宫腔声学造影诊断子宫内病变的临床价值

目的 探讨子宫内疾病的声像图特征，分析声学造影诊断宫内病变的临床价值。方法 搜集53例经声学造影检查、手术和刮宫后病理证实的资料，进行回顾性分析。结果 声学造影对子宫内膜息肉、子宫内膜增生、子宫粘膜下肌瘤、子宫内膜癌等作出初步判断，均提示不同的声像图特征。结论 子宫声学造影对官腔内疾病具有诊断与鉴别的作用。     

超声宫腔造影在诊断子宫内膜病变中的价值

目的 应用超声宫腔造影技术诊断子宫内膜病变。方法采用超声宫腔造影检查，对32例子宫内膜病变的患者进行观察，取得不同切面进行分析。结果 子宫内膜增生过长8例(占25％)，子宫内膜息肉14例(占43．8％)，子宫粘膜下肌瘤9例(占28．1％)，子宫内膜癌1例(占3．1％)。经临床及宫腔镜证实，仅1例内膜息肉误诊为粘膜下肌瘤(其原因我们认为是由于刮宫后出血、凝集导致周边显像不清所致)，准确率达96．9％。结论 经阴道宫腔造影操作简便、易行、准确率高，是诊断子宫内膜病变的可行方法。     

灌注法子宫声学造影对宫腔内病变中的应用

目的评价灌注法子宫声学造影对宫腔内病变的诊断作用。方法通过86例经阴道超声诊断宫腔内病变患者行子宫声学造影，以宫腔镜和病理结果为标准，进行比较。结果灌注法子宫声学造影内膜息肉诊断率77．8％，内膜癌达66．7％，均高于传统阴道B超。结论与传统经阴道超声相比，子宫声学造影对宫腔内病变的诊断有很高的敏感性和特异性，是一种简单易行、无合并症、痛苦小的诊断方法。     

宫腔声学造影在宫腔内病变鉴别诊断中的应用

目的 为了提高超声对宫腔疾病鉴别诊断的价值。方法 用生理盐作为造影剂，对60例疑有宫腔占位病变的患进行宫腔声学造影检查。结果 宫腔声学造影可直观地显示宫腔内病变的形态和回声特点，初步作出子宫黏膜下肌瘤、子宫内膜息肉、流产后组织物残留等疾病的具体诊断。结合病史诊断流产后组织物残留达100%，在诊断子宫黏膜下肌瘤上由常规阴道超声的64%提高到89%，在诊断子宫内膜息肉上由常规阴道超声的75%提高到88%。结论 经阴道超声宫颈声学造影检查是一项简便、准确、无创的宫腔内疾病鉴别诊断的方法。     

三维超声宫腔造影诊断子宫内膜病变

目的：评价经阴道三维超声宫腔造影对子宫内膜病变诊断价值。方法：应用阴道方式三维超声对子宫不规则出血30例患者进行宫腔内生理盐水灌注后扫查，并与宫腔镜检查及病理结果对照。结果：18例诊断子宫内膜息肉，7例诊断粘膜下肌瘤，3例子宫内膜增生，2例子宫内膜癌。宫腔造影敏感度100％，特异度93％。结论：经阴道三维超声宫腔内灌注显影方法简便、易行，准确度高，是诊断子宫内膜病变的可行方法。     

宫腔声学造影诊断子宫内病变40例分析

目的:提高超声对子宫内病变的诊断水平。方法:对40例经声学造影检查、手术和刮宫后病理证实的宫腔疾病,进行回顾性分析。结果:宫腔声学造影可清晰地显示宫腔内病变的形态和回声特点,从而对宫腔疾病作出较准确的超声造影诊断,且病理诊断符合率较常规阴道超声高。结论:宫腔声学造影检查是一项简便、准确、无创的宫腔内疾病鉴别诊断方法。     

超声造影在子宫宫腔病变诊断中的初步应用

目的 探讨超声造影在子宫宫腔病变诊断中的应用价值.方法 回顾性分析经手术病理或临床证实的子宫宫腔病变54例,分析其常规彩超和超声造影表现,比较常规彩超和超声造影对各种宫腔病变的诊断符合率.结果 子宫内膜癌及宫腔内血块超声造影检查诊断符合率明显增高,并有统计学显著差异(P<0.05);子宫黏膜下肌瘤、宫腔息肉、宫腔内残留诊断符合率提高,但无统计学显著差异(P>0.05).结论 超声造影能显示子宫宫腔病变微小血管的血流灌注,结合常规彩超能进一步提高子宫宫腔病变的诊断和鉴别诊断.     

