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中华医学超声杂志(电子版) ›› 2024, Vol. 21 ›› Issue (01) : 32 -36. doi: 10.3877/cma.j.issn.1672-6448.2024.01.004

妇产科超声影像学

经阴道超声联合生理盐水灌注直肠子宫陷凹对腹膜型子宫内膜异位症的诊断价值
朱成美1, 赵巧梅2, 邓学东3,()   
  1. 1. 215002 江苏苏州,南京医科大学附属苏州医院超声中心;223000 江苏淮安,淮安市妇幼保健院超声科
    2. 223000 江苏淮安,淮安市妇幼保健院超声科
    3. 215002 江苏苏州,南京医科大学附属苏州医院超声中心
  • 收稿日期:2023-01-17 出版日期:2024-01-01
  • 通信作者: 邓学东
  • 基金资助:
    淮安市市自然科学研究计划(HAB202130)

Diagnostic value of transvaginal ultrasound combined with saline-infusion sonoPODography in peritoneal endometriosis

Chengmei Zhu1, Qiaomei Zhao2, Xuedong Deng3,()   

  1. 1. Department of Ultrasound, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou 215002, China;Department of Ultrasound, Huaian Maternal and Child Health Hospital, Huaian 223000, China
    2. Department of Ultrasound, Huaian Maternal and Child Health Hospital, Huaian 223000, China
    3. Department of Ultrasound, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou 215002, China
  • Received:2023-01-17 Published:2024-01-01
  • Corresponding author: Xuedong Deng
引用本文:

朱成美, 赵巧梅, 邓学东. 经阴道超声联合生理盐水灌注直肠子宫陷凹对腹膜型子宫内膜异位症的诊断价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(01): 32-36.

Chengmei Zhu, Qiaomei Zhao, Xuedong Deng. Diagnostic value of transvaginal ultrasound combined with saline-infusion sonoPODography in peritoneal endometriosis[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(01): 32-36.

目的

探讨经阴道超声联合生理盐水灌注直肠子宫陷凹(SPG)对腹膜型子宫内膜异位症的诊断价值。

方法

选取2022年3月至9月淮安市妇幼保健院收治的50例具有痛经、慢性盆腔痛、性交痛、不孕症状,需要进行腹腔镜手术检查或治疗的患者为研究对象,患者均接受经阴道常规超声及SPG检查,且经腹腔镜及病理组织学最终确诊。统计分析经阴道常规超声及SPG检查在诊断腹膜型子宫内膜异位症的敏感度、特异度、准确性、阳性预测值及阴性预测值,并采用χ2检验比较2种检查方法的差异。

结果

50例患者,经腹腔镜手术病理检查确诊38例为腹膜型子宫内膜异位症,12例为非腹膜型子宫内膜异位症患者;经阴道常规超声诊断为腹膜型子宫内膜异位症者22例,非腹膜型子宫内膜异位症患者28例;SPG检查诊断为腹膜型子宫内膜异位症者40例,非腹膜型子宫内膜异位症10例。经阴道常规超声检查结果准确性为40.00%(20/50),敏感度为39.47%(15/38)、特异度为41.67%(5/12)、阳性预测值为68.18%(15/22)、阴性预测值为17.86%(5/28),SPG检查结果的准确性为84.00%(42/50)、敏感度为92.11%(35/38)、特异度为58.33%(7/12)、阳性预测值为87.50%(35/40)、阴性预测值为70.00%(7/10),均高于经阴道常规超声检查,差异具有统计学意义(χ2=6.518、27.109、0.114、0.860、1.656,P=0.013、0.006、0.042、0.035、0.029)。

结论

SPG是诊断腹膜型子宫内膜异位症安全、高效的方法,为早期子宫内膜异位症诊断提供了新方法。

Objective

To assess the diagnostic value of transvaginal ultrasound combined with saline-infusion sonoPODography (SPG) in peritoneal endometriosis to provide a new diagnostic method for early endometriosis.

Methods

Fifty patients with dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility who required laparoscopic surgery or treatment were selected as the research subjects at Huaian Maternal and Child Health Hospital from March to September 2022. All patients received routine transvaginal ultrasound and SPG examination, and were finally diagnosed by laparoscopy and histopathology. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of transvaginal ultrasound and SPG in the diagnosis of peritoneal endometriosis were analyzed statistically by χ2 test.

