【摘要】：[目的]運(yùn)用超聲造影技術(shù)對(duì)常規(guī)超聲難以診斷的子宮病變患者進(jìn)行造影檢查,旨在探討該技術(shù)在子宮病變?cè)\斷中的價(jià)值。[方法]選取2015年2月至2016年12月就診于昆明醫(yī)科大學(xué)第一附屬醫(yī)院,在婦產(chǎn)科超聲室常規(guī)經(jīng)腹部超聲或經(jīng)陰道超聲檢查疑為子宮肌瘤、子宮腺肌病、宮頸癌、子宮內(nèi)膜癌和剖宮產(chǎn)瘢痕部位妊娠的67例患者為研究對(duì)象。以聲諾維為造影劑,運(yùn)用脈沖反相諧波成像技術(shù)對(duì)患者進(jìn)行靜脈超聲造影檢查,觀察子宮病變區(qū)造影劑的灌注過(guò)程,分析灌注模式及時(shí)間強(qiáng)度曲線,其診斷結(jié)果與清宮、診斷性刮宮、宮腔鏡及手術(shù)病理結(jié)果對(duì)照。[結(jié)果](1)典型的子宮肌瘤表現(xiàn)為周邊呈環(huán)狀或半環(huán)狀增強(qiáng),達(dá)峰后有明顯邊界,消退時(shí)肌瘤中央早于子宮肌層消退;子宮腺肌病病灶的增強(qiáng)和消退與子宮肌層同步,邊界顯示不清;子宮肌瘤組的達(dá)峰時(shí)間(TP)晚于子宮腺肌病組(P0.05),半洗出時(shí)間(HWOT)早于腺肌病組(P0.05),差異有統(tǒng)計(jì)學(xué)意義,兩者的上升時(shí)間(RT)和峰值強(qiáng)度(PI)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);(2)宮頸癌和子宮內(nèi)膜癌表現(xiàn)為增強(qiáng)及消退均早于肌層,峰值強(qiáng)度高于肌層;宮頸上皮內(nèi)瘤變和子宮內(nèi)膜增生病變區(qū)內(nèi)的造影劑與宮體肌層同步灌注,同步消退;宮頸癌和子宮內(nèi)膜癌組的上升時(shí)間(RT)、達(dá)峰時(shí)間(TP)、半洗出時(shí)間(HWOT)早于宮頸上皮內(nèi)瘤變和子宮內(nèi)膜增生組(P0.05),峰值強(qiáng)度(PI)則大于宮頸上皮內(nèi)瘤變和子宮內(nèi)膜增生組(P0.05),差異有統(tǒng)計(jì)學(xué)意義;(3)孕囊型瘢痕妊娠患者的病灶區(qū)早于子宮肌層灌注,孕囊周邊呈環(huán)狀高增強(qiáng)似“面包圈”,包塊型瘢痕妊娠患者的病灶內(nèi)部分區(qū)域表現(xiàn)為快速灌注,快速消退,呈不均勻性高增強(qiáng),部分區(qū)域無(wú)增強(qiáng);難免流產(chǎn)的高回聲團(tuán)塊晚于肌層灌注,晚于肌層消退;瘢痕妊娠組的上升時(shí)間(RT)早于難免流產(chǎn)組(P0.05),峰值強(qiáng)度(PI)大于難免流產(chǎn)組(P0.05),差異有統(tǒng)計(jì)學(xué)意義;兩者的達(dá)峰時(shí)間(TP)和半洗出時(shí)間(HWOT)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]超聲造影從微循環(huán)的層面觀察子宮病變區(qū)的血流灌注特點(diǎn)。通過(guò)分析不同子宮病變的造影增強(qiáng)模式及時(shí)間強(qiáng)度曲線,進(jìn)一步提高診斷子宮病變的準(zhǔn)確性,為術(shù)前鑒別診斷及選擇合適的治療方案提供了一種新的影像學(xué)檢查方法。
[Abstract]:[objective] to evaluate the value of contrast-enhanced ultrasonography in the diagnosis of uterine lesions. [methods] from February 2015 to December 2016, we selected the first affiliated Hospital of Kunming Medical University to examine the suspected uterine leiomyoma, adenomyosis and cervical cancer by transabdominal ultrasound or transvaginal ultrasound in the Department of Obstetrics and Gynecology. 67 cases of endometrial carcinoma and cesarean scar pregnancy were studied. Using sonovir as contrast agent, the patients were examined by pulse inverse harmonic imaging (PRT), the perfusion process of contrast agent in uterine lesion area was observed, the perfusion mode and time intensity curve were analyzed, the diagnostic results and the clear palace were analyzed. Diagnostic curettage, hysteroscopy and surgical and pathological results were compared. [results] (1) the typical hysteromyoma showed circumferential or semi-annular enhancement with obvious boundary after peak, the central myoma subsided earlier than the myometrium, and the enhancement and regression of adenomyosis were synchronized with the myometrium. The peak time of uterine myoma group (TP) was later than that of adenomyosis group (P0.05), and the half-washing time (HWOT) was earlier than that of adenomyosis group (P0.05), the difference was statistically significant. There was no significant difference in the rising time (RT) and peak intensity (PI) between the two groups (P0.05); (2) the enhancement and regression of cervical carcinoma and endometrial carcinoma were earlier than that of muscular layer, and the peak intensity was higher than that of muscular layer. The contrast agent in the area of cervical intraepithelial neoplasia and endometrial hyperplasia was perfused synchronously with the myometrium of the uterine body and subsided simultaneously. The rising time of (RT), peak time in cervical cancer and endometrial carcinoma group was earlier than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05), and the peak intensity (PI) was higher than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05), which was lower than that in cervical intraepithelial neoplasia and endometrial hyperplasia group (P0.05). (3) the focus area of pregnant women with gestational cystic scar was earlier than that of uterine myometrium perfusion. The circumference of the gestational sac was annular high enhancement like "bread circle", and some of the lesions in the pregnant women with cicatricial scar showed rapid perfusion, fast regression, uneven enhancement, and no enhancement in some areas. The hyperechoic mass of inevitable abortion was later than the myometrial perfusion later than the myometrium regression; the rising time of scar pregnancy group was earlier than that of inevitable abortion group (P0.05) the peak intensity of (PI) was larger than that of unavoidable abortion group (P0.05) the difference was statistically significant. There was no significant difference in peak time (TP) and half washing time (HWOT) between the two groups (P0.05). [conclusion] Contrast-enhanced ultrasonography is used to observe the perfusion characteristics of uterine lesion from the microcirculation level. By analyzing the contrast enhancement mode and time intensity curve of different uterine lesions, the accuracy of diagnosis of uterine lesions was further improved, and a new imaging examination method was provided for differential diagnosis and selection of appropriate treatment schemes before operation.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R711.74

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