经阴道彩色多普勒能量图对绝经后子宫出血性疾病的诊断价值

目的 探讨经阴道彩色多普勒能量显像（TV－CDE）对绝经后子宫出血疾病的诊断价值。方法 对136例绝经后子宫出血妇女进行了TV－CDE检查,观察子宫内膜厚度、内膜回声及血流变化。结果 TV－CDE测量内膜厚度＜5mm不做诊刮,定期观察;内膜癌和良性病变的血流显示率、动脉PI值和PI值差异均有显著性意义（P均＜0．05）。结论 TV－CDE可作为绝经后子宫出血患者的首选检查方法。     

经阴道超声判断子宫内膜癌肌层浸润深度

术前应用经阴道超声（ＴＶＳ）对２７例子宫内膜癌患者进行了检查，测量子宫肌层浸润深度，并与术后组织病理学结果对照。结果显示：２１例可见内膜回声，其平均厚度为１４．５±５．４ｍｍ（４．８～２５ｍｍ）。ＴＶＳ准确判断出８５．２％患者的肌层浸润深度，２２例患者（８１．５％）的超声分期正确。彩色多普勒显示肿瘤内或周围有血流，深肌层浸润者的阻力指数和搏动指数明显低于无肌层浸润者。认为ＴＶＳ对子宫内膜癌的术前分期和制定个体化治疗方案具有重要作用。     

经阴道彩色多普勒对子宫内膜病的诊断价值

本文对２１９例临床拟诊为子宫内膜病患者进行经阴道彩色多普勒技术检查，另对２０例正常妇女作对照组。对被检查者子宫均进行子宫内膜厚度及形态学观察，以及子宫血流动力学变化的研究，并与病理检查比较。认为，正常子宫内膜与子宫良性内膜病在子宫血流动力学上无显著性差异（Ｐ＞０．０５）；子宫恶性内膜病与良性内膜病，在子宫内膜厚度、形态及血流动力学上存在显著差异（Ｐ＜０．０５）。绝经后子宫内膜癌发生率显著升高     

经阴道彩色多普勒超声对绝经后阴道出血的诊断

本文对１２６例绝经后阴道出血患者进行经阴道彩色多普勒检查，进行了子宫内膜厚度及形态学观察，以及子宫动脉血流动力学变化的研究，并与病理检查比较。认为，炎性病变引起绝经后出血最多。子宫内膜良性病与子宫内膜癌在内膜厚度及血液动力学上存在显著差异（Ｐ＜０．０５）。随绝经年限的增加，内膜癌的发生率显著升高     

经阴道彩色超声对绝经后子宫内膜病变的诊断

目的：探讨经阴道彩色超声对绝经后子宫内膜病变的诊断价值。方法：采用经阴道彩色超声回顾性观察200例绝经后子宫出血患者的超声图像特征、子宫内膜厚度及血流阻力指数。结果：子宫内膜癌的内膜厚度明显高于子宫良性病变的内膜厚度,且子宫内膜癌的内膜厚度均〉5 mm;子宫内膜癌的血流阻力指数明显低于良性病变,两项均有统计学差异（P〈0.05）。结论：经阴道彩色超声检查是诊断子宫内膜疾病的常规首选方法。     

米非司酮配伍米索前列醇终止早孕的子宫血流研究

本研究应用经阴道彩色多普勒（ＴＶＣＤ）观察早孕期药物流产，旨在探讨早孕期药物流产前、中、后子宫血流变化特点。６５例早孕期妇女自愿终止妊娠。研究结果显示：用药前，显示子宫动脉呈高阻（ＲＩ０．８４±０．０５），螺旋动脉、滋养层血流及妊娠黄体血流呈低阻（ＲＩ０．４４～０．５５）。用米非司酮后，可见子宫肌壁收缩运动，孕囊随宫缩发生大小、形态及位置的变化；子宫肌层血流较用药前增多；子宫动脉阻力指数较用药前下降；舒张期流速增加（Ｐ＜０．０１）．用米索前列醇后，显示子宫动脉ＲＩ较用米非司酮后升高（Ｐ＜０．０１）；螺旋动脉和用药前比较显示ＲＩ上升和流速下降（Ｐ＜０．０１）．滋养层血流检测率下降（Ｐ＜０．０１）。黄体血流舒张期流速下降。     

