【摘要】：背景與目的 子宮內(nèi)膜癌(Endometrial Carcinoma, EC)是女性生殖系統(tǒng)常見(jiàn)的三大腫瘤之一。在歐美國(guó)家發(fā)病率較高,在我國(guó)近年來(lái)發(fā)病率顯著增多。絕經(jīng)后婦女為高發(fā)人群。這種疾病發(fā)生在子宮內(nèi)膜,屬于上皮性惡性腫瘤。主要表現(xiàn)為陰道不規(guī)則出血。近些年來(lái),超聲彈性成像(Ultrasonic Elastography,UE)作為一項(xiàng)新的診斷技術(shù)在不斷發(fā)展。依據(jù)組織不同的軟硬度(與其病理構(gòu)成密切相關(guān))提供病變組織新的診斷信息。對(duì)乳腺、甲狀腺等淺表器官疾病的診斷也有了普遍應(yīng)用,在肝臟、心肌等方面也有了一系列的研究,但在宮腔方面的研究不多見(jiàn)。宮腔惡變時(shí)組織硬度增加。利用經(jīng)陰道超聲結(jié)合彈性成像技術(shù)客觀地分析病變組織硬度,然后通過(guò)不同顯色以及相關(guān)數(shù)據(jù)來(lái)表達(dá)病變的良惡性。 本研究的目的包括以下四項(xiàng)： 1.分別描述正常子宮、子宮內(nèi)膜息肉、粘膜下肌瘤及子宮內(nèi)膜癌等不同宮腔狀態(tài)下的二維超聲及彈性成像顯像特點(diǎn)。 2.探討血流類型不同的情況下子宮內(nèi)膜癌是否對(duì)彈性分級(jí)造成影響。 3.研究彈性成像技術(shù)對(duì)宮腔占位病變性質(zhì)的診斷價(jià)值。 4.比較彈性評(píng)分與應(yīng)變率比值(Strain Ratio, SR)對(duì)宮腔占位病變良惡性的診斷準(zhǔn)確性。 對(duì)象與方法 選取2013年1月-2014年1月在我院婦科就診的患者中,行經(jīng)陰道超聲及經(jīng)陰道超聲彈性成像檢查。正常宮腔組25例,平均年齡(30±2.3)歲。宮腔占位63例,平均年齡(43±3.1)歲。良性病灶28個(gè),惡性病灶35個(gè),均在我院進(jìn)行手術(shù)治療及病理診斷。 選用日立HV-900彩色多普勒超聲診斷儀,頻率4-8MHZ的陰道超聲探頭。對(duì)被檢者行經(jīng)陰道超聲檢查。發(fā)現(xiàn)病灶后,分析圖像特點(diǎn),取得理想二維圖像。然后進(jìn)入彈性成像模式。分析不同宮腔狀態(tài)的彈性圖像特點(diǎn)。測(cè)定應(yīng)變率比值。最后做出彈性評(píng)分(5分標(biāo)準(zhǔn))。結(jié)果 1.不同宮腔狀態(tài)的彈性圖像特點(diǎn) 正常宮腔：以綠色為主。 子宮內(nèi)膜息肉：以綠色為主伴少量紅色和(或)藍(lán)色。 粘膜下肌瘤：以綠色為主,可見(jiàn)藍(lán)綠相間,或以藍(lán)色、紅色為主。 子宮內(nèi)膜癌：以藍(lán)色為主,可見(jiàn)少許綠色,或全為藍(lán)色。 2.血流信號(hào)豐富型子宮內(nèi)膜癌15例,6例5分,7例4分,2例≤3分。血流信號(hào)不豐富型子宮內(nèi)膜癌11例,1例5分,7例4分,3例≤3分。無(wú)血流信號(hào)型子宮內(nèi)膜癌9例,1例5分,2例4分,6例≤3分。 3.分析宮腔占位病變的性質(zhì)時(shí),經(jīng)陰道超聲的特異度、靈敏度分別為：59.0%、79.2%。彈性評(píng)分的特異度、靈敏度分別為：68.8%、80.6%。兩者結(jié)合成像的特異度、靈敏度分別為：86.7%、93.9%。兩者分別與結(jié)合成像對(duì)比。統(tǒng)計(jì)結(jié)果分別為(χ2=5.760,P0.05。χ2=6.261,P0.05),提示統(tǒng)計(jì)學(xué)存在顯著差異。 4.應(yīng)變率比值測(cè)宮腔占位病變良惡性的最佳截?cái)嘀禐?.98。應(yīng)變率比值與彈性評(píng)分診斷宮腔占位病變的受試者工作曲線(ROC)下面積(Az)分別為：0.852和0.761,統(tǒng)計(jì)結(jié)果為(χ2=4.663,P0.05),提示統(tǒng)計(jì)學(xué)不存在顯著差異。結(jié)論 1.超聲彈性成像作為經(jīng)陰道超聲檢查的良好補(bǔ)充,為病變的確診提供了更多有價(jià)值的信息,為宮腔占位病變性質(zhì)的診斷提供更加直觀有力的佐證。 2.子宮內(nèi)膜癌的血流分布類型不會(huì)對(duì)彈性分級(jí)造成影響。 3.采用彈性評(píng)分、應(yīng)變率比值診斷宮腔占位病變性質(zhì)是一種新的技術(shù)手段,前者準(zhǔn)確度稍低于后者,二者差異無(wú)統(tǒng)計(jì)學(xué)意義。
[Abstract]:Background and Purpose Endometrial cancer (EC) is a common three-major tumor in female reproductive system One. In Europe, the incidence rate is high, and the incidence rate is remarkable in China in recent years. Increased number of postmenopausal women Population. This disease takes place in the endometrium and belongs to epithelial malignant. Neoplasm mainly manifested as irregular vagina In recent years, ultrasound elastography (UE) is a new diagnostic technique Development. New diagnosis of diseased tissue based on the different soft hardness of the tissue (closely related to its pathological composition) The diagnosis of superficial organ diseases, such as breast and thyroid, has also been widely used, and a series of studies have been carried out in liver, myocardium and so on, but the study in the aspect of uterine cavity does not Multiple see. Tissue hardness in case of malignancy of the uterine cavity Objective To study the tissue hardness of diseased tissue by means of transvaginal ultrasound combined with elastic imaging technique, and then to express lesions by different color development and related data. Malignant. Package for the purpose of this study The two-dimensional ultrasound in different uterine cavity states such as normal uterus, endometrial polyps, submucosal myoma and endometrial carcinoma were described. Characteristics of elastography imaging: study of endometrial carcinoma in different types of blood flow Is there an impact on the elastic grading? 