CAJ | 학술논문

目的比较子宫内膜息肉样病变的声像图表现、血流动力学特点及组织形态学改变，探讨超声诊断子宫内膜息肉样病变的价值。方法研究对象为临床初诊提示子宫内膜息肉、超声检查及病理资料完整的患者172例。经阴道超声检查：观察病变的边界、内部回声及血流分布，检测供养动脉血流速度及阻力指数；以边界清楚伴有较粗大穿入血流信号为超声诊断子宫内膜息肉的标准。病理检查：观察病变组织结构及供养血管；对比分析其超声检查与病理检查结果。结果172例患者中病理诊断为单纯子宫内膜息肉者68例，子宫内膜息肉合并子宫内膜癌者3例，其中2例患者息肉癌变；诊断为子宫内膜局灶性增生过长者63例，分泌期子宫内膜者27例，增生期子宫内膜者7例，子宫黏膜下肌瘤者3例，子宫内膜炎者1例。超声诊断子宫内膜息肉的敏感度为85.91%(61/71)，排除子宫内膜息肉的符合率为81.19%(82/101)，超声检查与病理诊断的总符合率为83.14%。结论宫腔内隆起样病变伴有较粗大穿入性血流信号是提示子宫内膜息肉的超声指征，宫腔镜下的定位活检是判断息肉样病变良恶性的关键。
목적비교자궁내막식육양병변적성상도표현、혈류동역학특점급조직형태학개변，탐토초성진단자궁내막식육양병변적개치。방법연구대상위림상초진제시자궁내막식육、초성검사급병리자료완정적환자172례。경음도초성검사：관찰병변적변계、내부회성급혈류분포，검측공양동맥혈류속도급조력지수；이변계청초반유교조대천입혈류신호위초성진단자궁내막식육적표준。병리검사：관찰병변조직결구급공양혈관；대비분석기초성검사여병리검사결과。결과172례환자중병리진단위단순자궁내막식육자68례，자궁내막식육합병자궁내막암자3례，기중2례환자식육암변；진단위자궁내막국조성증생과장자63례，분비기자궁내막자27례，증생기자궁내막자7례，자궁점막하기류자3례，자궁내막염자1례。초성진단자궁내막식육적민감도위85.91%(61/71)，배제자궁내막식육적부합솔위81.19%(82/101)，초성검사여병리진단적총부합솔위83.14%。결론궁강내륭기양병변반유교조대천입성혈류신호시제시자궁내막식육적초성지정，궁강경하적정위활검시판단식육양병변량악성적관건。
Objective To compare sonography image, hemodynamic characteristics and morphological changes of endometrial polypoid lesions and to discuss the value of sonography in diagnosis of endometrial polyps. Methods A total of 172 patients with a primary clinical diagnosis of endometrial polyps who underwent both transvaginal color Doppler sonography and pathology examinations were included. For sonography the lesion border, internal echo and distribution of blood signals were observed. The blood flow velocity and resistance index ( RI) were measured. Lesions with clearly border and penetrate blood flow signals was the diagnostic criteria of endometrial polyps. For pathology, the structure and vascular supply of endometrial polyps were observed. Results Of the 172 patients, 68 cases had a pathological diagnosis of simple endometrial polyps, 3 cases of endometrial polyps were in combination with endometrial cancer, with 2 of them having malignant transformation, 63 cases of endometrial hyperplasia, 27 cases had secretory endometrium, 7 cases had proliferative endometrium, 3 cases had submucosal uterine fibroids, 1 case had endometritis. The agreement rate between sonography and pathology was 85. 91%(61/71) for establishing the diagnosis of endometrial polyps, and 81. 19%(82/101) for excluding the diagnosis. The total agreement rate was 83. 14%. Conclusion Intrauterine lesions with penetrate or point-like flow is the diagnostic indications of endometrial polypoid lesions using sonography. Hysteroscopic biopsy has a significant role in differential diagnosis of benign and malignant polypoid lesions.