二尖瓣狭窄球囊扩张术前、后肺静脉血流和左房压力的关系

目的： 探讨定量评估左房压力和左室舒张功能的新途径。方法： 利用经胸多普勒超声测量１５例窦性心律风心病二尖瓣狭窄患者在二尖瓣球囊扩张术（ＰＢＭＶ） 前、后的肺静脉血流, 并与ＰＢＭＶ术前、后的左房压力对比。结果： １、成功的ＰＢＭＶ术后, 立即引起窦性心律患者肺静脉收缩血流的增加。收缩期血流峰值（Ｓ） 从４３．９１±７．６９ｃｍ ／ｓ增至５０．９７±１０．０９ｃｍ ／ｓ, Ｐ＜ ０．００２。收缩期血流速度时间积分 （ＳＶＴＩ） 从７．８８±３．１７ｃｍ 增至９．８５±３．１３ｃｍ , Ｐ＜ ０．００１。２．左房压力和肺静脉血流有良好的相关性。左房压力和收缩分数（ＳＦ＝ ＳＶＴＩ／ＳＶＴＩ＋ ＤＶＴＩ） 相关性最好为ｒ＝ － ０．７１, Ｐ＜ ０．０５。结论： 肺静脉血流可以评估左房压力。即ＳＦ％ ＜ ５０％ 时, 左房压力＞ １８ｍ ｍ Ｈｇ。     

彩色多普勒超声对绝经后宫颈癌血流变化及其意义的探讨

目的　为了探讨绝经后宫颈癌血流动力学的变化及其临床意义。方法　对６５ 例绝经后的宫颈癌和４０ 例绝经后的正常妇女进行了ＣＤＦＩ检查。结果　宫颈癌患者宫颈处见丰富的血管回声,子宫动脉收缩期的血流速度为２１ ±２１４ｃｍ／ｓ,较正常组（１０ ±１９５ ｃｍ／ｓ） 高。两者比较有显著性差异（ Ｐ＜ ００１） 。宫颈癌患者子宫动脉的阻力指数０４ ±００５６ ,较正常组０７ ±００７４ 低。两者比较有显著性差异（ Ｐ＜ ００１） 。结论　绝经后宫颈癌导致子宫动脉产生高速低阻的血流和宫颈处血管数目增加。随着肿瘤内血管数目的增加,肿瘤宫旁浸润和淋巴结转移的发生率逐渐增加     

糖尿病与动脉硬化关系的超声检查

目的：使用超声这一无创性检查手段研究糖尿病与动脉硬化性血管障碍的关系。方法：对糖尿病７５例及非糖尿病者４５例进行超声检查,观察两侧颈动脉、髂动脉及股动脉并计测血管内径（Ｄ）、内膜－中层厚度（ＩＭＴ）、收缩期最高流速（ＭＡＸ）、舒张期流速（ＭＩＮ）、血流速度积分（ＶＴＩ）、脉动指数（ＰＩ）、阻力指数（ＲＩ）、Ｓ／Ｄ及有无斑块形成,进行分组统计。结果：ＩＭＴ随年龄增加而增厚（Ｐ＜０．０５）,相同年龄组之间比较,糖尿病组较非糖尿病组增厚（Ｐ＜０．０１）。各大动脉的有合并症组、斑块组、５年以上组、ＩＤＤＭ组比无合并症组、无斑块组、５年以下组、ＮＩＤＤＭ组增厚（Ｐ＜０．０５）。各项血流参数在糖尿病与非糖尿病组间无显著差别（Ｐ＞０．０５）。结论：大动脉的ＩＭＴ与动脉粥样硬化的程度有关,如定期观察,可以判断糖尿病动脉硬化的进展情况、治疗效果及予后。     

