经阴道三维超声结合血管成像对宫腔内良恶性病变的诊断价值

发布时间：2018-02-26 01:07

本文关键词： 三维超声宫腔内病变阻力指数内膜体积　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的比较评价经阴道二维超声(Two-dimensional transvaginal ultrasound2D-TVS)及经阴道三维超声(Three-dimensional transvaginal ultrasound3D-TVS)对宫腔内病变的诊断价值,比较子宫内膜各种病变的内膜厚度(endometrial thicknessET)、阻力指数(resistant index RI)、搏动指数(pulsatility index PI)及内膜体积(endometrial volume EV)之间的差别,为临床超声的诊断提供指导。方法收集2012年10月1日至2013年10月31日在山西大医院经病理确诊的宫腔内病变171例,其中58例子宫内膜增殖症,63例子宫内膜息肉,38例子宫粘膜下肌瘤,12例子宫内膜癌,于术前1-3天行2D-TVS同时行3D-TVS,观察声像图特点,对子宫内膜进行三维重建并储存,调用虚拟器官计算机辅助分析(Virtual Organ Computer Aided Analysis, VOCAL)软件描记内膜轮廓测量并记录EV。采用SPSS18.0统计软件,.采用Kappa检验两种方法的检查结果与病理检查结果的一致性,采用灵敏性(Sensitivity Se)和特异性(Specificity Sp)描述两种检查方法诊断宫腔内各种病变的能力,两种检查方法的检出率的比较采用χ2检验,子宫内膜各种病变之间参数的比较采用方差分析、LSD-t检验各组两两之间参数是否有统计学差别。结果 1.2D-TVS和3D-TVS对宫腔内良恶性病变的诊断结果与病理结果的一致性均较好。 2.2D-TVS诊断子宫内膜增殖症、子宫内膜息肉、子宫粘膜下肌瘤、子宫内膜癌的特异性和灵敏性分别为85.0%、90.7%、97.0%、98.7%和84.5%、71.4%、86.8%、66.7%。 3.3D-TVS诊断子宫内膜增殖症、子宫内膜息肉、子宫粘膜下肌瘤、子宫内膜癌的特异性和灵敏性分别为93.8%、96.3%、97.7%、98.7%和91.4%、87.3%、92.1%、83.3%。 4.3D-TVS对宫腔内良恶性病变的检出率89.5%(153/171)高于2D-TVS的检出率78.9%(135/171),且差别有统计学意义(P0.05)。 5.绝经前三组内膜病变之间,除了内膜增生组和内膜癌组之间的ET、EV差别无统计学意义(P=0.41/P=0.82),其余各组之间ET、EV差别均有统计学意义(P0.05)。 6.绝经后各组内膜病变中,内膜癌组的平均ET(16.21±3.96mm)和平均EV(18.22±3.97cm3)均高于内膜良性病变组,各组之间的ET、EV差别均有统计学意义(P0.05)。 7.子宫内膜恶性病变的RI平均值为0.45±0.05,低于内膜良性病变组,差别有统计学意义(P0.05)；子宫内膜恶性病变的PI平均值为0.86±0.30,低于子宫内膜良性病变组,差别无统计学意义(P=0.15)。结论 1.2D-TVS和3D-TVS诊断宫腔内良恶性病变的特异性、灵敏性均较高,3D-TVS对宫腔内良恶性病变的检出率略高于2D-TVS,为疑难病症的鉴别诊断提供了一种新的检查思路。 2.ET、EV对鉴别绝经前子宫内膜良恶性病变的意义不大,对鉴别绝经后子宫内膜良恶性病变有重要参考价值。 3.RI对鉴别子宫内膜良恶性病变有重要参考价值,PI对鉴别子宫内膜良、恶性病变意义不大。
[Abstract]:objective
A comparative evaluation of transvaginal two dimensional ultrasonography (Two-dimensional transvaginal ultrasound2D-TVS) and transvaginal three-dimensional ultrasound (Three-dimensional transvaginal ultrasound3D-TVS) in diagnosis of uterine cavity disease, endometrial thickness comparison endometrial lesions (endometrial thicknessET), resistance index (resistant index RI), pulsatility index (pulsatility index PI) and endometrial volume EV (endometrial volume the difference between) to provide guidance for the clinical diagnosis of ultrasound.
From October 1, 2012 to October 31, 2013 in Shanxi hospital after intrauterine lesions confirmed pathologically in 171 cases, including 58 cases of endometrial hyperplasia, 63 cases of endometrial polyp, 38 cases submucous myoma of uterus, 12 cases of endometrial carcinoma before operation, 1-3 days 2D-TVS and 3D-TVS, to observe the sonographic features, 3D reconstruction of the the lining of the uterus and the storage, analysis and transfer of virtual organ computer aided (Virtual Organ Computer Aided Analysis, VOCAL) software tracing and recording EV. endometrial contour measurement