Results

Of the 50 patients included, 38 were confirmed as having peritoneal endometriosis by pathological examination after laparoscopic surgery. Fifteen cases were diagnosed with peritoneal endometriosis by conventional transvaginal ultrasonography, and 35 were diagnosed with peritoneal endometriosis by transvaginal ultrasound combined with SPG. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of routine transvaginal ultrasonography for the diagnosis of peritoneal endometriosis were 40.00% (20/50), 39.47% (15/38), 41.67% (5/12), 68.18% (15/22), and 17.86% (5/28), respectively; the corresponding values of SPG were 84.00% (42/50), 92.11% (35/38), 58.33% (7/12), 87.50% (35/40), and 70.00% (7/10). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of SPG in the detection of peritoneal endometriosis were all significantly higher than those of conventional transvaginal ultrasound (χ2=6.518, 27.109, 0.114, 0.860, and 1.656; P=0.013, 0.006, 0.042, 0.035, and 0.029, respectively).

Conclusion

SPG is a safe and effective method for the diagnosis of peritoneal endometriosis.

图1 腹膜型子宫内膜异位症术中及病理图像。图a:箭头所示病灶位于直肠子宫陷凹处,呈紫蓝色,与周围组织分界清晰。图b:箭头所示病灶位于子宫后壁下段浆膜层处,呈紫蓝色,与周围组织分界清晰。图c:镜下可见子宫异位腺体
图2 子宫内膜异位症经阴道常规超声声像图表现为病灶呈线样改变,边界清晰
表1 可疑子宫内膜异位症患者经阴道常规超声检查结果(例)
图3 腹膜型子宫内膜异位症超声声像图。图a:直肠子宫陷凹处,箭头所示病灶呈低回声改变,内部回声均匀,边界清晰,形态规则。图b:直肠子宫陷凹处,箭头所示病灶呈线状改变,边界欠清晰。图c:子宫后壁下段浆膜层处,箭头所示病灶呈低回声改变,内部回声均匀,边界清晰,形态规则
表2 经阴道超声联合生理盐水灌注直肠子宫陷凹检查结果(例)
表3 经阴道常规超声与SPG检查结果比较[(%)例/例]
1
Johnson NP, Hummelshoj L, Adamson GD, et al. World endometriosis society consensus on the classification of endometriosis [J]. Hum Reprod, 2017, 32(2): 315-324.
2
Pirtea P, Ziegler DD, Ayoubi JM. Effects of endometriosis on assisted reproductive technology: gone with the wind [J]. Fertilit Steril, 2020, 115(2): 321-322.
3
中国医师协会妇产科医师分会, 中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症诊治指南(第三版) [J]. 中华妇产科杂志, 2021, 56(12): 812-824.
4
Whitaker L, Doust A, Stephen J, et al. Laparoscopic treatment of isolated superficial peritoneal endometriosis for managing chronic pelvic pain in women: study protocol for a randomised controlled feasibility trial (ESPriT1) [J]. Pilot Feasibility Stud, 2021, 7(1): 19.
5
Reid S, Leonardi M, Lu C, et al. The association between ultrasound-based 'soft markers' and endometriosis type/location: a prospective observational study [J]. Eur J Obstet Gynecol Reprod Biol, 2019, 234: 171-178.
6
Robinson AJ, Rombauts L, Ades A, et al. Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments [J]. J Endometr Pelvic Pain Disord, 2018, 10(1): 10-17.
7
Chowdary P, Stone K, Ma T, et al. Multicentre retrospective study to assess diagnostic accuracy of ultrasound for superficial endometriosis-Are we any closer? [J]. Aus N Z J Obstet Gynaecol, 2019, 59(2): 279-284.
8
郎景和. 子宫内膜异位症基础与临床研究的几个问题 [J]. 中国实用妇科与产科杂志, 2002, 18(3): 129-130.
9
Nisenblat V, Bossuyt PMM, Farquhar C, et al. Imaging modalities for thenon-invasive diagnosis of endometriosis [J]. Cochrane Database Syst Rev, 2016, 2(2): CD009591.
10
Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action [J]. Am J Obstet Gynecol, 2019, 220(4): 354.e1-354.e12.
11
Ilangavan K, Kalu E. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners [J]. Fertil Steril, 2010, 93(3): e10. author reply e12.
12
Ludwin I, Ludwin A, Wiechec M, et al. Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye [J]. Hum Reprod, 2017, 32(4): 1-12.
13
Yalcinkaya TM, Rowan SP, Akar ME. Culdocentesis followed by saline solutionenhanced ultrasonography: technique for evaluation of suspected ectopic pregnancy [J]. J Minim Invasive Gynecol, 2010, 17(6): 754-759.
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