Im DD, Murphy CA, Rosenshein NB
The Gynecologic Oncology Center, Mercy Medical Center, Maryland, Baltimore, USA
Prim Care Update Ob Gyns. 1998 Jul 1;5(4):194. doi: 10.1016/s1068-607x(98)00122-x.
Objective: Hysteroscopy is a simple technique that can be used to outline the contours of the uterine cavity under real-time ultrasound guidance. This study was undertaken to determine whether hysterosonography can be used as an adjunct to transvaginal sonography in predicting either the presence or absence of intraluminal lesions in the uterine cavity and in distinguishing these lesions from subendometrial or myometrial lesions.Methods: In this retrospective analysis, 1,467 transvaginal sonograms performed in the office of a single gynecologic oncology practice from March 1996 through June 1997 were reviewed. Of these, 38 sonograms were considered to have possible intraluminal lesions of the uterine cavity and thus further evaluated by hysterosonography. The principle investigator performed all the hysterosonograms by infusing 15-30 mL of sterile saline directly into the uterine cavity using a Soules 5.3F transcervical catheter. Real-time transvaginal sonography was performed simultaneously, and representative images were compared with the initial transvaginal sonograms.Results: Successful hysterosonograms were obtained in 36 patients (97.3%). One patient had cervical stenosis from a previous conization, precluding access to the uterine cavity. The hysterosonography was tolerated well by the patients with minimal discomfort. There was no incidence of endometritis. The median age was 56.2 years. Postmenopausal bleeding was the most common presenting symptom (30.0%). The indications for hysterosonography were abnormal findings on the initial transvaginal sonograms including lesions suggestive of intraluminal mass (73.0%), thickened endometrial stripe (13.5%), and increased echogenicity (10.8%). Hysterosonography revealed presence of intraluminal masses in only 11 of the 31 cases (35.5%) that had been suggested to contain either a mass or thickened endometrial stripe. Subsequent hysteroscopy, dilatation, and curettage confirmed the presence of endometrial polyp in all 11 cases. The remaining 65.5% contained no intraluminal masses or thickened endometrial stripe.Conclusion: Hysterosonography can be a valuable adjunct to transvaginal sonography and may be used in selected cases to eliminate the need for hysteroscopy, dilatation, and curettage.
宫腔镜检查是一种简单的技术，可在实时超声引导下勾勒出子宫腔的轮廓。本研究旨在确定子宫超声造影是否可作为经阴道超声检查的辅助手段，用于预测子宫腔内是否存在腔内病变，并将这些病变与子宫内膜下或肌层病变区分开来。
在这项回顾性分析中，对1996年3月至1997年6月在单一妇科肿瘤诊所进行的1467例经阴道超声检查进行了回顾。其中，38例超声检查被认为可能存在子宫腔内病变，因此进一步通过子宫超声造影进行评估。主要研究者使用Soules 5.3F经宫颈导管将15 - 30 mL无菌生理盐水直接注入子宫腔，完成所有子宫超声造影检查。同时进行实时经阴道超声检查，并将代表性图像与最初的经阴道超声检查图像进行比较。
36例患者（97.3%）成功完成子宫超声造影检查。1例患者因先前宫颈锥切术导致宫颈狭窄，无法进入子宫腔。患者对子宫超声造影耐受性良好，不适轻微。未发生子宫内膜炎。患者中位年龄为56.2岁。绝经后出血是最常见的症状（30.0%）。子宫超声造影的指征是最初经阴道超声检查发现异常，包括提示腔内肿块的病变（73.0%）、子宫内膜增厚（13.5%）和回声增强（10.8%）。在31例被提示可能存在肿块或子宫内膜增厚的病例中，子宫超声造影仅显示11例（35.5%）存在腔内肿块。随后的宫腔镜检查、刮宫术证实这11例均存在子宫内膜息肉。其余65.5%不存在腔内肿块或子宫内膜增厚。
子宫超声造影可作为经阴道超声检查的有价值辅助手段，在某些特定病例中可用于避免进行宫腔镜检查、刮宫术。
