三维超声子宫造影术在异常子宫出血患者子宫内病变检测中的价值。

Value of 3-dimensional sonohysterography for detection of intrauterine lesions in women with abnormal uterine bleeding.

机构信息

Department of Obstetrics and Gynaecology, Cairo University Faculty of Medicine, Cairo, Egypt.

出版信息

J Minim Invasive Gynecol. 2010 Mar-Apr;17(2):200-4. doi: 10.1016/j.jmig.2009.12.010.

DOI:10.1016/j.jmig.2009.12.010

PMID:20226408

Abstract

STUDY OBJECTIVE

To compare 2-dimensional (2D) sonohysterography (SHG) and 3D-SHG with saline solution infusion vs diagnostic hysteroscopy for investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding.

DESIGN

Comparative observational cross-sectional study (Canadian Task Force classification II-1).

SETTING

University hospital.

PATIENTS

Fifty perimenopausal and 20 postmenopausal women with abnormal intrauterine bleeding with clinically or ultrasonically suspected intrauterine lesions.

INTERVENTIONS

Conventional 2D- and 3D ultrasonography and 2D- and 3D-SHG with saline solution infusion followed by diagnostic hysteroscopy, and endometrial curettage or subsequent operative treatment (e.g., hysterectomy, myomectomy, or polypectomy). Ultrasonographic and hysteroscopic findings were compared with histopathologic findings.

MEASUREMENTS AND MAIN RESULTS

For 2D-SHG, sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio for a positive result, and likelihood ratio for a negative result were 79%, 72%, 89%, 54%, 76%, 2.82, and 0.29, respectively, and for 3D-SHG, were 92%, 89%, 96%, 80%, 91%, 8.36, and 0.09, respectively; and for diagnostic hysteroscopy, were 94%, 89%, 96%, 84%, 93%, 8.55, and 0.07, respectively. Thus, 3D-SHG was superior to 2D SHG (p = .02) and comparable to diagnostic hysteroscopy (p = .75) for diagnosis of intrauterine lesions.

CONCLUSION

3D-SHG can be used in the initial investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding before resorting to invasive procedures such as diagnostic hysteroscopy. Further studies of computer-reconstructed 3D-SHG virtual hysteroscopy are recommended.

摘要

研究目的

比较二维（2D）经阴道超声造影（SHG）和 3D-SHG 盐水灌注与诊断性宫腔镜检查，以评估围绝经期和绝经后异常子宫出血患者的宫腔内病变。

设计

对比观察性横断面研究（加拿大任务组分类 II-1）。

设置

大学医院。

患者

50 例围绝经期和 20 例绝经后异常子宫出血患者，伴有临床或超声检查疑似宫腔内病变。

干预措施

常规 2D 和 3D 超声检查、2D 和 3D-SHG 盐水灌注，随后行诊断性宫腔镜检查、子宫内膜刮宫或后续手术治疗（如子宫切除术、子宫肌瘤切除术或息肉切除术）。比较超声和宫腔镜检查结果与组织病理学检查结果。

测量和主要结果

对于 2D-SHG，灵敏度、特异度、阳性预测值、阴性预测值、总准确率、阳性结果似然比和阴性结果似然比分别为 79%、72%、89%、54%、76%、2.82 和 0.29，而对于 3D-SHG，分别为 92%、89%、96%、80%、91%、8.36 和 0.09，对于诊断性宫腔镜检查，分别为 94%、89%、96%、84%、93%、8.55 和 0.07。因此，3D-SHG 在诊断宫腔内病变方面优于 2D-SHG（p=0.02），与诊断性宫腔镜检查相当（p=0.75）。