阴道超声联合宫腔镜诊治围绝经期妇女子宫内膜病变的临床价值

目的探究子宫内膜厚度与组织病理学诊断之间的关系,以及经阴道超声(TVS)联合宫腔镜检查(HS)对围绝经期妇女子宫内膜病变的临床应用价值。方法选取因异常子宫出血收治的围绝经期女性共130例。所有入选者均行经阴道超声检查,后行宫腔镜直视下检查行分段诊刮,送检刮出的组织,做病理学诊断。结果筛查子宫内膜病变的最佳内膜厚度的截止值为5.5 mm,其对应的灵敏度、特异度、约登指数、阳性预测值、阴性预测值分别是95.24%、51.38%、46.62%、27.40%、98.20%,HS对子宫内膜病变的灵敏度、特异度、阳性预测值、阴性预测值、符合率分别为96.26%,特异度86.96%,阳性预测值97.17%,阴性预测值83.33%,其中,对于子宫内膜非典型增生和子宫内膜癌的符合率分别为97.69%、99.23%。结论 TVS测量的子宫内膜厚度对子宫内膜病变是具有初筛作用的敏感方法,可在此基础上指导实施组织病理学检查鉴别内膜的性质。HS对诊断子宫内膜良恶性病变具有较高的符合率,可提高准确率。     

TVCDS联合HS检查对绝经后妇女子宫出血的诊断效能

目的探究经阴道彩色多普勒超声(TVCDS)联合宫腔镜检查(HS)对绝经后妇女子宫出血的诊断效能。方法选取2014年11月-2017年3月我院疑似绝经后子宫出血患者124例,均行TVCDS、HS,并于HS后取子宫内膜组织,行病理组织学检查,将其作为诊断金标准。观察对比TVCDS、HS单独及联合检查特异度、敏感度、准确性、阳性及阴性预测值。结果 TVCDS、HS联合诊断敏感度96.15%(50/52)高于TVCDS诊断82.69%(43/52)、HS诊断84.62%(44/52),阴性预测值97.18%(69/71)高于TVCDS诊断87.67%(64/73),差异有统计学意义(P0.05),TVCDS、HS单独及联合诊断特异度、准确性及阳性预测值相比,无明显差异(P0.05)。结论对疑似绝经后子宫出血患者,联合采用TVCDS、HS诊断,可有效提高诊断敏感度,诊断效能较高,在临床诊断中具有重要意义。     

经腹超声和经阴道超声诊断子宫内膜息肉的价值分析

目的:探讨经腹超声(TACDS)和经阴道超声(TVCDS)诊断子宫内膜息肉(EP)的临床价值。方法:选择2018年4月—2020年1月120例拟诊断为E P患者,均行TACDS和TVCDS检查,EP诊断以病理检查为诊断标准。比较TACDS、TVCDS以及TACDS+TVCDS诊断EP的符合率、特异度和灵敏度。结果:120例疑似EP患者中,经病理诊断,EP为106例,其他子宫内膜病变14例。TVCDS和TACDS+TVCDS诊断符合率分别为93.08%和96.15%,均高于TACDS诊断符合率(84.62%)(P<0.05)。TACDS、TVCDS、TACDS+TVCDS诊断EP特异度比较差异无统计学意义(P>0.05)。TVCDS和TACDS+TVCDS诊断EP灵敏度分别为93.40%和97.17%,均高于TACDS诊断EP的灵敏度(84.91%)(P<0.05)。结论:TVCDS是诊断EP的重要的无创检查方法,具有较高灵敏度,可联合TACDS为EP早期诊断提供有价值的参考。     

经阴道彩色多普勒超声检查对围绝经期妇女子宫内膜性质的预测价值

目的:评价经阴道彩色多普勒血流显像(TVCDFI)对预测围绝经期异常子宫出血妇女子宫内膜性质的价值.材料与方法:对临床拟诊子宫内膜病变需做诊刮或宫腔镜检查的512例围绝经期异常子宫出血妇女行常规经阴道超声检查(TVS)及TVS+CDFI,并与病理检查对照,比较两者的诊断符合率.结果:TVS与TVS+CDFI两者比较:内膜生理性改变、内膜增生、内膜炎的诊断符合率差异不大,无统计学意义;内膜息肉、内膜癌TVS与TVS+CDFI诊断符合率分别为:61.54%(32/52),61.54%(8/13);88.47%(46/52),92.86%(13/14),结果差异具有极显著性意义(P＜0.01).结论:TVS+CDFI对围绝经期异常子宫出血妇女子宫内膜性质有较高的预测价值.阴超检查子宫内膜时,常规应用CDFI观察内膜区血流信号,能有效提高子宫内膜微小病变及早期子宫内膜癌的检出率.     

