探讨经直肠双平面高频超声评估正常女性阴道结构的应用价值。

由1名超声医师于2021年1月至3月间对深圳市罗湖区人民医院超声科的103名正常女性使用经直肠双平面高频超声阴道成像检查，其中53名为生育期女性、50名为绝经后女性。通过双平面探头观察直肠前壁和膀胱尿道后壁之间阴道中下段矢状切面和横切面的超声表现，留存图像在超声仪器中，由2名超声医师（测量者1和测量者2）分别在阴道矢状切面膀胱三角区尿道内口水平测量阴道壁厚度，其中1名超声医师（测量者2）1周后重复测量一次。采用独立样本t检验比较2组女性阴道壁厚度的差异，采用组内相关系数（ICC）和Bland-Altman图表达测量重复性和一致性。

位于直肠前壁和膀胱尿道后壁之间的阴道在矢状切面上呈“三线两区”征，“三线”为高回声的阴道前后壁外层纤维组织膜和中间闭合在一起的前后壁黏膜层；“两区”为低回声的阴道前后壁肌层。在横切面上，阴道肌层呈低回声的“倒梯形”征，分别是阴道前后壁及两侧壁，阴道黏膜层呈高回声的“H”型。测量者1和测量者2测量的生育期女性阴道壁厚度为（10.43±3.02）mm、（10.78±3.06）mm，绝经后女性阴道壁厚度为（9.05±2.22）mm、（9.15±2.28）mm，二者测量的女性阴道壁厚度差异具有统计学意义（t=2.651，P=0.048；t=3.077，P=0.024）。生育期女性的阴道壁厚度测量具有非常好的测量者自身重复性（ICC=0.98）与测量者间重复性（ICC=0.97）。绝经后女性的阴道壁厚度测量同样具有非常好的测量者自身重复性（ICC=0.96）与测量者间重复性（ICC=0.95）。

经直肠双平面高频超声测量阴道壁厚度具有很好的重复性和一致性，可以在矢状切面及横切面对阴道成像，是一个准确有效地评估阴道中下段形态的影像学方法。

To explore the clinical value and advantages of transrectal biplanar high-frequency ultrasound in imaging vaginal structure.

From January to March 2021, a ultrasound physician used biplane high-frequency ultrasound to transrectally image the vagina of 103 normal women from the Ultrasound Center of Shenzhen Luohu People's Hospital, of which 53 were reproductive women and 50 were postmenopausal women. The sagittal section of the middle and lower vagina was imaged by the linear array high-frequency ultrasound with a biplane probe, and the transverse section of the lower vagina was imaged by the convex array high-frequency ultrasound, and the images were saved in the ultrasound system. Then, two ultrasound physicians measured the vaginal wall thickness at the level of the internal urethra of the bladder triangle in the sagittal section of the vagina. One of the ultrasound physicians repeated the measurement once a week later. The independent sample t test was used to compare the difference of vaginal wall thickness between the two groups, and the repeatability and consistency were assessed by intra-group correlation coefficient (ICC) and Bland-Altman diagram.

The vagina located between the anterior wall of the rectum and the posterior wall of the bladder and urethra showed "three lines and two zones" on the sagittal section. The "three lines" were the hyperechoic fibrous membrane of the outer wall of the anterior and posterior wall of the vagina and the mucosal layer of the anterior and posterior wall closed together in the middle. The "two zones" were the hypoechoic muscle layer of the anterior and posterior wall of the vagina. In the transverse section, the vaginal muscular layer showed an "inverted trapezoid" sign of low echo, which was the anterior and posterior wall of the vagina and the lateral wall of the vagina, respectively. The vaginal mucosa layer showed a hyperechoic "H" shape. The thickness of the vaginal wall measured by the two ultrasound physicians was (10.43±3.02) mm and (10.78±3.06) mm in reproductive women, and (9.05±2.22) mm and (9.15±2.28) mm in postmenopausal women, respectively; the difference was statistically significant (t=2.651, P=0.048; t=3.077, P=0.024). The measurement of vaginal wall thickness in reproductive women had excellent reproducibility (ICC=0.98) and consistency (ICC=0.97). Vaginal wall thickness measurements in postmenopausal women also had excellent reproducibility (ICC=0.96) and consistency (ICC=0.95).

The measurement of vaginal wall thickness by transrectal biplanar high-frequency ultrasound has good repeatability and consistency, and it can be used to evaluate vaginal morphology in sagittal and transverse sections, which is an accurate and efficient imaging method to evaluate the middle and lower segments of the vagina.