55岁及以下乳腺癌术后患者子宫及卵巢病变的监测价值研究

目的：探讨55岁及以下乳腺癌术后患者出现子宫内膜及卵巢病变的临床及超声监测价值 方法：回顾性分析首都医科大学北京妇产医院及首都医科大学大兴教学医院2011年1月至2021年10月以来所有55岁及以下乳腺癌术后患者临床怀疑出现子宫及卵巢病变的病例共148例,所有病例均做出了诊刮或手术取得了子宫内膜织学病理或做出随访观察,根据组织学病理结果应用X2检验及独立样本T检验统计分析出55岁及以下乳腺癌术后患者出现子宫及卵巢恶性病变特点,并应用统计积分量化的方式分析经阴道超声监测子宫内膜恶性病变的价值。 结果：首先根据病例是否应用他莫昔芬TAM治疗分为TAM组87例及非TAM组61例,根据子宫内膜诊刮及手术病理两组出现良性及恶性子宫内膜比例进行统计学比较得出P=0.712;进而对所有子宫内膜良性组共128例及恶性组共20例病例的病人一般资料及超声声像图各指标进行分别统计,两组病例在病人体重指数（P=0.048）、乳腺癌术后时间（P=0.000）、家族史（P=0.005）及是否出现临床症状（P=0.000）上存在明显差异,超声指标上在子宫内膜回声是否均匀（P=0.038）、内膜是否存在囊性变（P=0.038）、内膜有无息肉样变（P=0.000）、有无宫腔积液（P=0.000）及内膜是否存在动脉血流（P=0.000）上均存在明显差异。采用超声指标积分量化的方式评估子宫内膜恶性病变,当积分≥2分时诊断的敏感性及特异性分别为70%及82%,而当超声积分≥3分时诊断的敏感性较低约40%,但特异性较高约96%。本研究148例乳腺癌病人中63例发现卵巢包块,62例为囊性、部分囊内伴有细分隔,1例为囊实性,手术病理均为良性病变或在随访中缩小或消失。 结论：本研究服用TAM的乳腺癌术后患者子宫内膜恶性变的发生率与未服用者比较无明显差异。本研究中子宫内膜恶性病例的总体发生率较高,为13.5%,临床上乳腺癌术后患者出现体重指数增加、乳腺术后时间较长、有恶性肿瘤家族史及出现妇科临床症状的患者出现子宫内膜恶变机率增加;超声图像上显示子宫内膜回声不均、内膜出现息肉样变、宫腔积液及内膜存在动脉血流应警惕出现子宫内膜恶变;而乳腺癌患者出现卵巢病变本组均为良性或可自行吸收。临床上可以尝试应用超声指标积分量化的方式评估子宫内膜恶性病变。     

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.     

"高回声边缘"在诊断子宫内膜息肉中的价值

子宫内膜息肉是子宫内膜的局部增生．临床上不易与子宫内膜癌、子宫内膜增生等鉴别。Caspi等曾提出于宫内膜息肉在超声下呈现“高回声的边缘”，为研究“高回声边缘”在诊断子宫内膜息肉中的价值．本研究对经阴道超声检查发现可疑子宫内膜病变的100例患者进行分析；     

经阴道超声宫腔造影术在诊断子宫疾病中的应用

目的探讨经阴道超声宫腔造影术(SHG)在诊断子宫疾病中的价值.方法应用经阴道超声宫腔造影术对40例子宫疾病的声像图特点进行了观察,并与手术及诊刮结果对比.结果 40例病例中子宫体肥大、子宫肌腺症合并结节5例,宫腔粘连5例,子宫内膜息肉8例、子宫内膜增厚4例、子宫内膜增厚伴囊样改变2例、子宫内膜息肉样增生1例、子宫粘膜下肌瘤10例、子宫内膜异常回声(怀疑内膜癌)2例、不全纵隔子宫1例、节育环移位嵌顿2例,粘膜下肌瘤与内膜息肉诊断与手术对比均准确.结论 SHG的操作简单易行,患者无痛苦、易接受,诊断效果明确.是一种诊断宫腔内疾病的良好方法.     