经阴道超声与宫腔镜检查诊断绝经后服用他莫昔芬妇女子宫内膜病变的比较

目的 该研究比较了经阴道超声（transvaginal ultrasonography,TVS）与宫腔镜检查（hysteroscopy,HS）在诊断绝经后服用他莫昔芬（tamoxifen,TAM）对子宫内膜病变的价值,以探讨与其相关的监测方法.方法 随诊了46例绝经后因乳腺癌服用TAM（20mg/d）超过6个月的妇女.所有患者均施行了TVS、HS以及内膜组织病理学检查.TVS以子宫内膜厚度≥5mm为阳性判断标准.结果 TVS检查结果阳性21例（45.7%）中,经HS及病理诊断证实内膜息肉14例,单纯增殖型内膜2例,萎缩型内膜5例;TVS检查结果阴性25例（54.3%）中,内膜息肉8例,单纯增殖型内膜3例,萎缩型内膜14例.TVS检查的特异性为70.8%,敏感性为63.6%,阳性预测值为66.7%,阴性预测值为68.0%.而HS分别为100%、96.0%、95.7%和95.7%.息肉病人的TVS结果与非息肉病人比较差异有显著性（P=0.019）.结论 由于TAM对绝经后的子宫内膜具有雌激素样作用,能够引起内膜基质水肿,产生类似增生内膜的超声影像,导致TVS的检查结果与HS下所见以及内膜病检不相符.服用TAM的绝经后乳腺癌患者,单纯以TVS作为其内膜病变的筛选方法具有一定诊断价值,但存在较高的假阳性率且特异性较差.在确诊子宫内膜息肉方面HS具有特殊优势.     

宫腔镜应用于绝经后子宫内膜病变的临床诊断价值

目的探讨宫腔镜应用于绝经后子宫内膜病变诊断的临床价值。方法选取2016年4月-2018年4月该院100例绝经后子宫内膜病变患者,根据随机数字法,将其分为对照组(诊断性刮宫)和观察组(宫腔镜),每组各50例,比较两组患者子宫腔病变检出率,以及诊断各种子宫内膜病变的敏感度、特异度、阳性预测值和阴性预测值。结果观察组子宫内膜病变检出率明显高于对照组(P 0.05);观察组患者子宫内膜息肉、子宫黏膜下肌瘤检出率明显高于对照组(P 0.05);观察组患者子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜增生和子宫内膜癌等病变诊断的敏感度、特异度、阳性预测值和阴性预测值均高于对照组。结论宫腔镜能够有效、准确地诊断绝经后子宫内膜病变,其简单、快速、损伤小,值得临床推广。     

阴道超声联合腹部超声检查对子宫瘢痕妊娠患者诊断价值

目的研究阴道超声联合腹部超声检查对子宫瘢痕妊娠患者诊断准确率的影响。方法选取我院2017年5月~2019年5月收诊的疑似子宫瘢痕妊娠患者126例为研究对象,均行阴道超声、腹部超声检查,以临床诊断为金标准,比较阴道超声、腹部超声联合检查及单独检查的诊断价值。结果临床诊断证实,126例疑似子宫瘢痕妊娠患者中74例为子宫瘢痕妊娠,52例为非子宫瘢痕妊娠;阴道超声联合腹部超声诊断准确率91.27%、敏感度98.65%高于两者单独检查的准确率和敏感度(P<0.05);阴道超声联合腹部超声诊断特异度80.77%与两者单独检查比较无显著性差异(P>0.05)。结论子宫瘢痕妊娠患者应用阴道超声联合腹部超声检查可明显提高诊断准确率、敏感度,且不影响诊断特异度,为临床判断病情、选择处理措施提供合理、可靠的参考依据。     

宫腔镜与阴道超声检查子宫腔内病变临床价值探讨

目的对比宫腔镜检查（HS）与阴道超声检查（TVS）诊断子宫腔内病变的价值。方法对235例患者同时采用HS和TVS，并与最后的病理结果对照。结果HS对子宫内膜息肉和子宫内膜增生的敏感性和特异性分别是94．37％、81.7％和90．74％、98％；均高于TVS的71.2％、63％和77.2％、94％。TVS对子宫内膜癌诊断的敏感性是100％，高于HS的敏感性84.62％，但其特异性仅为66．67％，低于HS的敏感性91．67％。结论HS结合直视下活检是宫内疾病诊断的金标准。而TVS因其无创、低价、重复性好，可作为初筛方法。     

