本文關(guān)鍵詞： 三維超聲 宮腔內(nèi)病變 阻力指數(shù) 內(nèi)膜體積　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 比較評(píng)價(jià)經(jīng)陰道二維超聲(Two-dimensional transvaginal ultrasound2D-TVS)及經(jīng)陰道三維超聲(Three-dimensional transvaginal ultrasound3D-TVS)對(duì)宮腔內(nèi)病變的診斷價(jià)值,比較子宮內(nèi)膜各種病變的內(nèi)膜厚度(endometrial thicknessET)、阻力指數(shù)(resistant index RI)、搏動(dòng)指數(shù)(pulsatility index PI)及內(nèi)膜體積(endometrial volume EV)之間的差別,為臨床超聲的診斷提供指導(dǎo)。方法 收集2012年10月1日至2013年10月31日在山西大醫(yī)院經(jīng)病理確診的宮腔內(nèi)病變171例,其中58例子宮內(nèi)膜增殖癥,63例子宮內(nèi)膜息肉,38例子宮粘膜下肌瘤,12例子宮內(nèi)膜癌,于術(shù)前1-3天行2D-TVS同時(shí)行3D-TVS,觀察聲像圖特點(diǎn),對(duì)子宮內(nèi)膜進(jìn)行三維重建并儲(chǔ)存,調(diào)用虛擬器官計(jì)算機(jī)輔助分析(Virtual Organ Computer Aided Analysis, VOCAL)軟件描記內(nèi)膜輪廓測(cè)量并記錄EV。 采用SPSS18.0統(tǒng)計(jì)軟件,.采用Kappa檢驗(yàn)兩種方法的檢查結(jié)果與病理檢查結(jié)果的一致性,采用靈敏性(Sensitivity Se)和特異性(Specificity Sp)描述兩種檢查方法診斷宮腔內(nèi)各種病變的能力,兩種檢查方法的檢出率的比較采用χ2檢驗(yàn),子宮內(nèi)膜各種病變之間參數(shù)的比較采用方差分析、LSD-t檢驗(yàn)各組兩兩之間參數(shù)是否有統(tǒng)計(jì)學(xué)差別。 結(jié)果 1.2D-TVS和3D-TVS對(duì)宮腔內(nèi)良惡性病變的診斷結(jié)果與病理結(jié)果的一致性均較好。 2.2D-TVS診斷子宮內(nèi)膜增殖癥、子宮內(nèi)膜息肉、子宮粘膜下肌瘤、子宮內(nèi)膜癌的特異性和靈敏性分別為85.0%、90.7%、97.0%、98.7%和84.5%、71.4%、86.8%、66.7%。 3.3D-TVS診斷子宮內(nèi)膜增殖癥、子宮內(nèi)膜息肉、子宮粘膜下肌瘤、子宮內(nèi)膜癌的特異性和靈敏性分別為93.8%、96.3%、97.7%、98.7%和91.4%、87.3%、92.1%、83.3%。 4.3D-TVS對(duì)宮腔內(nèi)良惡性病變的檢出率89.5%(153/171)高于2D-TVS的檢出率78.9%(135/171),且差別有統(tǒng)計(jì)學(xué)意義(P0.05)。 5.絕經(jīng)前三組內(nèi)膜病變之間,除了內(nèi)膜增生組和內(nèi)膜癌組之間的ET、EV差別無統(tǒng)計(jì)學(xué)意義(P=0.41/P=0.82),其余各組之間ET、EV差別均有統(tǒng)計(jì)學(xué)意義(P0.05)。 6.絕經(jīng)后各組內(nèi)膜病變中,內(nèi)膜癌組的平均ET(16.21±3.96mm)和平均EV(18.22±3.97cm3)均高于內(nèi)膜良性病變組,各組之間的ET、EV差別均有統(tǒng)計(jì)學(xué)意義(P0.05)。 7.子宮內(nèi)膜惡性病變的RI平均值為0.45±0.05,低于內(nèi)膜良性病變組,差別有統(tǒng)計(jì)學(xué)意義(P0.05)；子宮內(nèi)膜惡性病變的PI平均值為0.86±0.30,低于子宮內(nèi)膜良性病變組,差別無統(tǒng)計(jì)學(xué)意義(P=0.15)。 結(jié)論 1.2D-TVS和3D-TVS診斷宮腔內(nèi)良惡性病變的特異性、靈敏性均較高,3D-TVS對(duì)宮腔內(nèi)良惡性病變的檢出率略高于2D-TVS,為疑難病癥的鑒別診斷提供了一種新的檢查思路。 2.ET、EV對(duì)鑒別絕經(jīng)前子宮內(nèi)膜良惡性病變的意義不大,對(duì)鑒別絕經(jīng)后子宮內(nèi)膜良惡性病變有重要參考價(jià)值。 3.RI對(duì)鑒別子宮內(nèi)膜良惡性病變有重要參考價(jià)值,PI對(duì)鑒別子宮內(nèi)膜良、惡性病變意義不大。
[Abstract]:objective
A comparative evaluation of transvaginal two dimensional ultrasonography (Two-dimensional transvaginal ultrasound2D-TVS) and transvaginal three-dimensional ultrasound (Three-dimensional transvaginal ultrasound3D-TVS) in diagnosis of uterine cavity disease, endometrial thickness comparison endometrial lesions (endometrial thicknessET), resistance index (resistant index RI), pulsatility index (pulsatility index PI) and endometrial volume EV (endometrial volume the difference between) to provide guidance for the clinical diagnosis of ultrasound.