经阴道三维超声对宫腔病变的鉴别诊断

目的 评价经阴道三维超声在宫腔病变中的诊断价值。方法 对74例经阴道三维超声诊断并经宫腔镜及手术病理证实的宫腔病变的超声图像特征进行了回顾性分析，子宫黏膜下肌瘤38例，内膜息肉21例，子宫内膜增生过长10例，子宫内膜癌5例。结果 常见几种宫腔病变的声像图特征如下：1．子宫黏膜下肌瘤：多呈圆形均匀低回声区，内膜线中断或断续状，并可找到蒂所在处；2．子宫内膜息肉：呈椭圆形中等或较强回声，病变大多呈水滴状，基底窄；3．子宫内膜增生过长：内膜最厚达24mm，分泌期呈三线征；4．子宫内膜癌：病灶形态不规则，多呈较强回声，与肌层分界不清。结论 经阴道三维超声宫腔和内膜厚度及形态显示清晰，形象，立体感强，有利于了解病灶大小和病灶空间位置，大大提高了诊断准确率。     

经阴道彩色多普勒超声对更年期子宫内膜的检测价值

目的：探讨经阴道彩色多普勒超声对更年期子宫内膜的检测价值。方法：对98例更年期妇女的子宫内膜进行经阴道彩色多普勒超声检查，并与病理结果进行对照分析。结果：无子宫内膜病变者56例，良性者（内膜增生、内膜息肉）者29例，内膜癌13例，三者声像图表现不同，良恶性者血流显示率及RI值存在显著差异。结论：经阴道彩色多普勒超声检查是筛选更年期子宫内膜病变的重要手段。     

经阴道超声对子宫内膜息肉的诊断价值

目的探讨经阴道超声在子宫内膜息肉诊断中的价值。方法回顾性分析121例经病理诊断为子宫内膜息肉患者的彩色多普勒声像图特征,分析误漏诊的原因。结果 121例患者中,超声准确诊断107例,确诊率为88.4%;误诊10例,分别为3例误诊为子宫黏膜下肌瘤,6例误诊为子宫内膜增生过长,1例误诊为宫腔内残留物;漏诊4例。子宫内膜息肉的声像图特点主要表现为宫腔或宫颈管内异常团状回声,回声强弱不一,呈舌形、类圆形或不规则形。结论经阴道超声对诊断子宫内膜息肉有较高的临床价值,可作为诊断子宫内膜息肉的首选方法。     

子宫内膜病变的经阴道超声检查

目的 探讨经阴道超声诊断子宫内膜病变的临床价值。方法 回顾分析97例妇女(绝经前57例，绝经后40例)阴道超声检查结果并与其子宫内膜病理比较。结果 97例妇女子宫内膜活检的病理分类有内膜癌、内膜息肉、内膜增生过长等。其超声声像图表现以内膜增厚为主多伴内膜回声增强、不均或表现为宫腔内混合回声。结论 经阴道超声诊断子宫内膜病变具有较大的临床应用价值。     

经阴道超声对子宫内膜疾病的诊断价值

目的探讨经阴道超声对子宫内膜疾病的诊断价值。方法回顾分析86例妇女(绝经前50例,绝经后36例)经腹及经阴道超声检查结果并与子宫内膜病理对照。结果内膜活检的病理分类有内膜癌、内膜息肉、内膜增生过长等,其超声表现以内膜增厚为主,多伴内膜回声增强、不均或宫腔内混合回声。经腹超声(TAS)和经阴道超声(TVS)诊断子宫内膜疾病诊断符合率分别为70.9％及91．8％。结论经阴道超声诊断子宫内膜病变与经腹超声相比有明显的优势,有重要的临床应用价值。     

子宫有蒂粘膜下肌瘤的超声鉴别诊断、病理基础及临床意义

目的 探讨有蒂子宫粘膜下肌瘤的超声鉴别诊断要点，以期为临床选择治疗方案提供准确信息。方法 对140例经手术病理证实的有蒂子宫粘膜下肌瘤、内膜息肉、内膜癌及内膜增生进行经腹或经阴道超声检查，观察病灶大小、形态、位置、回声、边界、结节表面及基底与子宫内膜的关系，子宫内膜轮廓的完整性及结节血供情况。结果 全部病灶为不同程度高回声，其中粘膜下肌瘤40例，内膜息肉54例，内膜癌及内膜增生各23例。粘膜下肌瘤的声像图特征为：圆形，有包膜，周边多有无回声区，内部回声均匀，蒂部子宫内膜中断，结节表面被膜与子宫内膜相延续。子宫内膜息肉常呈舌形或椭圆型，无被膜，蒂部子宫内膜连续，结节内常见有小无回声区。内膜癌形态多不规则。良性增生内膜轮廓完 整，能观察到居中的宫腔线。结论 子宫腔内病变的组织形态学基础构成了超声图像上的特征，可作为相互间鉴别诊断的依据。     

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.     