经阴道超声诊断深部浸润型子宫内膜异位症的临床价值分析

目的:探讨深部浸润型子宫内膜异位症(DIE)应用经阴道超声(TVS)诊断的临床价值。方法:选取2017年10月—2020年11月本院收治的80例DIE患者为研究对象,所有患者术前均接受TVS检查,并将检查结果与病理诊断结果相比,分析TVS诊断DIE的检出率及对累及组织检查的敏感度、特异度、阳性预测值、阴性预测值。结果:术后病理诊断结果为80例均为DIE,其中23例累及宫骶韧带,21例累及阴道直肠隔,26例累及子宫直肠陷窝,6例累及直肠,4例累及阴道。TVS诊断结果为73例为DIE,检出率为91.25%,其中22例累及宫骶韧带,18例累及阴道直肠隔,24例累及子宫直肠陷窝,5例累及直肠,4例累及阴道。TVS诊断DIE与术后病理诊断结果具有较高一致性(P<0.05)。TVS诊断DIE阴道直肠隔、宫骶韧带、子宫直肠陷窝、直肠、阴道等不同受累位置的敏感度、特异度、阳性预测值、阴性预测值分别为85.71%、88.14%、81.82%、89.66%;95.65%、91.23%、91.67%、92.86%;92.31%、92.59%、85.71%、96.15%;83.33%、93.24%、71.43%、94.52%;100.00%、85.53%、100.00%、85.53%,诊断效能较为理想。结论:TVS诊断DIE有较高检出率,且能够对病灶位置进行准确定位,有效反映患者病变累及状况,具有较高应用价值。     

高频超声联合低频超声诊断急性阑尾炎的价值

目的:探讨高频超声联合低频超声诊断急性阑尾炎的价值。方法:以62例疑似急性阑尾炎患者为对象,手术病理检查56例确诊为急性阑尾炎。所有患者均接受超声检查,分析高频及低频超声诊断急性阑尾炎的价值。结果:高频超声诊断急性阑尾炎的敏感度为87.50%、特异度为83.33%、准确度为87.10%。低频超声诊断急性阑尾炎的敏感度为82.14%、特异度为66.67%、准确度为80.65%。高频、低频超声联合检测诊断急性阑尾炎的敏感度为98.21%、特异度为100.00%、准确度为98.39%。高频超声、低频超声、联合检查诊断急性阑尾炎的敏感度比较,差异有显著性(P<0.05)。联合检查诊断急性阑尾炎的敏感度高于高频超声、低频超声(P<0.05)。低频超声诊断急性阑尾炎分类的符合率为82.14%,高频超声诊断急性阑尾炎分类的符合率为87.50%,联合检测诊断急性阑尾炎分类的符合率为98.21%。高频超声、低频超声联合检查诊断急性阑尾炎分类的价值高于高频、低频超声单独诊断(P<0.05)。结论:高频及低频超声对急性阑尾炎均具有一定的诊断价值,二者联合检查可提高急性阑尾炎诊断的准确度,并...     

经阴道彩色多普勒超声诊断子宫内膜病变的临床价值

目的：探讨评价经阴道彩色多普勒超声（TVS）对子宫内膜病变的临床诊断价值以及对子宫内膜癌肌层浸润的估计。方法：应用经阴道彩色多普勒超声对72例子宫内膜病变进行诊断并与手术病理结果对照分析。结果：经阴道彩色多普勒超声对子宫内膜病变的敏感性高为100％。与病理诊断符合率也高。其中萎缩性子宫内膜炎均100％；子宫内膜增生过长、粘膜下子宫肌瘤、子宫内膜息肉、子宫内膜癌分别为96．7％、94．1％、91．7％和83．3％。另外，内膜癌与其他宫内膜良性病变的血流显示率及动脉阻力指数RI值有显著性差异（P〈0．05），与病理结果有着显著的相关性。结论：经阴道彩色多普勒超声对子宫内膜病变诊断的敏感性和诊断符合率高。对于子宫内膜病变的诊断及鉴别诊断以及临床治疗方面具有极其重要价值。     

经阴道三维超声诊断子宫内膜病变的临床应用

目的 探讨经阴道三维超声诊断子宫内膜病变的价值。方法 对经阴道二维超声检查疑似宫腔内病变的46例已婚妇女进行经阴道三维超声检查，其结果与宫腔镜及病理相对照。结果 46例患者中子宫内膜增生16例，子宫内膜息肉12例．黏膜下子宫肌瘤9例，子宫内膜癌3例．余6例为正常子宫内膜分泌期改变；二维经阴道超声、三维经阴道超声诊断子宫内膜增生的特异性、敏感性、准确性分别为66．7%、93．7%、76．1%和90．0%、100％、93.5%；诊断内膜．息肉的特异性、敏感性、准确性分别为88．2%，58．3%、80．4%和100%、83．3％、95.7％，结论 三维经阴道超声提高了子宫内膜病变的诊断水平．与二维经阴道超声结合是诊断子宫内膜病变的首选方法。     

Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation.