3. Study elastic imaging technology Diagnostic value of the nature of lesions in the uterine cavity. 4. Comparison of the ratio of elastic score to strain rate (Strain Ratio, SR) The uterine cavity accounts for Accuracy of diagnosis of benign and malignant lesions in patients with benign and malignant lesions. The object and method were selected from January 2013 to January 2014 in the department of gynaecology in our hospital In patients, transvaginal ultrasound and transvaginal ultrasound elastography Normal uterine cavity group (n = 25), mean age (30/ 2. 3) There were 63 cases with uterine cavity, and the average age was 43. 3. 1. There were 28 benign lesions. 35 malignant lesions were operated in our hospital for surgical treatment and pathological diagnosis. Hitachi HV-900 was selected. Color Doppler ultrasonic diagnostic instrument, frequency A 4-8MHz vaginal ultrasound probe. Ultrasonic examination. After the lesion was found, An ideal two-dimensional image is obtained by analyzing the characteristics of the image. and then enters the elastic imaging, Mode. Analysis of elastic patterns of different uterine cavity states Elephant Point. Measure the ratio of strain rate. Finally, make a bullet. Sex score (5 sub-standard). Junction Fruit 1. The characteristics of elastic images of different uterine cavity states are normal. Uterine cavity: predominantly green. Endometrial polyp: Mainly green with a small amount of red and/ or blue. Submucosal myoma: predominantly green, visible blue Green and interphase, or blue, red predominantly. Endometrial cancer: predominantly blue, visible with a little green Color, or total blue. 2. Blood flow signal rich endometrial carcinoma 15 cases, 6 cases 5 points 7 cases, 4, 2 cases, 3 points. The blood flow signal was not abundant in 11 cases of endometrial carcinoma, 1 In 5, 7, 4, 3, 3, 9, 5, 2, 6, and 3, respectively.. 3. Analysis of the specificity of transvaginal ultrasound in the analysis of the properties of uterine cavity occupying lesions The sensitivity was 59. 0%, 79. 2%, and the specificity of the elastic score, the spirit and the sensitivity were: 59. 0%, 79. 2%, respectively. acuity of 68. 8%, 80. 6%. The specificity and sensitivity of both of them are: 86. 7%, 93. 9%. Both of them were compared with the combined imaging. The results showed that the results showed that the results showed that the results showed that the results were as follows: (2 = 5. 760, P 0.05. 2 = 6. 261, respectively). The ratio of strain rate was 2. 98. The ratio of strain rate and elastic score were used to diagnose the area under the working curve (ROC) of the subjects with uterine cavity occupying lesions (Az). respectively The results showed that there was no significant difference between 0. 852 and 0. 761. Conclusion 1. Ultrasound elastography was used as a model. The good complement of vaginal sonography provides more value for the diagnosis of lesions Information that provides more visual support for the diagnosis of the nature of the uterine cavity occupying lesions. The type of blood flow distribution in endometrial cancer does not have an impact on the elastic grading
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1

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