经阴道超声检查加或不加肠道准备对直肠乙状结肠子宫内膜异位症的诊断价值：前瞻性研究。

Transvaginal sonography with vs without bowel preparation in diagnosis of rectosigmoid endometriosis: prospective study.

机构信息

Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, Genoa, Italy.

Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.

出版信息

Ultrasound Obstet Gynecol. 2019 Mar;53(3):402-409. doi: 10.1002/uog.19194. Epub 2019 Feb 6.

DOI:10.1002/uog.19194

PMID:30079504

Abstract

OBJECTIVES

The primary aim of this study was to compare the diagnostic accuracy of transvaginal sonography (TVS) with vs without bowel preparation (BP) in detecting the presence of rectosigmoid endometriosis. Secondary objectives were to compare the diagnostic accuracy of the two techniques in estimating infiltration of the submucosa, length of the largest rectosigmoid nodules, distance of the nodules from the anal verge and presence of multifocal disease.

METHODS

This was a prospective study of patients with symptoms of pelvic pain for more than 6 months and/or suspicion of endometriosis referred to our institution between October 2016 and April 2018. Participants underwent a first TVS without BP followed by TVS with BP within a time interval of 1 week to 3 months. The examinations were performed independently and blindly by two sonographers. Only patients who underwent laparoscopy within the 6 months following the second ultrasound examination were included. Ultrasound results using the two techniques were compared with surgical and histological findings.

RESULTS

Of the 262 patients included in the study, 118 had rectosigmoid endometriosis confirmed at surgery. There was no significant difference in accuracy between TVS with and that without BP in diagnosing the presence of rectosigmoid endometriosis (93.5% vs 92.3%; P = 0.453). No significant difference was observed in accuracy between TVS with and that without BP in diagnosing submucosal infiltration (88.8% vs 84.6%; P = 0.238) and multifocal disease (97.2% vs 95.2%; P = 0.727) in patients diagnosed sonographically with rectosigmoid endometriosis. The accuracy of TVS with BP was similar to that of TVS without BP in estimating the maximum diameter of the largest nodule (P = 0.644) and the distance between the more caudal rectosigmoid nodule and the anal verge (P = 0.162).

CONCLUSION

BP does not improve the diagnostic performance of TVS in detecting rectosigmoid endometriosis and in assessing characteristics of endometriotic nodules. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

摘要

目的

本研究的主要目的是比较经阴道超声（TVS）联合与不联合肠道准备（BP）在诊断直肠乙状结肠子宫内膜异位症中的准确性。次要目的是比较两种技术在评估黏膜下浸润、最大直肠乙状结肠结节的最长直径、结节距肛门缘的距离和多发病灶方面的诊断准确性。

方法

这是一项前瞻性研究，纳入 2016 年 10 月至 2018 年 4 月期间因盆腔疼痛超过 6 个月和/或疑似子宫内膜异位症而就诊于我院的患者。所有患者均先进行一次未经 BP 的 TVS，然后在 1 周至 3 个月内进行一次经 BP 的 TVS。这两次检查均由两名超声医师独立、盲法进行。仅纳入在第二次超声检查后 6 个月内接受腹腔镜检查的患者。比较两种技术的超声结果与手术和组织学结果。

结果

本研究共纳入 262 例患者，其中 118 例经手术证实存在直肠乙状结肠子宫内膜异位症。TVS 联合 BP 与 TVS 不联合 BP 诊断直肠乙状结肠子宫内膜异位症的准确率无显著差异（93.5% vs 92.3%；P=0.453）。TVS 联合 BP 与 TVS 不联合 BP 诊断黏膜下浸润（88.8% vs 84.6%；P=0.238）和多发病灶（97.2% vs 95.2%；P=0.727）的准确率也无显著差异。在超声诊断为直肠乙状结肠子宫内膜异位症的患者中，BP 对 TVS 估计最大结节直径和最下直肠乙状结肠结节距肛门缘的距离的准确性与 TVS 不联合 BP 相似（P=0.644）。