OBJECTIVES: To evaluate the accuracy of transabdominal sonography (TAS) and transvaginal sonography (TVS) for the diagnosis of adenomyosis, and to determine the diagnostic relevance of various sonographic criteria. SUBJECTS AND METHODS: A total of 129 women scheduled for hysterectomy were enrolled into this prospective study. Group 1 (n = 23) consisted of patients with menometrorrhagia who were free of myoma and endometrial disorders on TAS. Group 2 consisted of all the other patients (n = 106). TAS and TVS findings were compared to histopathological results. RESULTS: The prevalence of adenomyosis in Groups 1 and 2 was 91.3% and 24.5%, respectively. TAS had limited value for the diagnosis of adenomyosis in both groups. The sensitivity, specificity, and positive and negative predictive values of TVS in Groups 1 and 2 were 80.9% and 38.4%, 100% and 97.5%, 100% and 83.3%, and 40% and 82.9%, respectively. The accuracy of combined TAS and TVS in Groups 1 and 2 was 91.3% and 83%, respectively. The presence of myometrial cysts was the most specific ultrasound diagnostic criterion for adenomyosis. Hypoechoic linear myometrial striations related to the presence of myometrial hypertrophy correlated to hormonal status with a sensitivity of 66.6% and a specificity of 100% in Group 1. CONCLUSIONS: Our results show that TAS has a limited diagnostic capacity for adenomyosis but also that TVS alone was poor in patients with an enlarged uterus. In these cases a combination of TVS and TAS should be used.     

Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women.

OBJECTIVE: To compare the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonography (SIS) for detecting intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. METHOD: Consecutive premenopausal women who underwent hysterectomy for abnormal uterine bleeding were included. All women underwent TVS and SIS before their hysterectomy. The findings at TVS and SIS were compared with the findings of the hysterectomy specimen. Sensitivity, specificity, and likelihood ratios were calculated. RESULTS: The results of 50 patients with abnormal uterine bleeding were evaluated. Histological examination revealed normal endometrial histology in 27 patients, submucous myomas in 13 patients and intracavitary polyps in 10 patients. The sensitivity of TVS in directly visualizing intracavitary abnormalities was 61% for a specificity of 96%. The likelihood ratio of presence of an intracavitary abnormality was 16 and the likelihood ratio of absence of such a finding was 0.41. When defining abnormality at TVS as direct visualization of an intracavitary abnormality or an increased endometrial thickness (cut-off level 5 mm), the sensitivity of TVS was 87% for a specificity of 56%, with corresponding likelihood ratios of 2 and 0.23, respectively. The sensitivity and specificity of SIS was 100% and 85% with likelihood ratios of 6 and 0.0, respectively. No intracavitary abnormality was missed by SIS. CONCLUSION: The diagnostic accuracy of SIS is higher than the accuracy of TVS. A combined approach using endometrial thickness measurement by TVS and, reserving SIS for patients with increased (> 5 mm) endometrial thickness, or endometrium inadequately visualized on TVS, is the optimal method of reducing the hysteroscopy rate.     

宫腔声学造影诊断子宫内膜息肉的价值

目的：评价宫腔声学造影（SHG）对子宫内膜息肉的诊断价值。方法：对临床拟诊宫内膜息肉的76例患者进行TVS、SHG及官腔镜手术-病理检查,并对结果进行分析。结果：以手术病理结果作为诊断金标准,内膜息肉48例,黏膜下肌瘤9例,内膜增生10例,官腔内机化血凝块3例,正常内膜6例。SHG对子宫内膜息肉诊断的准确性为93．4％,敏感性为93．7％,特异性为92．8％。TVS对子宫内膜息肉诊断的准确性为59．2％,敏感性为81．2％,特异性为21．4％。两种方法对内膜息肉的诊断准确率比较有显著差异（χ^2=5．45,P=0．019）。结论：官腔声学造影准确率高,是诊断子宫内膜息肉的可靠方法。     

