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基于特殊征象分析经阴道二维超声鉴别诊断不同病理类型子宫内膜病变的价值

Value of transvaginal two-dimensional ultrasonography in differential diagnosis of endometrial lesions with distinct pathological types based on characteristic imaging features

    摘要
  • 摘要:
    目的 基于特殊征象分析经阴道二维超声鉴别诊断不同病理类型子宫内膜病变的价值。
    方法 选取2022年5月—2024年4月在北京市通州区妇幼保健院超声科诊断的160例疑似子宫内膜息肉病变患者为研究对象，均行经阴道二维超声检查。以手术病理诊断结果为金标准，分析经阴道二维超声检查的影像学特征和诊断价值。
    结果 160例疑似子宫内膜息肉病变患者中，经手术病理诊断者124例，包括子宫内膜增生48例(38.71%)、子宫内膜息肉样病变27例(21.77%)、子宫黏膜下肌瘤24例(19.35%)、子宫内膜炎19例(15.32%)和子宫内膜癌6例(4.84%)。以手术病理诊断结果为依据，经阴道二维超声检查的诊断准确率为92.50%(148/160), 阳性预测值为96.67%(116/120), 敏感度为93.55%(116/124)。经阴道二维超声检查诊断的116例超声显示宫腔内内膜回声异常患者中，检出宫腔内膜团块声像98例(84.48%), 子宫内膜回声异常30例(25.86%), 子宫内膜增厚12例(10.34%), 子宫增大5例(4.31%)。124例患者中，超声检查有8例未表现出明显异常图像特征，总漏诊率为6.45%(8/124); 超声检查有4例被误诊为其他疾病，总误诊率为3.23%(4/124)。
    结论 经阴道二维超声在子宫内膜息肉及其病变的鉴别诊断中可发挥一定的诊断效能，影像学特征明显，可为临床提供可靠参考依据。

     

    Abstract:
    Objective To evaluate the diagnostic efficacy of transvaginal two-dimensional ultrasonography in differentiating endometrial lesions with distinct pathological types based on characteristic imaging features.
    Methods A total of 160 patients with suspected endometrial polyps diagnosed via ultrasonography at Department of Ultrasonography of Beijing Tongzhou District Maternal and Child Health Hospital between May 2022 and April 2024 were enrolled. All patients underwent transvaginal two-dimensional ultrasonography examination. Using histopathological diagnosis as the gold standard, the imaging characteristics and diagnostic performance of transvaginal two-dimensional ultrasonography were analyzed.
    Results Among 160 patients with suspected endometrial polyps, histopathological confirmation was obtained in 124 cases, including 48 cases (38.71%) of endometrial hyperplasia, 27 cases (21.77%) of endometrial polypoid lesions, 24 cases (19.35%) of submucosal uterine myomas, 19 cases (15.32%) of endometritis, and 6 cases (4.84%) of endometrial carcinoma. Based on histopathological findings, transvaginal two-dimensional ultrasonography demonstrated a diagnostic accuracy of 92.50% (148/160), a positive predictive value of 96.67% (116/120), and a sensitivity of 93.55% (116/124). Among 116 patients diagnosed by transvaginal two-dimensional ultrasonography with abnormal endometrial echo patterns, 98 cases (84.48%) exhibited intrauterine mass-like echoes, 30 cases (25.86%) showed abnormal endometrial echoes, 12 cases (10.34%) presented endometrial thickening, and 5 cases (4.31%) demonstrated uterine enlargement. Notably, 8 of 124 histopathologically confirmed cases (6.45%) exhibited no obvious abnormal imaging features on transvaginal two-dimensional ultrasonography, while 4 cases (3.23%) were misdiagnosed due to other conditions.
    Conclusion Transvaginal two-dimensional ultrasonography exhibits diagnostic efficacy in differentiating endometrial polyps and related lesions, with characteristic imaging features providing reliable references for clinical decision-making.

     

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