宫腔声学造影经阴道超声对宫内病变诊断的价值

目的:评价宫腔声学造影经阴道超声对宫内病变的诊断价值.方法:宫腔声学造影经阴道超声,宫内插管采用宫腔造影专用管,部分使用代用管.造影剂采用无菌生理盐水,部分患者加用庆大霉素.结果:共检查22例经腹常规超声或经阴道超声发现宫腔内有异常团块而又难以明确诊断的各种宫内病变患者.22例中检出黏膜下肌瘤12例,息肉5例,子宫内膜增生过长1例,子宫平滑肌肉瘤1 例,胎盘残留1例,宫内未见异常2例.除1例子宫内膜增生过长者外,其余均经手术和病理证实.结论:宫腔声学造影经阴道超声检查是一项简便易行、敏感性、特异性高、疼痛少的诊断宫腔内病变的有效诊断方法.     

子宫腔声学造影在诊断宫腔内病变中的应用

目的 评价宫腔声学造影对宫腔内疾病的诊断价值。方法 对80例不规则阴道流血者先行常规经腹超声检查，后经阴道插入双腔管，5％葡萄糖或5％甘露醇持续灌注宫腔行宫腔声学造影。其诊断结果与宫腔镜检查及术后病理结果进行对比分析。结果 宫腔声学造影超声诊断宫内病变较常规超声检查诊断符合率高(前者为92.5％，后者为62．5％)。结论 宫腔声学造影诊断子宫腔内病变有较高的应用价值。     

生理盐水子宫腔声学造影检查对诊断宫腔内病变的价值

生理盐水子宫腔声学造影是在常规经阴道超声检查时经子宫颈向腔内缓慢地灌注适量生理盐水,在宫腔内形成无回声液性区域,使得子宫内膜结构显示更清晰。这项技术提高了对子宫内膜息肉、内膜增生、宫腔粘连及子宫黏膜下肌瘤的显示率,使一些患者避免了不必要的官腔镜或诊断性刮宫等介入性检查。近年来常用于寻找子宫出血的原因及正确的评价子宫腔内病变的诊断。     

宫腔镜联合B超检查诊断异常子宫出血104例临床分析

目的探讨宫腔镜联合B超检查在各种异常子宫出血中的诊断价值。方法我院应用宫腔镜联合B超检查异常子宫出血104例，术前均行B超检查，术中行定位取材或诊断性刮宫。结果在异常子宫出血病因诊断中，宫腔镜联合B超检查诊断子宫内膜增生症12例，与病理诊断的符合率为70．59％；子宫内膜息肉26例，符合率为92．86％；子宫黏膜下肌瘤13例，符合率为92．86％；慢性子宫内膜炎30例，符合率为93．75％。结论对异常子宫出血的病因诊断中，宫腔镜联合B超检查提高子宫内膜息肉及子宫黏膜下肌瘤的诊断率，尽管对子宫内膜增生症及子宫内膜癌需经病理诊断，但因镜下可以定位诊刮，亦提高了诊断率。宫腔镜联合B超检查是诊断各种异常子宫出血的有效且有价值的方法。     

The added value of transvaginal sonohysterography over transvaginal sonography alone in women with known or suspected leiomyoma.

OBJECTIVE: To assess whether sonohysterography provides added diagnostic value over transvaginal sonography in patients with suspected or known myomas by comparing diagnostic confidence, interobserver agreement, accuracy, and change in diagnoses when 2 independent observers interpreted transvaginal sonography alone and later interpreted transvaginal sonography and sonohysterography together. METHODS: Hard copy images from 72 women were interpreted independently by 2 sonologists on separate occasions, rating parameters (abnormal uterus, myoma in any location, submucous myoma, classification of location of a submucous myoma with respect to the uterine cavity, myoma remote from the cavity, adenomyosis, and focal and diffuse endometrial lesions) on a scale of 1 to 5 (1 indicated definitely no; 2, probably no; 3, uncertain; 4, probably yes; and 5, definitely yes). Correlation was made with clinical and imaging follow-up, surgery, and pathologic examination. RESULTS: The added information provided by sonohysterography resulted in improved diagnostic confidence for most parameters. Interobserver agreement was markedly improved for the diagnosis and location of submucous myomas and focal endometrial lesions. Sensitivity values for submucous myomas and focal endometrial lesions were 100% and 90% for transvaginal sonography and sonohysterography together and 100% and 70% for transvaginal sonography alone. CONCLUSIONS: We found that sonohysterography does provide additional information over transvaginal sonography alone and is an important adjunct to transvaginal sonography in symptomatic women with known or suspected myomas, particularly before surgical or medical therapy.     