经食管多普勒定量估测冠状动脉血管阻力及血管储备

应用经食管多普勒超声心动图（ＴＥＥ）对３０例冠状动脉造影患者测量注射潘生丁前后左前降支平均舒张期血流率（Ｖｃｏｒ）、冠脉血管阻力（Ｒｃｏｒ）和冠脉血管储备（ＣＶＲ）。静息状态正常组与狭窄各组平均动脉压（ＭＡＰ）、Ｖｃｏｒ和Ｒｃｏｒ无显著差异。注射潘生丁后狭窄各组较对照组的Ｒｃｏｒ显著增加、Ｖｃｏｒ和ＣＶＲ显著降低而ＭＡＰ基本不变；ＰＤＳ＜７５％与≥７５％组的注药后Ｒｃｏｒ和ＣＶＲ无显著差异，血管狭窄积分（ＡＳＩ）＜１．５ｃｍ与≥１．５ｃｍ组两指标差异显著。注药后的Ｒｃｏｒ与ＡＳＩ成正相关（ｒ＝０．６３，Ｐ＜０．０１），与ＰＤＳ不相关；ＣＶＲ与ＡＳＩ和ＰＤＳ成较好的负相关（ｒ＝－０．８２，－０．５２）。本研究为冠状动脉病变功能严重度的定量估价提供了参考依据。     

Transvaginal sonography in postmenopausal women

Transvaginal sonography (TVS) is a recent addition to the diagnostic techniques available for the evaluation of the female pelvis. Our experience in over 200 cases of postmenopausal women is the subject of this synoptic review. Using this technique in 60 women, we were able to detect endometrial changes such as endometrial carcinoma or adenomatous hyperplasia in 81% and in a group of 19 patients myometrial invasion in 84%. Fibroids of different sizes and locations could be recognized, some of them with signs of cystic degenerations. In 48 postmenopausal women, TVS was used to follow the morphologic changes in the endometrium stimulated by hormone replacement therapy. Histological features of the endometrium were in close correlation with the sonographic patterns obtained. Ultrasound evaluation has been suggested as a possible screening tool for early changes in ovarian size and morphology. Fifty patients were evaluated for the effectiveness of TVS to detect ovarian pathology. The sensitivity and specificity were 83% and 100%, the same as that of gross examination of the ovary at the time of surgery. It seems that TVS is a reliable tool in the detection of early changes in the postmenopausal ovary, but further evaluation in a large population is necessary to assess the usefulness of TVS as a routine screening tool for early ovarian carcinoma. Twenty-nine postmenopausal women with unilateral simple cysts (diameter less than or equal to 5 cm) were identified. All exhibited benign histopathologic changes. We conclude that small (less than 5 cm) postmenopausal cysts have a low incidence of malignancy and could be followed by TVS without immediate surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Transvaginal color and pulsed Doppler sonography of the endometrium: a possible role in reducing the number of dilatation and curettage procedures.

The objectives of the study were to establish color and pulsed Doppler sonographic characteristics of uterine vascularity in postmenopausal patients with pathologic endometrium in order to reduce the number of unnecessary diagnostic dilatation and curettage procedures. The prospective study involved 42 postmenopausal patients who were examined, prior to dilatation and curettage operation, with transvaginal color and pulsed Doppler sonography. Twenty patients had symptoms such as vaginal bleeding or clinically enlarged uterus and 22 postmenopausal women, from our screening group, were asymptomatic. Endometrial thickness (cut-off value of 8 mm), rates of visualization, and the density of uterine, myometrial (peritumoral) and endometrial (intratumoral) vessels were used, along with pulsatility and resistive indices of these vessels, to assess and correlate with endometrium pathology. Endometrial thickness was greater than 8 mm in all cases of endometrial carcinoma (14 of 14 cases), endometrial hyperplasia (eight of eight cases), and one endometrial polyp. In all cases of uterine myoma (nine cases) and in asymptomatic controls (11 subjects) the endometrium thickness was below 8 mm. Percentage of visualization of myometrial and endometrial vessels in cases of endometrial carcinoma was 93% and 43% respectively, which was significantly higher than for cases with benign endometrium (P < 0.05). RI and PI values of these studied vessels of endometrial carcinoma were significantly lower than those for endometrial hyperplasia (P < 0.05). In 80% of cases of endometrial carcinoma, dense vascularity was found in the myometrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium.