经阴道彩色多普勒对子宫内膜良性病变的观察

目的　经阴道彩色多普勒技术准确、有效地诊断及鉴别诊断子宫内膜良性病变。方法　运用高分辨率探头观察经宫腔镜或手术证实的 5 4例患者的子宫内膜形态及血流状态 ,并测量内膜厚度及病变处的阻力指数。结果　有效地诊断了内膜息肉、黏膜下小肌瘤和内膜增生过长。结论　经阴道彩色多普勒所提供的二维及血流信息能较为准确地鉴别子宫内膜良性病变     

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.     

育龄期妇女子宫内膜病变的声像图表现与病理分析

目的分析育龄期妇女异常子宫出血的声像图表现与病理结果,探讨育龄期子宫内膜病变的诊断思路。 方法选取2001年10月至2016年9月在首都医科大学附属复兴医院就诊的子宫内膜病变育龄期妇女149例,分析其声像图表现与病理结果,分为子宫内膜增生过长组88例,子宫内膜息肉组41例,子宫内膜癌组20例;超声检查的时间为月经周期的增殖早期或阴道出血停止后3 d内,以宫腔回声厚径≥10 mm作为内膜增厚的标准。内膜息肉组与息肉样增生组患者间最大径比较采用独立样本t检验;子宫内膜增生过长组、子宫内膜息肉组与子宫内膜癌组之间年龄、子宫体三径之和、宫腔回声厚径比较采用方差分析,有统计学意义的组间两两比较采用Bonferroni检验;比较3组患者的声像图表现与病理结果;镜下病理观察卵巢的组织结构。 结果（1）子宫内膜增生过长组、子宫内膜息肉组及子宫内膜癌组患者的平均年龄比较,差异无统计学意义（P>0.05）。（2）超声检查：3组患者子宫体三径之和比较,差异无统计学意义（P>0.05）;内膜增生过长组的宫腔回声厚径与内膜息肉组及内膜癌组比较[（11.70±5.42）mm vs（10.59±3.83）mm vs（17.14±8.70）mm],差异有统计学意义（F=9.779,P<0.001）,内膜增生过长组与内膜癌组、内膜息肉组与内膜癌组宫腔回声厚径比较,差异均有统计学意义（P均<0.001）;内膜增生过长组与内膜息肉组宫腔回声厚径比较,差异无统计学意义（P>0.05）。88例内膜增生过长病例中53例表现为息肉样,息肉样隆起的最大径的平均值与内膜息肉组比较[（17.13±10.45）mm vs（12.14±4.67）mm],差异有统计学意义（t=3.112,P=0.002）;41例内膜息肉及53例息肉样增生组出现点、条状血流信号的比例分别为75.61%（31/41）,41.51%（22/53）。3组患者中宫腔回声的测值<10 mm占42.3%（63/149）。（3）病理检查：20例子宫内膜癌均为内膜样癌,11例子宫切除者中,高分化子宫内膜样癌7例,中分化3例,低分化1例;同时,切除卵巢的8例中,7例见多个闭锁卵泡,1例见单纯囊肿。88例子宫内膜增生过长组中单纯增生过长77例,1例伴不典型增生;复杂增生过长11例,3例伴不典型增生。41例子宫内膜息肉中非功能性息肉33例,功能性息肉3例,4例腺肌瘤性息肉中1例癌变。 结论在子宫内膜的增殖早期或阴道出血停止后3 d内,宫腔回声厚径≥10 mm提示子宫内膜异常;宫腔回声厚径<10 mm,不能排除子宫内膜异常;可监测是否排卵,超声动态监测是否排卵可提示有无子宫内膜异常生长的危险因素。     

Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding.