Sonohysterography for ultrasonographic evaluation of tamoxifen-associated cystic thickened endometrium.

Most menopausal patients with breast cancer receive tamoxifen therapy. In these patients, TVS may show thickened, irregular cystic endometria. For better visualization of these patients' uterine cavities, we performed transvaginal sonohysterography. During vaginal ultrasonography, sterile saline was introduced by transcervical 8 French Foley catheter into the uterine cavity of 20 women who were referred with tamoxifen-associated cystic thickened endometria. In eight women, transvaginal sonohysterography provided the means to diagnose occult, free-floating endometrial polyps, whereas in 12 women, the fluid contrast augmented the diagnosis of an irregular cystic endometrial-myometrial junction. All 20 patients underwent diagnostic hysteroscopy: eight polyps, none of which were malignant, were confirmed and removed by hysteroscopic resection. Of the remaining 12 patients with an irregular endometrial-myometrial junction, endometrial curettage showed no significant pathologic findings. Transvaginal sonohysterography seems to enhance the differentiation between endometrial polyps that should be resected by operative hysteroscopy and an abnormal endometrial-myometrial junction that may benefit from biopsy sampling only.     

经阴道三维超声对不孕不育患者宫腔病变的诊断价值

目的探讨三维超声在不孕不育患者宫腔病变中的诊断价值。 方法选取2017年1月至2018年12月在南京医科大学第一附属医院生殖医学中心的不孕不育患者行经阴道三维超声检查，将428例诊断为不同类型宫腔病变患者的三维超声结果与宫腔镜或病理组织学结果进行比较分析，以宫腔镜或病理组织学结果为"金标准"，采用四格表计算三维超声诊断各类宫腔病变的敏感度、特异度、阳性预测值、阴性预测值及准确性。 结果三维超声诊断宫腔病变患者428例，其中包括宫腔粘连235例（54.9%），子宫内膜息肉153例（35.7%），子宫黏膜下肌瘤40例（9.4%）。将428例患者的三维超声结果与宫腔镜或病理组织学结果相比较，诊断结果一致为404例（94.4%），误诊24例（5.6%），其中，宫腔粘连误诊14例，子宫内膜息肉误诊7例，子宫黏膜下肌瘤误诊3例。三维超声与宫腔镜或病理组织学结果相比，其诊断各种类型宫腔病变的准确性分别为：宫腔粘连96.73%，子宫内膜息肉96.96%，子宫黏膜下肌瘤98.83%。 结论三维超声对各种宫腔病变有较高的诊断准确性，可作为不孕不育患者排除宫腔病变的首选检查方法。     

Sonohysterography compared with endometrial biopsy for evaluation of the endometrium in tamoxifen-treated women.

OBJECTIVE: This study was performed to compare endometrial biopsy and sonohysterography for evaluation of the endometrium in tamoxifen-treated women. METHODS: Medical records were retrospectively reviewed to identify 51 consecutive tamoxifen-treated women who had sonohysterography and correlative endometrial biopsy for evaluation of postmenopausal bleeding or thickened endometrium of greater than 8 mm. Endometrial biopsy and sonohysterographic results were compared in all women, and for 27 (53%) women who had hysteroscopy with dilation and curettage, endometrial biopsy and sonohysterographic findings also were compared with surgical pathologic findings. RESULTS: Thirty-two (63%) of 51 sonohysterograms revealed endometrial polyps; 4 (8%) showed endometrium of greater than 5 mm; 14 (27%) showed endometrium of less than 5 mm; and 1 (2%) was inadequate. Endometrial biopsy findings were benign endometrium in 42 (82%), polyps in 4 (8%), and insufficient samples in 5 (10%). Among the adequate sonohysterograms, 64% (32 of 50) resulted in a diagnosis of polyps (95% confidence interval, 49%-77%) whereas the corresponding proportion for endometrial biopsy was 9% (4 of 46; 95% confidence interval, 2%-21%). For the group with hysteroscopy, 24 (92%) of 26 polyps were confirmed histopathologically; 1 polyp had complex hyperplasia. Polyps were present in 23 (89%) of 26 women with benign endometrium or insufficient samples by endometrial biopsy, and only 1 confirmed polyp was identified by endometrial biopsy. The sensitivity of sonohysterography for diagnosis of endometrial polyps (100%) was significantly higher than for endometrial biopsy (4%; P < .01). CONCLUSIONS: In tamoxifen-treated women, sonohysterography provides a significant improvement in sensitivity for diagnosis of endometrial polyps compared with endometrial biopsy.     

Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding.

Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10-25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.     