OBJECTIVE: To evaluate the role of transvaginal power Doppler sonography to discriminate between benign and malignant endometrial conditions in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography. METHODS: Ninety-one postmenopausal women (median age, 58 years; range, 47-83 years) presenting with uterine bleeding and a thickened endometrium (> or = 5-mm double-layer endometrial thickness) on transvaginal sonography were included in this prospective study. Endometrial blood flow distribution was assessed in all patients by power Doppler immediately after B-mode transvaginal sonography. Three different vascular patterns were defined: Pattern A: multiple-vessel pattern, Pattern B: single-vessel pattern and Pattern C: scattered-vessel pattern. Histological diagnoses were obtained in all cases. No patient taking tamoxifen citrate or receiving hormone replacement therapy was included. RESULTS: Histological diagnoses were as follows: endometrial cancer: 33 (36%), endometrial polyp: 37 (41%), endometrial hyperplasia: 14 (15%), endometrial cystic atrophy: 7 (8%). Blood flow was found in 97%, 92%, 79% and 85% of cases of carcinoma, polyp, hyperplasia and endometrial cystic atrophy, respectively. A total of 81.3% of vascularized endometrial cancers showed Pattern A, 97.1% of vascularized polyps exhibited Pattern B and 72.7% of vascularized hyperplasias showed Pattern C. Sensitivity and specificity for endometrial cancer were 78.8% and 100%. For endometrial polyp these respective values were 89.2% and 87% and for hyperplasia they were 57.1% and 88.3%. CONCLUSIONS: Transvaginal power Doppler blood flow mapping is useful to differentiate benign from malignant endometrial pathology in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.     

Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound/hysteroscopic study.

OBJECTIVES: The aim of this study was to assess if endometrial thickness could be used to select postmenopausal women on hormonal replacement therapy (HRT) at increased risk for endometrial abnormalities. The secondary aim was to assess if endometrial abnormalities were more likely to occur in patients with increased endometrial thickness or in patients with unexpected bleeding. METHODS: Bi-endometrial thickness was measured by transvaginal ultrasound (TVS) in postmenopausal patients on sequential or combined HRT regimens. Women following a sequential regimen underwent TVS examination immediately after their withdrawal bleed, always between 5 and 10 days after the last progesterone tablet. A hysteroscopy with endometrial biopsy was performed within 5 days after the TVS examination, when endometrial thickness was > or = 4 mm, or when unscheduled bleeding was observed. RESULTS: A total of 190 women were recruited. In 138 women on sequential regimens, the mean value of endometrial thickness was 3.6 mm +/- 1.5, and in 52 women on combined regimens it was 3.2 mm +/- 1.8 (P = n.s.) Twenty-eight patients (15%) had an endometrial thickness > 4 mm, 35 patients (18.4%) reported unexpected bleeding. The percentage of abnormal endometrial findings (9%; three of 35) in patients selected for unscheduled bleeding was significantly lower than the percentage of abnormal findings in patients selected for hysteroscopy for endometrial thickness > 4 mm (36%; 10 of 28) (P < 0.01). All patients with unexpected bleeding and endometrial thickness < or = 4 mm (24 cases) were found to have an atrophic endometrium. CONCLUSIONS: Endometrial thickness in patients on sequential HRT, measured soon after withdrawal bleeding, is not significantly different from thickness measured in patients on combined HRT. Patients on HRT with an endometrial thickness of > 4 mm could be considered for histological sampling. The prevalence of abnormal endometrial findings in patients with a thick endometrium is significantly higher than the prevalence observed in patients with unexpected bleeding.     