From October 1, 2012 to October 31, 2013 in Shanxi hospital after intrauterine lesions confirmed pathologically in 171 cases, including 58 cases of endometrial hyperplasia, 63 cases of endometrial polyp, 38 cases submucous myoma of uterus, 12 cases of endometrial carcinoma before operation, 1-3 days 2D-TVS and 3D-TVS, to observe the sonographic features, 3D reconstruction of the the lining of the uterus and the storage, analysis and transfer of virtual organ computer aided (Virtual Organ Computer Aided Analysis, VOCAL) software tracing and recording EV. endometrial contour measurement
Using SPSS18.0 statistical software, using Kappa test. The consistency of two methods of examination results and pathological results, the sensitivity and specificity (Sensitivity Se) (Specificity Sp) to describe the ability of two methods in diagnosis of uterine cavity lesions, two kinds of inspection methods to compare the detection rate by 2 test. Compared with the parameters between endometrial lesions of variance analysis, LSD-t test was used between 22 parameters if the difference was statistically significant.
Result
The consistency of both 1.2D-TVS and 3D-TVS in the diagnosis of benign and malignant lesions in the intrauterine is better than that of the pathological results.
The specificity and sensitivity of 2.2D-TVS in diagnosing endometrial hyperplasia, endometrial polyps, submucous myoma and endometrial carcinoma were 85%, 90.7%, 97%, 98.7% and 84.5%, 71.4%, 86.8%, 66.7%. respectively.
The specificity and sensitivity of 3.3D-TVS in diagnosing endometrial hyperplasia, endometrial polyps, submucous myoma and endometrial carcinoma were 93.8%, 96.3%, 97.7%, 98.7% and 91.4%, 87.3%, 92.1%, 83.3%. respectively.
The detection rate of 4.3D-TVS for benign and malignant lesions in the intrauterine 89.5% (153/171) was 78.9% (135/171) higher than that of 2D-TVS, and the difference was statistically significant (P0.05).
5. there was no significant difference in the ET between the three groups of endometrium before menopause, except the intimal hyperplasia group and the endometrial cancer group (EV). There was no significant difference in the P=0.41/P=0.82 between the two groups (P=0.41/P=0.82), and the difference between the other groups was statistically significant (P0.05).
6. after menopause, the average ET (16.21 + 3.96mm) and the average EV (18.22 + 3.97cm3) in endometrial cancer group were all higher than those in the benign endometrial lesion group. The difference of ET and EV between groups was statistically significant (P0.05).
7. the average value of RI in endometrial malignant lesions is 0.45 + 0.05, which is lower than that in benign endometrial lesions. The difference is statistically significant (P0.05). The mean value of PI in endometrial malignant lesions is 0.86 + 0.30, which is lower than that in benign endometrial lesions, and the difference is not statistically significant (P=0.15).
conclusion
The specificity and sensitivity of 1.2D-TVS and 3D-TVS in diagnosing intrauterine benign and malignant lesions are all high. The detection rate of 3D-TVS for benign and malignant lesions in uterine cavity is slightly higher than that of 2D-TVS. It provides a new way of thinking for differential diagnosis of difficult and difficult cases.
2.ET and EV are of little significance in differentiating the benign and malignant lesions of the premenopausal endometrium, and are of important reference value for the differential diagnosis of the benign and malignant lesions of the endometrium after menopause.
3.RI has important reference value in differentiating benign and malignant endometrium, and PI is of little significance in identifying benign and malignant lesions of the endometrium.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.74;R445.1

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