-DUS的蒂部条束状血流方面，确诊组病人检出率均高于疑似组（P < 0.05~P < 0.01）。
结论2D-TVS与3D-TVS均能检查脱出型黏膜下肌瘤，但后者诊断特异度高于前者；2D-TVS、3D-TVS及3D-DUS显示的瘤体形态及血流的声像图特征可以作为诊断及鉴别诊断指标，提高诊断准确率，减少误诊及漏诊。

Abstract:
ObjectiveTo evaluate the application value of two-dimensional transvaginal ultrasonography(2D-TVS), three-dimensional transvaginal ultrasonography(3D-TVS) volumetric imaging and three-dimensional Doppler ultrasound(3D-DUS) in the diagnosis and initial location of submucous myoma of prolapsed type.
MethodsFifty-seven patients with suspected prolapsed submucosal myoma deciding on surgical treatment were detected using 2D-TVS and 3D-TVS before operation. Taking the surgery results as golden standard, the diagnostic accuracy was compared between the two methods. According to the surgical results, the patients with protuberant submucosal myoma and patients with non-myomatous disease were divided into the confirmed group and suspected group, respectively. The ultrasonographic characteristics of "low echo" and "Ⅰ shaped pedicle structure" were compared between two groups.
ResultsThere were 34 cases of prolapsive submucosal myoma, 20 cases of cervical polyp, 1 case of cervical cancer, 1 case of endometrial cancer and 1 case of cervical myom according to the results of the surgery and pathology. The diagnostic sensitivity of 2D-TVS and 3D-TVS was 88.2% and 94.1%, respectively, and the difference of which was not statistically significant(P > 0.05). The specificity of 2D-TVS and 3D-TVS was 54.5% and 86.4%, respectively, and which of 3D-TVS was higher than that of 2D-TVS(P < 0.05). The percentage of consistency in 2D-TVS and 3D-TVS was 75% and 91%, respectively. In terms of the low echo, "Ⅰ shaped" pedicle structure and rich strip blood flow in 2D-TVS, and pear-shaped" mass of 3D-TVS and strip bundle blood flow of 3D-DUS, the detection rate of which in confirmed group was higher than that in suspected group(P < 0.05 to P < 0.01).
Conclusions2D-TVS and 3D-TVS can be used to diagnose the submucous myoma of prolapsed type, and the diagnostic specificity of the 3D-TVS is higher than that of the 2D-TVS. The sonographic characteristics of tumor morphology and blood flow displayed by 2D-TVS, 3D-TVS and 3D-DUS can be used as the diagnostic and differential diagnostic indicators, which can improve the diagnostic accuracy and reduce misdiagnosis and missed diagnosis.

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