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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (02) : 127 -133. doi: 10.3877/cma.j.issn.1672-6448.2017.02.011

所属专题： 文献；

妇产科超声影像学

三维超声对弓形子宫与纵隔子宫的诊断价值及诊断指标研究
郑芳媛1, 周毓青2,†(), 隋龙3, 任芸芸3, 戴蓓蓓3, 林如3   
  1. 1. 200011　上海，复旦大学附属妇产科医院超声科；310008　杭州市妇产科医院　杭州市第一人民医院钱江新城院区
    2. 200051　上海市长宁区妇幼保健院超声科
    3. 200011　上海，复旦大学附属妇产科医院超声科
  • 收稿日期:2016-09-30 出版日期:2017-02-01
  • 通信作者: 周毓青

A discussion of diagnostic value and diagnostic indicator in distinguishing arcuate uterus from septate uterus by three dimensional sonography

Fangyuan Zheng1, Yuqin Zhou2,†(), Long Sui3, Yunyun Ren3, Beibei Dai3, Ru Lin3   

  1. 1. Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; Hangzhou Obstetrics and Gynecology Hospital, Qianjiang New construction branch of The Frist People′s Hospital of Hangzhou, Hangzhou 310008, China
    2. Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, Shanghai 200051, China
    3. Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
  • Received:2016-09-30 Published:2017-02-01
  • Corresponding author: Yuqin Zhou
  • About author:
    Corresponding author: Zhou Yuqing, Email:
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引用本文：

郑芳媛, 周毓青, 隋龙, 任芸芸, 戴蓓蓓, 林如. 三维超声对弓形子宫与纵隔子宫的诊断价值及诊断指标研究[J]. 中华医学超声杂志（电子版）, 2017, 14(02): 127-133.

Fangyuan Zheng, Yuqin Zhou, Long Sui, Yunyun Ren, Beibei Dai, Ru Lin. A discussion of diagnostic value and diagnostic indicator in distinguishing arcuate uterus from septate uterus by three dimensional sonography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(02): 127-133.

目的

探讨三维超声诊断弓形子宫与纵隔子宫的准确性，构建弓形子宫与纵隔子宫鉴别诊断的定量指标。

方法

对2011年8月至2013年3月复旦大学附属妇产科医院临床检查拟诊为子宫畸形的96例患者行三维超声检查，在Omni view成像模式下对子宫三维容积图像进行子宫冠状面的重建、测量分析和分型诊断。与宫（腹）腔镜诊断结果对照，计算三维超声诊断弓形子宫、不全纵隔子宫和完全纵隔子宫的敏感度、特异度、阳性预测值、阴性预测值及总体符合率。构建弓形子宫与纵隔子宫鉴别诊断的定量指标。

结果

96例患者经三维超声诊断为弓形子宫33例（34.4%，33/96），不全纵隔子宫54例（56.2%，54/96），完全纵隔子宫9例（9.4%，9/96）。三维超声诊断弓形子宫和纵隔子宫的总体符合率为86.5%（83/96）。三维超声诊断弓形子宫的敏感度、特异度、阳性预测值、阴性预测值分别为100%、82.9%、60.6%、100%；诊断不全纵隔子宫的敏感度、特异度、阳性预测值、阴性预测值分别为80.6%、100%、100%、69.1%；诊断完全纵隔子宫的敏感度、特异度、阳性预测值及阴性预测值均为100%。纵隔子宫的子宫内膜凹陷深度占子宫底部浆膜层-纵隔顶端间距的50%以上，而大部分弓形子宫的子宫内膜凹陷深度占子宫底部浆膜层—纵隔顶端间距的50%以下。

结论

三维超声对不同分型子宫畸形的诊断准确率不同。应用三维超声定量指标辅助诊断，有助于提高三维超声诊断弓形子宫与纵隔子宫的准确率。

关键词: 超声检查，三维, 先天性子宫畸形, 弓形子宫, 纵隔子宫, 诊断
Objective

To discuss the accuracy of three-dimensional (3D) sonography in diagnosing arcuate uterus and septate uterus and propose a quantitative indicator in distinguishing arcuate uterus and septate uterus.

Methods

Ninety-six patients with suspected congenital uterine malformation underwent 3D sonography to assess uterine anomalies at Obstetrics and Gynecology Hospital of Fudan University from August 2011 to March 2013. Uterine coronal section was reconstructed and measured in omni view imaging mode of 3D sonography. Then qualitative diagnosis and categorization was done. The results were compared with diagnosis of hysteroscopy, hysteroscopy combined with laparoscope to determine the sensitivity, specificity, positive predictive values, negative predictive values and total accuracy of 3D sonography in diagnosing arcuate uterus, partial and complete septate uterus respectively. The variable was created in coronal section of uterus constructed through 3D imaging mode to differentiate arcuate uterus from septate uterus.

Results

There were 33 cases (34.4%, 33/96) of arcuate uterus, 54 cases (56.2%, 54/96) of partial septate uterus and 9 cases (9.4%, 9/96) of complete uterus in 96 cases diagnosed by 3D sonography. The accuracy of 3D sonography in diagnosing arcuate uterus and septate uterus was 86.5%. We concluded that 3D sonography had 100% sensitivity, 82.9% specificity, 60.6% positive predictive value and 100% negative predictive value in the diagnosis of arcuate uterus. The sensitivity of 3D sonography for diagnosis of partial septate uterus was 80.6%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 69.1%. The sensitivity, specificity, positive and negative predictive values of 3D sonography for detecting complete septate uterus were all 100%. The ratio of depth of uterine internal indentation and depth from uterine fundus to the top of internal indentation was more than 50% for septate uterus, while less than 50% for most of the arcuate uterus.

Conclusions

The diagnostic efficiency of 3D sonography in specific uterine malformation is different. The new quantitative indicator maybe helpful in improving the accuracy of 3D sonography in diagnosing arcuate uterus and septate uterus.

Key words: Ultrasonography, three-dimensional, Congenital uterine malformations, Arcuate uterus, Septate uterus, Diagnosis
图2 三维超声Omin view模式下不全纵隔子宫冠状面图像，该切面需测量：子宫底部肌层厚度（图中1所示），子宫内膜凹陷深度（图中2所示）和宫腔深度（图中3所示）
图7，8 三维超声Omin view模式下完全纵隔子宫冠状面声像图[图中1为子宫底部内膜呈锐角凹陷；2为子宫底部肌层厚度；3为纵隔呈低回声，自宫底延伸至宫颈内口，纵隔深度（子宫内膜凹陷深度）与宫腔深度一致）]。子宫底外部轮廓平直、增宽，宫底部内膜呈锐角（41.9°）凹陷，子宫底部肌层厚度约0.5 cm，纵隔呈低回声，自宫底延伸至宫颈内口，纵隔深度（子宫内膜凹陷深度）与宫腔深度均为3.3 cm
表1 96例子宫畸形患者三维超声检查结果与腔镜诊断结果比较（例）
三维超声检查 宫（腹）腔镜 合计
弓形子宫 纵隔子宫
不全纵隔子宫 完全纵隔子宫
弓形子宫 20 13 0 33
不全纵隔子宫 0 54 0 54
完全纵隔子宫 0 0 9 9
合计 20 67 9 96
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