Application of ultrasound combined with sonohysterography in intrauterine adhesion
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摘要:
目的 以宫腔镜检查为金标准，通过分析超声结合宫腔声学造影(sonohysterography，SHG)诊断宫腔粘连(intrauterine adhesion，IUA)的敏感性、分度及类型检出率，探讨超声结合SHG在IUA中的应用价值。 方法 选取2018年4月—2019年10月于湖州市妇幼保健院经宫腔镜检查确诊为IUA的患者65例，研究对象均接受经阴道三维超声(three-dimensional transvaginal ultrasound，3D-TVUS)与SHG检查，比较65例患者经3D-TVUS结合SHG与宫腔镜检查的诊断结果。 结果 3D-TVUS与SHG的结合检查确诊病例为62例，敏感性为95.38%，与宫腔镜的结果差异无统计学意义(P>0.05)。宫腔镜诊断轻度粘连者为15例(23.08%)，中度18例(27.69%)，重度32例(49.23%)，超声结合宫腔声学造影检查诊断为轻度者15例(23.08%)，中度19例(29.23%)，重度28例(43.08%)，2种检查结果对比差异无统计学意义(P>0.05)，Kappa值为0.801(P < 0.001)。宫腔镜在子宫粘连的类型中，确诊为单纯颈管粘连的病例数是15例(23.08%)，宫腔内粘连33例(50.77%)，混合粘连有17例(26.15%)，3D-TVUS结合SHG检查在粘连类型中检出人数分别为14(21.54%)、30(46.15%)、18例(27.69%)，对比差异无统计学意义(P>0.05)，Kappa值为0.900(P < 0.001)。 结论 超声结合宫腔声学造影适用于宫腔粘连患者的诊断，具有较高的诊断准确性，值得临床推广使用。 Abstract:Objective With hysteroscopy as the gold standard, the diagnostic sensitivity and grade and type of intrauterine adhesion (IUA) detected by ultrasound combined with sonohysterography (SHG) were analysed, and the application value of ultrasound combined with SHG in detecting IUA was discussed. Methods Sixty-five patients diagnosed with IUA by hysteroscopy in our hospital from April 2018 to October 2019 were selected. The subjects were examined by three-dimensional transvaginal ultrasound (3D-TVUS) and SHG, and the diagnosis results of 65 patients evaluated using 3D-TVUS combined with hysteroscopy were compared. Results The combined examination of 3D-TVUS and SHG resulted in 62 confirmed cases with a sensitivity of 95.38%, which was not significantly different from the results of hysteroscopy (P>0.05). There were 15 cases (23.08%) with mild adhesions, 18 cases (27.69%) with moderate adhesions and 32 cases (49.23%) with severe adhesions diagnosed by hysteroscopy. There were 15 cases (23.08%) with mild adhesions, 19 cases (29.23%) with moderate adhesions and 28 cases (43.08%) with severe adhesions diagnosed by ultrasound combined with hysteroscopy. There was no significant difference between the two examinations (P>0.05), Kappa value was 0.801 (P < 0.001). Among the types of uterine adhesions by hysteroscopy, 15 cases (23.08%) were diagnosed as simple cervical adhesions, 33 cases (50.77%) were diagnosed as intrauterine adhesions, 17 cases (26.15%) were diagnosed as mixed adhesions, and 14 cases (21.54%), 30 cases (46.15%) and 18 cases (27.69%) were detected by 3D-TVUS combined with SHG respectively, with no significant difference (P>0.05), Kappa value was 0.900 (P < 0.001). Conclusion Ultrasound combined with sonohysterography is suitable for the diagnosis of patients with IUA and has high diagnostic accuracy, which is worthy of clinical popularisation and use. -
表 1 IUA分度评分标准
内容 对应评分/内容标准 1分 2分 4分 范围 < 1/3 1/3~2/3 >2/3 性质 膜性 纤维性 肌性 输卵管 观察到单侧开口 双侧未见开口 桶状宫腔、未见宫角 子宫内膜 ≥7 mm 4~6 mm ≤3 mm 月经情况 ≤平时1/2 点滴经血 闭经 妊娠情况 自然流产1次 复发性流产 不孕 刮宫情况 人流 早孕期清宫 中晚期清宫 
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表 2 结合检查与宫腔镜分度确诊结果对比
结合检查(n=62) 宫腔镜(n=62) 轻度 中度 重度 轻度 14 2 1 中度 1 15 2 重度 0 2 25 注：排除3例结合检查漏诊、误诊患者。
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表 3 结合检查与宫腔镜分型确诊结果对比
结合检查(n=62) 宫腔镜(n=62) 单纯颈管粘连 宫腔内粘连 混合粘连 单纯颈管粘连 14 0 1 宫腔内粘连 1 28 0 混合粘连 0 2 17 注：排除3例结合检查漏诊、误诊患者。
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