OBJECTIVE: To determine if gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and endometrial vascular morphology as assessed by color Doppler ultrasonography can discriminate between benign and malignant endometrium in women with postmenopausal bleeding. METHODS: In a prospective study 95 consecutive women with postmenopausal bleeding and endometrial thickness > or = 4.5 mm as measured by transvaginal ultrasound were included. Gray-scale and color Doppler ultrasound examination of the endometrium was performed. The ultrasound examiner characterized the morphology of the endometrium before and during saline infusion and assessed the endometrial vascular tree using a predetermined classification protocol without suggesting a diagnosis. A histopathological diagnosis was obtained by operative hysteroscopy, dilatation and curettage or hysterectomy. RESULTS: There were no statistically significant differences in ultrasound findings between benign and malignant endometria of uterine cavities without fluid. Heterogeneous echogenicity, irregular surface, and both heterogeneous echogenicity and irregular surface of a focal lesion (or of the endometrium in the absence of focal lesions) in a uterine cavity filled with fluid (spontaneous or infused) were significantly more common in malignant than in benign endometrium. The sensitivity, false positive rate, positive and negative likelihood ratios of these findings were as follows: heterogeneous echogenicity, 80%, 29%, 2.74, 0.28, P = 0.003; irregular surface, 89%, 33%, 2.70, 0.17, P = 0.002; and both, 78%, 12%, 6.59, 0.25, P < 0.001. Two or more vessels were found in 67% (8/12) of the malignant endometria vs. 51% (40/79) of the benign endometria (non-significant difference). Vascular branching tended to be more common in malignant endometria (10/11; 91%) than in benign endometria (39/61; 64%), P = 0.09. CONCLUSION: Heterogeneous echogenicity and an irregular surface of a focal lesion or of the endometrium in a fluid-filled uterine cavity are useful ultrasound criteria for predicting endometrial malignancy. Assessment of vascular morphology using color Doppler ultrasound is of limited--if any--value for discrimination between benign and malignant endometrium.     

子宫内膜息肉的经阴道超声误诊分析

目的 探讨经阴道超声在子宫内膜息肉诊断和鉴别诊断中的应用价值.方法 对110例经阴道超声检耷拟诊为子宫内膜息肉并进行官腔镜手术者结合病理结果 作回顾性分析.结果 110例术前超声诊断为子宫内膜息肉者,经宫腔镜和病理证实符合者为75例,占68.2%;误诊35例,误诊率31.8%,误诊病例包括内膜增生、宫腔粘连和黏膜下肌瘤.结论 通过临床症状、声像图特征及选择适当的检查时间可降低子宫内膜息肉的误诊率.     

超声观察115例乳癌术后服用三苯氧胺及甲孕酮的子宫变化

本文应用实时超声对１１５例乳癌术后患者服用三苯氧胺后子宫变化进行观察，其中１０例并用甲孕酮；对照组５１例为乳癌术后未服药者（以下简称对照组）。经测量及统计学对照分析，结果可见：绝经前期服药组与对照组比较，子宫及内膜的变化无明显统计学意义（Ｐ＞０．０５）；绝经后期服药组与对照组相比，显示子宫增大，内膜增厚，体颈比例增大，与对照组相比有明显的统计学意义（Ｐ＜０．０１）；１０例绝经期并服甲孕酮后上述变化更为显著。病理证实，子宫内膜增生过长为子宫及内膜变化的主要原因。     

宫颈腺癌的超声声像图特征研究

目的：探讨经阴道超声检查在宫颈腺癌诊断中的应用价值。方法：回顾性分析首都医科大学附属北京妇产医院 2012年2月—2017 年4月经病理证实宫颈腺癌的病例60例,结合病理结果及分期,对其术前超声声像图特点进行分析。结果：60例宫颈腺癌超声图像中,29例呈现正常宫颈声像图或仅宫颈前后径增大,31例呈现异常宫颈声像图,以宫颈实性低回声肿块、宫颈内膜线回声中断为主要表现。结论：中晚期宫颈腺癌经经阴道超声检查具有宫颈实性低回声肿块,宫颈内膜线回声中断等声像特点。经阴道超声对中、晚期宫颈腺癌有较高的诊断价值, 但对于早期宫颈腺癌有一定的局限性。     

宫腔镜与阴道超声诊断绝经后妇女子宫内膜病变的比较研究

[目的]比较宫腔镜与阴道超声对绝经后妇女子宫内膜病变的诊断价值.[方法]2006年3月至2009年3月诊治243例绝经后妇女,平均年龄61.4岁,平均绝经后时间为11.3年,对其子宫内膜宫腔镜及阴道超声结果进行分析.[结果]6.6%的病例经病理确诊为子宫内膜增生和子宫内膜癌.阴道超声的诊断灵敏度为95.6%,特异度为7.4%,阳性预测值为53.3%,阴性预测值为60%,诊断准确率为53.7%.宫腔镜的诊断灵敏度为95.7%,特异度为83%,阳性预测值为82.2%,阴性预测值为95.9%,诊断准确率为88.7%.[结论]宫腔镜较阴道超声诊断子宫内膜疾病的准确性更高.