经阴道超声测量对绝经后子宫内膜癌的诊断价值

目的:评价经阴道超声测量对绝经后子宫内膜癌的诊断价值。方法:选择因经阴道超声提示宫腔占位行宫腔镜检查术绝经后妇女520例,分析绝经后子宫内膜癌患者的相关特征。以病理诊断结果为金标准,评价经阴道超声和宫腔镜诊断子宫内膜癌的灵敏度和特异度。以ROC曲线下面积确定经阴道超声测量宫腔占位大小诊断绝经后子宫内膜癌的最佳临界值。结果:绝经后阴道流血(postmenopausal bleeding,PMB)、宫腔占位大及宫腔积液多与绝经后子宫内膜癌相关,而年龄、绝经年龄、绝经时间、内膜厚度与绝经后子宫内膜癌无关。伴PMB妇女的子宫内膜癌发生率是无PMB妇女的6.4倍。宫腔镜诊断绝经后子宫内膜癌的准确性高于经阴道超声。超声测量宫腔占位大小诊断无PMB子宫内膜癌的最佳临界值为14.5mm,此时阳性预测值为10.75%、阴性预测值为99.14%。超声测量宫腔占位大小诊断伴PMB绝经后子宫内膜癌的最佳临界值为18.5mm,此时阳性预测值为55.56%、阴性预测值为91.94%。结论:对于无PMB的妇女,经阴道超声测量宫腔占位大于14.5mm作为行宫腔镜检查的指征较合理;而对于经阴道超声发现宫腔占位且伴PMB的妇女,子宫内膜癌发生率较高,建议均行宫腔镜检查。     

Errors in the measurement of endometrial depth using transvaginal sonography in postmenopausal women on tamoxifen: random error is reduced using saline instillation sonography.

OBJECTIVE: The endometrium in women on tamoxifen is often made irregular by small cysts. The aim of this study was to assess the accuracy and precision of the measurement of endometrial depth by transvaginal sonography. METHODS: The endometrial depth from endometrial biopsies obtained with the resectoscope in 15 women receiving tamoxifen was compared to the endometrial depth measured by TVS. The inter-observer variability was measured in 58 women. RESULTS: In those biopsies of sufficient quality to allow a measurement, the corresponding depth measurement obtained by ultrasound was up to 3 mm greater than the histological measurement. The interobserver variability for the measurement of endometrial depth using TVS was assessed in 58 postmenopausal women on tamoxifen. The interobserver variability deteriorated as the mean endometrial depth increased, probably because the increase in depth resulted from greater morphological changes within the endometrium such as cyst formation which resulted in an irregular endometrial/myometrial boundary. This may, however, be improved by performing saline instillation sonography. In a prospective study of 10 postmenopausal women, the interobserver variability was significantly greater during tamoxifen treatment compared to pretreatment. CONCLUSIONS: On the basis of the above, if uterine surveillance using TVS were to be offered to postmenopausal women on tamoxifen, then the procedure should be augmented by saline instillation sonography if the endometrial depth is > 4 mm, as this will improve the measurement precision and also identify intrauterine pathology.     

How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding.