经腹部联合经阴道彩色多普勒超声可提高子宫肌瘤诊断的准确率

目的研究经腹部联合经阴道彩色多普勒超声检查鉴别诊断子宫肌瘤的价值。方法选择2015年5月~2018年9月本院收治的子宫肌瘤患者(n=245)和子宫腺肌瘤患者(n=105),均在本院进行经腹部超声（TAS)和经阴道超声（TVS)检查,扫查子宫以及肿块的形态、大小、回声等情况,并观察肌层、内膜血流分布情况。以手术病理学为金标准,分析TAS、TVS以及两者联合鉴别诊断子宫肌瘤的准确度,并分析两者声图像表现,比较两者子宫动脉血流参数。结果TAS联合TVS诊断的准确度为96.57%、敏感度为96.19%、特异度为96.73%,均高于单纯TAS或TVS诊断（P < 0.05);子宫肌瘤大部分病灶较为清晰,且有假包膜,病灶回声以低回声为主,病灶部位血流较为丰富,呈环形或半环形;子宫腺肌瘤子宫形态较为正常,病灶部位模糊不清,且无假包膜,内部回声多见强回声,病灶部位周围血流不丰富;子宫肌瘤患者阻力指数、血流搏动指数等血流动力学参数指标水平均低于子宫腺肌瘤患者（P < 0.05)。结论TVS联合TAS检查可提高子宫肌瘤鉴别诊断的准确率,降低误诊、漏诊现象,有较好的临床诊断价值。      

经腹联合经阴道超声诊断血管前置

目的 探讨经腹部超声(TAS)联合经阴道超声(TVS)检查诊断血管前置的临床应用价值。方法 回顾性分析31例产前临床疑诊血管前置孕妇的超声检查及手术病理资料。以手术病理结果为金标准,评价并比较单纯TAS检查与TAS联合TVS检查对血管前置的诊断效能。结果 21例经手术病理证实为血管前置,另10例非血管前置。单纯TAS检查的敏感度、特异度、准确率分别为80.95%(17/21)、63.64%(7/11)及77.42%(24/31);TAS联合TVS检查的敏感度(21/21)、特异度(10/10)及准确率(31/31)均为100%,均高于单纯TAS检查(P均< 0.05)。结论 TAS联合TVS检查诊断血管前置较单纯TAS检查可明显提高诊断敏感度、特异度及准确率。     

宫腔镜、宫腔声学造影与阴道超声对绝经后子宫出血诊断价值的比较

[目的]评价和比较宫腔镜、宫腔声学造影与阴道超声对绝经后子宫出血的诊断价值.[方法]2010年5月至2011年1月诊治绝经后子宫出血患者158例,平均年龄62岁,对137例资料完整患者其子宫内膜宫腔镜、宫腔声学造影与阴道超声检查结果进行分析比较.[结果]137例患者所有异常病变,宫腔镜、宫腔声学造影、阴道超声的诊断灵敏度分别为92.3％、89.6％、70.0％,特异度分别为80.7％、77.3％、50.0％,阳性预测值分别为96.2％、95.3％、80.9％,阴性预测值分别65.3％、58.3％、35.4％.[结论]宫腔镜是一种优于宫腔声学造影和阴道超声诊断绝经后子宫出血的方法,宫腔声学造影具有方面、安全、诊断精确性优于阴道超声并接近于宫腔镜等优点,可作为绝经后子宫出血的优选检查方法.     

Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics.

Despite the widespread use of TVS for diagnosing EP and extensive literature on the subject, there is no consensus regarding the best positivity criterion for adnexal findings or the performance characteristics of TVS. We conducted a literature search to identify original studies presenting suitable data on the use of TVS for the diagnosis of EP. The data were combined to determine the sensitivity and specificity of four sonographic criteria for EP, listed in order from most to least stringent: Criterion A, living extrauterine pregnancy; criterion B, extrauterine gestational sac containing yolk sac or embryo; criterion C, empty "tubal ring" or extrauterine gestational sac containing yolk sac or embryo; and criterion D, any adnexal mass other than a simple cyst. Positive and negative predictive values were computed using Bayes' theorem. Ten studies involving a total of 2216 patients, 565 with EP and 1651 without EP, were included in our analysis. Based on the combined data from these studies, criteria A, B, and C all have high specificities (99.5-100%) and positive predictive values (97.8-100%) but low sensitivities (20.1-64.6%) and mediocre negative predictive values (78.5-89.1%). Criterion D, the most lax criterion, has the most uniformly excellent characteristics, with only slightly lower specificity (98.9%) and positive predictive value (96.3%) but considerably higher sensitivity (84.4%) and negative predictive value (94.8%). The performance characteristics of TVS criteria for EP, computed by pooling data from published studies, indicate that the appropriate TVS criterion to diagnose EP is any noncystic adnexal mass. These performance characteristics can be used as a basis for comparing TVS with other proposed diagnostic modalities for EP.