Using SPSS18.0 statistical software, using Kappa test. The consistency of two methods of examination results and pathological results, the sensitivity and specificity (Sensitivity Se) (Specificity Sp) to describe the ability of two methods in diagnosis of uterine cavity lesions, two kinds of inspection methods to compare the detection rate by 2 test. Compared with the parameters between endometrial lesions of variance analysis, LSD-t test was used between 22 parameters if the difference was statistically significant.
Result
The consistency of both 1.2D-TVS and 3D-TVS in the diagnosis of benign and malignant lesions in the intrauterine is better than that of the pathological results.
The specificity and sensitivity of 2.2D-TVS in diagnosing endometrial hyperplasia, endometrial polyps, submucous myoma and endometrial carcinoma were 85%, 90.7%, 97%, 98.7% and 84.5%, 71.4%, 86.8%, 66.7%. respectively.
The specificity and sensitivity of 3.3D-TVS in diagnosing endometrial hyperplasia, endometrial polyps, submucous myoma and endometrial carcinoma were 93.8%, 96.3%, 97.7%, 98.7% and 91.4%, 87.3%, 92.1%, 83.3%. respectively.
The detection rate of 4.3D-TVS for benign and malignant lesions in the intrauterine 89.5% (153/171) was 78.9% (135/171) higher than that of 2D-TVS, and the difference was statistically significant (P0.05).
5. there was no significant difference in the ET between the three groups of endometrium before menopause, except the intimal hyperplasia group and the endometrial cancer group (EV). There was no significant difference in the P=0.41/P=0.82 between the two groups (P=0.41/P=0.82), and the difference between the other groups was statistically significant (P0.05).
6. after menopause, the average ET (16.21 + 3.96mm) and the average EV (18.22 + 3.97cm3) in endometrial cancer group were all higher than those in the benign endometrial lesion group. The difference of ET and EV between groups was statistically significant (P0.05).
7. the average value of RI in endometrial malignant lesions is 0.45 + 0.05, which is lower than that in benign endometrial lesions. The difference is statistically significant (P0.05). The mean value of PI in endometrial malignant lesions is 0.86 + 0.30, which is lower than that in benign endometrial lesions, and the difference is not statistically significant (P=0.15).
conclusion
The specificity and sensitivity of 1.2D-TVS and 3D-TVS in diagnosing intrauterine benign and malignant lesions are all high. The detection rate of 3D-TVS for benign and malignant lesions in uterine cavity is slightly higher than that of 2D-TVS. It provides a new way of thinking for differential diagnosis of difficult and difficult cases.
2.ET and EV are of little significance in differentiating the benign and malignant lesions of the premenopausal endometrium, and are of important reference value for the differential diagnosis of the benign and malignant lesions of the endometrium after menopause.
3.RI has important reference value in differentiating benign and malignant endometrium, and PI is of little significance in identifying benign and malignant lesions of the endometrium.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.74;R445.1

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