OBJECTIVE: Transvaginal sonography (TVS) is routinely performed as part of a pelvic sonogram in postmenopausal women, and images of the endometrium are frequently obtained. In women without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium is not known. The aim of this study was to determine an endometrial thickness threshold that should prompt biopsy in a postmenopausal woman without vaginal bleeding. METHODS: This was a theoretical cohort of postmenopausal women aged 50 years and older who were not receiving hormone therapy. We determined the risk of cancer for a postmenopausal woman with vaginal bleeding when the endometrial thickness measures > 5 mm, and then determined the endometrial thickness in a woman without vaginal bleeding that would be associated with the same risk of cancer. We used published and unpublished data to determine the sensitivity and specificity of TVS, the incidence of endometrial cancer, the percentage of women symptomatic with vaginal bleeding, and the percentage of cancer that occurs in women without vaginal bleeding. Ranges for each estimate were included in a sensitivity analysis to determine the impact of each estimate on the overall results. RESULTS: In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is thick (> 5 mm) and < 0.07% if her endometrium is thin (< or = 5 mm). An 11-mm threshold yields a similar separation between those who are at high risk and those who are at low risk for endometrial cancer. In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the endometrium is thick (> 11 mm) and 0.002% if the endometrium is thin (< or = 11 mm). The estimated risk of cancer was sensitive to the percentage of cancer cases that were estimated to occur in women without vaginal bleeding. For the base case we estimated that 15% of cancers occur in women without vaginal bleeding. When we changed the estimate to project that only 5% of cancers occur in women without vaginal bleeding, the projected risk of cancer with a thick measurement was only 2.2%, whereas when we estimated that 20% of endometrial cancers occur in women without bleeding, the projected risk of cancer with a thick measurement was 8.9%. As a woman's age increases, her risk of cancer increases at each endometrial thickness measurement. For example, using the 11 mm threshold, the risk of cancer associated with a thick endometrium increases from 4.1% at age 50 years to 9.3% at age 79 years. Varying the other estimates used in the decision analysis within plausible ranges had no substantial effect on the results. CONCLUSIONS: In a postmenopausal woman without vaginal bleeding, if the endometrium measures > 11 mm a biopsy should be considered as the risk of cancer is 6.7%, whereas if the endometrium measures < or = 11 mm a biopsy is not needed as the risk of cancer is extremely low.     

Endometrial and myometrial thickness and uterine blood flow in postmenopausal women: the influence of hormonal replacement therapy and age

The aim of our study was to assess the age and hormonal influence on endometrial and myometrial thickness and uterine blood flow in postmenopausal women. One hundred and nine healthy postmenopausal women were examined by transvaginal ultrasonography and color Doppler ultrasonography. Twenty women (18.4%) were under continuous HRT for at least 1 year. In all patients, full thickness of the endometrium and half thickness of the myometrium was measured. Pulsed Doppler waveforms were used to calculate the RI for the left and right uterine arteries. Endometrium thickness in the groups without HRT did not change as the years of postmenopause progressed. This was also true for myometrial thickness. The resistance to blood flow in the uterine arteries remained the same as the postmenopause progressed, but with each 5 year analysis, the ability to see the uterine arteries decreased. The duration of the therapy did not affect the measured parameters. The thickness of the endometrium was larger in the groups with HRT in comparison with all groups without HRT (P < 0.01). Myometrial thickness and uterine blood flow are not affected and did not show any significant influence from HRT. In conclusion, continuous HRT significantly influences the thickness of the postmenopausal endometrium but not of the myometrium or the uterine artery blood flow.     

经阴道彩色多普勒诊断绝经后子宫内膜良恶性病变的应用

目的 观察经阴道彩色多普勒血流显像在鉴别早期子宫内膜癌与内膜良性病变中的临床价值。方法 对54例绝经后异常子宫出血妇女行 级超声检查、经阴道彩色多普勒（TVCD）检查及诊刮病理活检，比较良、恶性内膜病变组子宫动脉收缩期峰值流速（PSV）、阻力指数（RI）以及子宫内膜动脉的收缩期峰值流速（PSVen）及阻力指数（RIen）的差异，并观察良、恶性内膜病变组内膜内血注显像的差异。结果 子宫动脉的PSV、RI在良恶性病变组间的差异无显著性意义（P＞0.05），恶性病变组内膜血流显示率为90.0%，明显高于良性病变组的9.1％（P＜0.01）。两组间内膜动脉PSV值无显著性差异，而RI值虽有重叠,但恶性内膜病组内膜动脉显示出低阻力的血流动力学特点，与良必病变组比较有显著性差异，而RI值虽有重叠,但恶性内膜病组内膜动脉显示出低阻力的血流动力学特点，与良性病变组比较有显著性差异（P＜0.05）。结论 TVCD可进一步提高内膜良恶性病变的鉴别水平，对子宫内膜癌的早期检出有一定价值。