CAJ | 학술논문

　　目的探讨经阴道超声诊断宫腔粘连的临床应用价值。方法对临床疑诊为宫腔粘连的136例患者行经阴道超声检查并与宫腔镜检查结果进行比较，总结宫腔粘连经阴道超声声像图特征。结果136例患者宫腔镜手术后病理检查证实宫腔粘连121例（89．0％，121/136），宫腔镜下显示：（1）宫腔粘连程度：轻度粘连47例（38．9％，47/121）、中度粘连46例（38．0％，46/121）、重度粘连28例（23．1％，28/121）；（2）宫腔粘连范围：中央型粘连61例（50．4％，61/121）、周围型粘连24例（19．8％，24/121）、混合型粘连36例（29．8％，36/121）。经阴道超声示：（1）宫腔粘连程度：轻度粘连19例（40．4％，19/47）、中度粘连33例（71．7％，33/46）、重度粘连23例（82．1％，23/28）；（2）宫腔粘连范围：中央型粘连39例（63．9％，39/61）、周围型粘连9例（37．5％，9/24）、混合型粘连27例（75．0％，27/36）。宫腔镜检查证实术前经阴道超声正确诊断宫腔粘连75例（62．0％，75/121），漏诊46例（38．0％，46/121），误诊3例（3．8％，3/78，将子宫内膜息肉1例、子宫内膜菲薄1例、不全子宫纵隔1例误诊为宫腔粘连）。经阴道超声诊断宫腔粘连的敏感度为62．0％（75/121）、特异度为80．0％（12/15）、准确性为64．0％（87/136）。经阴道超声对不同程度宫腔粘连的检出率间差异有统计学意义（χ2＝15．956，P＝0．000）；对不同类型宫腔粘连的检出率间差异亦有统计学意义（χ2＝8．792，P＝0．012）。结论经阴道超声是诊断宫腔粘连的有效方法，较宫腔镜检查简便且无创。经阴道超声可作为宫腔粘连病变的常规筛查方法，具有较高的临床应用价值。
　　목적탐토경음도초성진단궁강점련적림상응용개치。방법대림상의진위궁강점련적136례환자행경음도초성검사병여궁강경검사결과진행비교，총결궁강점련경음도초성성상도특정。결과136례환자궁강경수술후병리검사증실궁강점련121례（89．0％，121/136），궁강경하현시：（1）궁강점련정도：경도점련47례（38．9％，47/121）、중도점련46례（38．0％，46/121）、중도점련28례（23．1％，28/121）；（2）궁강점련범위：중앙형점련61례（50．4％，61/121）、주위형점련24례（19．8％，24/121）、혼합형점련36례（29．8％，36/121）。경음도초성시：（1）궁강점련정도：경도점련19례（40．4％，19/47）、중도점련33례（71．7％，33/46）、중도점련23례（82．1％，23/28）；（2）궁강점련범위：중앙형점련39례（63．9％，39/61）、주위형점련9례（37．5％，9/24）、혼합형점련27례（75．0％，27/36）。궁강경검사증실술전경음도초성정학진단궁강점련75례（62．0％，75/121），루진46례（38．0％，46/121），오진3례（3．8％，3/78，장자궁내막식육1례、자궁내막비박1례、불전자궁종격1례오진위궁강점련）。경음도초성진단궁강점련적민감도위62．0％（75/121）、특이도위80．0％（12/15）、준학성위64．0％（87/136）。경음도초성대불동정도궁강점련적검출솔간차이유통계학의의（χ2＝15．956，P＝0．000）；대불동류형궁강점련적검출솔간차이역유통계학의의（χ2＝8．792，P＝0．012）。결론경음도초성시진단궁강점련적유효방법，교궁강경검사간편차무창。경음도초성가작위궁강점련병변적상규사사방법，구유교고적림상응용개치。
Objective To evaluate the value of transvaginal ultrasound in diagnosing intrauterine adhesions.Methods Transvaginal ultrasound was performed in 136 patients with suspicious intrauterine adhesions and compared with hysteroscopy correspondingly .The ultrasonographic features of intrauterine adhesions on transvaginal ultrasound were summarized .Results One hundred and twenty one cases (89.0%, 121/136 ) of intrauterine adhesions were verified by hysteroscopy .The hysteroscopic findings included:(1) Forty seven cases(38.9%,47/121) were minimal intrauterine adhesions , 46 cases(38.0%, 46/121) were moderate intrauterine adhesions , and 28 cases (23.1%,28/121) were severe intrauterine adhesions.(2) Sixty one cases(50.4%,61/121) were central intrauterine adhesions , 24 cases(19.8%, 24/121) were marginal intrauterine adhesions , and 36 cases (29.8%, 36/121) were mixed type of intrauterine adhesions.The transvaginal ultrasound findings included:(1)Nineteen cases(40.4%,19/47) were minimal intrauterine adhesions ,33 cases(71.7%,33/46)were moderate intrauterine adhesions ,and 23 cases(82.1%,23/28) were severe intrauterine adhesions .(2) Thirty nine cases (63.9%,39/61) were central intrauterine adhesions ,9 cases(37.5%,9/24) were marginal intrauterine adhesions ,and 27 cases (75.0%, 27/36 ) were mixed type of intrauterine adhesions .By transvaginal ultrasound, seventy-five (62.0%,75/121) cases of intrauterine adhesions were correctly diagnosed , whereas 46 cases (38.0%, 46/121) were missed.And 3 cases ( 3.8%, 3/78 ) were misdiagnosed as intrauterine adhesions on transvaginal ultrasound,including one endometrial polyp ,one thin endometrium and one septate uterus .The sensitivity, specificity and accuracy of transvaginal ultrasound in diagnosing intrauterine adhesions were 62.0%(75/121), 80.0%(12/15) and 64.0%(87/136) respectively.There were significant statistical differences in diagnosing different degrees of intrauterine adhesions ( χ2 =15.956,P=0.000) and different parts of intrauterine adhesions( χ2 =8.792,P=0.012) by transvaginal ultrasound.Conclusions Transvaginal ultrasound is an effective, easy to perform and noninvasive technique in screening and diagnosing intrauterine adhesions.Transvaginal ultrasound is an effective way in diagnosing intrauterine adhesions showing a noninvasive and simpler way than hysteroscopy .Transvaginal ultrasound is of great value in screening and diagnosing intrauterine adhesions .