The value of sonohysterography combined with cytological analysis of the fluid retrieved from the endometrial cavity in predicting histological diagnosis.

OBJECTIVE: The purpose of the study was to assess the efficacy of sonohysterography combined with cytological analysis of the fluid retrieved from the endometrial cavity in predicting histological diagnosis. STUDY DESIGN: A prospective study was conducted comparing sonohysterography combined with endometrial washings for cytology with histological evaluation after surgical procedures. Of 152 patients referred for sonohysterography, 87 were premenopausal and 65 were postmenopausal. Some of the injected fluid was aspirated for cytological analysis. Sixty-one patients (40%) underwent surgical hysteroscopy and eight (5%) had dilatation and curettage as a result of the sonohysterographic findings. Histological diagnoses were compared with the sonohysterographic and cytological findings. RESULTS: In 99 (65%) patients, sonohysterography demonstrated endometrial polypoid lesions. Only 54 endometrial cavitary lesions were confirmed pathologically. Epithelial cells with atypia were more often found in patients without (five of 53) than in those with (two of 99) an endometrial polyp (p < 0.05). Only one out of nine cases of histological diagnosis of hyperplasia was predicted cytologically. CONCLUSIONS: The addition of cytological analysis of the fluid retrieved from the endometrial cavity during sonohysterography did not contribute to the prediction of benign histological diagnosis of endometrial hyperplasia.     

Comparative study of transvaginal sonography and hysteroscopy for the detection of pathologic endometrial lesions in women with postmenopausal bleeding.

Dilatation and curettage is used as the "gold standard" for diagnosing pathologic endometrial lesions in women with postmenopausal bleeding. In this group of women, about 10% have an endometrial cancer and an additional 20% have some other endometrial abnormality. However, some abnormalities, such as endometrial polyps and submucous fibroids, are difficult to diagnose by dilatation and curettage. In such cases, combining transvaginal sonography with hysteroscopy may be of value. This study compared the use of transvaginal sonography and hysteroscopy for evaluation of the uterine cavity in women with postmenopausal bleeding. The study included 51 women, 39 of whom had an abnormally thick ( > 4 mm) endometrium as measured by transvaginal sonography, and 35 of 39 had an abnormal appearance at hysteroscopy. The sensitivity and specificity for the measurement of endometrial thickness using transvaginal sonography to diagnose an endometrial abnormality were 100% and 75%, respectively. The corresponding figures for hysteroscopy were 97% and 88%. In all women with an endometrial thickness of 8 mm as measured by transvaginal sonography, hysteroscopy is identified as an abnormality. The study indicates that transvaginal sonography reveals an endometrial thickness of > or = 8 mm and the histopathologic diagnosis after dilatation and curettage is atrophic endometrial polyp or submucous myoma.     

宫腔镜及三维超声造影对子宫内膜器质性病变的诊断价值

目的评价宫腔镜及三维超声宫腔造影检查方法对子宫内膜器质性病变的诊断价值.方法回顾性分析54例子宫不正常出血的病人,应用经阴道三维超声宫腔内注液后扫查,再行宫腔镜检查,以病理结果为确诊依据对照不同检查结果间的差异.结果 23例诊断为子宫内膜息肉,15例诊断为黏膜下肌瘤,6例诊断为子宫内膜癌,10例诊断为子宫内膜增殖症.宫腔镜检查敏感度100%,特异度98.1%.三维超声造影检查敏感度为100%,特异度94.4%.结论宫腔镜为诊断子宫内膜占位病变的首选方法,结合三维超声宫腔造影,对确定治疗方案有很大辅助作用.     

宫腔镜对绝经后出血宫腔病因的诊断价值探讨

目的探讨宫腔镜对绝经后子宫出血(PMB)诊断效果。方法对我院2004年1月至2006年12月门诊收治绝经后子宫出血患者,妇科检查局部阴道及宫颈未发现明显异常,考虑出血来自宫腔的共125例,宫腔镜检查后常规刮宫,未能刮出组织者在直视下取活检。所有刮出物或活检组织均送病理检查。结果宫腔镜诊断宫腔异常病变的敏感性为97.8%(90/92),特异性为81.8%(27/33),阳性预测值为93.8%(90/96),阴性预测值为93.1%(27/29)。其中子宫黏膜下肌瘤100%,子宫内膜息肉90.0%,子宫内膜炎87.0%,子宫内膜癌73.3%,子宫内膜增生70.6%。结论对于绝经后阴道出血患者,行宫腔镜检查,全面观察宫腔情况,全面诊刮,必要时在直视下取活检,可以大大提高宫腔病变确诊率。