为确定直肠/乙状结肠深部子宫内膜异位症的最佳超声筛查方法：超声“滑动征”、经阴道超声直接可视化还是两者都有？

To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis: Ultrasound "sliding sign," transvaginal ultrasound direct visualization or both?

机构信息

Department of Obstetrics and Gynecology, Liverpool Hospital, Liverpool, NSW, Australia.

Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia.

出版信息

Acta Obstet Gynecol Scand. 2018 Nov;97(11):1287-1292. doi: 10.1111/aogs.13425. Epub 2018 Aug 9.

DOI:10.1111/aogs.13425

PMID:30007066

Abstract

INTRODUCTION

The study aim was to evaluate the transvaginal sonography (TVS) "sliding sign" alone, direct visualization of the bowel with TVS, and the combination of both methods (ie "sliding sign" and direct visualization of the bowel), to determine the optimal TVS method for the prediction of rectal/rectosigmoid deep endometriosis (DE).

MATERIAL AND METHODS

Multicenter prospective observational study (January 2009-February 2017). All women underwent TVS to determine whether the "sliding sign" was positive/negative and whether rectal/rectosigmoid DE was present, followed by laparoscopic surgery. The association between a negative TVS "sliding sign" alone and the direct visualization of a rectal/rectosigmoid DE nodule alone during the TVS were correlated with the presence of rectal/rectosigmoid DE at laparoscopy. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were evaluated. Data were analyzed using Fisher's exact test.

RESULTS

During the recruitment period, 410 consecutive women with suspected endometriosis were included. Complete TVS and laparoscopic surgical outcomes were available for 376 of the women (91.7%). Complete TVS and laparoscopic data were available for 376 women. Of the 376 women 76 (20.2%) had rectal/rectosigmoid DE at laparoscopy. The accuracy, sensitivity, specificity, PPV, NPV, positive and negative LRs for each method to predict bowel DE were: negative "sliding sign": 87%, 73.7%, 90.3%, 65.9%, 93.1%, 7.62, and 0.29, respectively; direct visualization: 91.0%, 86.8%, 92.3%, 74.2%, 96.5%, 11.3, and 0.14, respectively; combined approach: 90.2%, 69.7%, 95.3%, 79.1%, 92.6%, 14.94, and 0.32, respectively. A negative TVS "sliding sign" was significantly associated with the need for bowel surgery (P < 0.05).

CONCLUSIONS

The combination of the TVS "sliding sign" and direct visualization of the bowel during TVS appears to provide the most accurate assessment for the identification of rectal/rectosigmoid DE preoperatively.

摘要

介绍

本研究旨在评估经阴道超声（TVS）“滑动征”、TVS 下直接观察肠管和这两种方法（即“滑动征”和直接观察肠管）联合应用对预测直肠/直肠乙状结肠深部子宫内膜异位症（DE）的最佳 TVS 方法。

材料与方法

多中心前瞻性观察性研究（2009 年 1 月至 2017 年 2 月）。所有女性均行 TVS 检查以确定“滑动征”是否为阳性/阴性以及是否存在直肠/直肠乙状结肠 DE，随后行腹腔镜手术。TVS 下阴性“滑动征”和直肠/直肠乙状结肠 DE 结节的直接可视化与腹腔镜下直肠/直肠乙状结肠 DE 的相关性。评估了阴性 TVS“滑动征”单独和 TVS 下直接观察直肠/直肠乙状结肠 DE 结节单独与腹腔镜下直肠/直肠乙状结肠 DE 存在的准确性、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和似然比（LRs）。采用 Fisher 精确检验进行数据分析。

结果

在招募期间，410 例疑似子宫内膜异位症的连续女性患者纳入研究。376 例女性（91.7%）完成了完整的 TVS 和腹腔镜手术结局评估。376 例女性均有完整的 TVS 和腹腔镜数据。376 例女性中，76 例（20.2%）在腹腔镜下有直肠/直肠乙状结肠 DE。预测肠 DE 的每种方法的准确性、敏感性、特异性、PPV、NPV、阳性和阴性 LRs 分别为：阴性“滑动征”：87%、73.7%、90.3%、65.9%、93.1%、7.62 和 0.29；直接可视化：91.0%、86.8%、92.3%、74.2%、96.5%、11.3 和 0.14；联合方法：90.2%、69.7%、95.3%、79.1%、92.6%、14.94 和 0.32。TVS“滑动征”阴性与需要肠手术显著相关（P<0.05）。