经阴道彩色多普勒在子宫肌瘤及子宫腺肌瘤诊断中的应用
作者：文秋平，田志先，陈献明，吕晓霞。
［摘要］ 目的：探讨经阴道超声二维及彩色多普勒诊断子宫肌瘤及子宫腺肌瘤的临床应用价值。方法：对35例子宫腺肌瘤、42例子宫肌瘤患者行经阴道彩色多普勒超声，分析其二维及彩色多普勒血流特征，并测定各组子宫动脉、病灶周边及内部RI。选取50名健康妇女为正常对照组。结果：二维图像上子宫肌瘤及子宫腺肌瘤均呈特征性改变。CDFI示子宫肌瘤及子宫腺肌瘤患者子宫动脉平均RI低于正常对照组(P0.05)。子宫肌瘤周边血流丰富，内部血流信号稀少或无;子宫腺肌瘤周边血流信号稀少，内部见丰富或星点状血流信号，子宫肌瘤周边及内部动脉RI均低于子宫腺肌瘤内部动脉RI(P0.05)。结论：经阴道彩色多普勒为子宫肌瘤及子宫腺肌瘤的鉴别诊断提供有价值的信息。
Usefulness of Transvaginal Color Doppler Sonography in Diagnosing Hysteromyoma and Adenomyoma。
Abstract：Objective To explore the clinical value of transvaginal two dimensional and color Doppler ultrasonography in diagnosing uterine hysteromyoma and adenomyoma.Methods Transvaginal color doppler sonographywas performed in 42 cases with hysteromyoma and35 cases with adenomyoma to analyze the characteristics of transvaginal two dimensional and color doppler flow with them,and to measurate the resistance index(RI) of uterine artery and the RI of focus.50 normal women were chosen for control.Results Characteristic changes were observed in the transvaginaltwo dimensionalultrasonography of both the hysteromyoma and adenomyoma.Color doppler flow imaging was as following:RI of uterine artery of hysteromyoma and adenomyoma were lower than that of control group(P0.05).The blood stream at the edge of mass in patients with hysteromyoma was rich and abundant,and the sparse or absence of blood flow imagingin its interior.The blood stream at edge of mass in patients with adenomyoma was sparse or absence,and there was rich blood flow or starlike flicker color blood signal in the interior.The values of RI within and at the egde of the hysteromyoma was lower than in the adenomyoma‘s interior.Conclusion Transvaginal color doppler ultrasonogrphy provided differential diagnosis in hysteromyoma and adenomyoma.
Key words：Transvaginal Color Doppler Sonography；Hysteromyoma；Adenomyoma。
子宫肌瘤及子宫腺肌瘤是妇科常见子宫肌壁良性病变。超声诊断被公认为最简单有效的临床首选诊断方法。本文分析应用经阴道彩色多普勒对35例子宫腺肌瘤及42例子宫肌瘤患者的声像图及血流动力学，旨在探讨经阴道彩色多普勒在该类疾病的临床应用价值。
1 资料与方法。
1.1 研究对象 经手术病理证实的35例子宫腺肌瘤及42例子宫肌瘤患者。子宫腺肌瘤患者年龄30岁~56岁，平均年龄42岁，均有孕产史，有痛经史30例，无痛经史5例；子宫肌瘤患者年龄25岁~51岁，其中22例月经量多。另随机选择年龄相当的50名健康妇女为正常对照组。
1.2 检查方法 LOGIQ5彩色多普勒超声诊断仪，经腹壁凸阵探头3.5 MHz~5 MHz，阴道探头频率5.5 MHz~7.5 MHz，先常规使用经腹壁途径，适度充盈膀胱，检查子宫、双侧附件，然后嘱患者排空膀胱后取膀胱截石位行经阴道检查，观察子宫及双侧附件区，子宫内肿块大小、边界、内部回声及子宫内膜厚度，子宫动脉、病灶区内部及其周围血流分布情况，应用脉冲多普勒技术显示多普勒血流频谱、分析频谱特点，计算阻力指数。
2 结果。
2.1 超声诊断结果 子宫肌瘤42例符合诊断40例，诊断符合率95.2%，2例多发性子宫小肌瘤误诊为子宫腺肌瘤2例，误诊率4.8%；子宫腺肌瘤35例符合诊断31例，诊断符合率88.6%，误诊为子宫肌瘤4例，误诊率11.4%，子宫腺肌瘤诊断符合率明显低于子宫肌瘤诊断符合率。
2.2.1 正常子宫动脉及肌壁血流特征 位于子宫颈两侧的子宫动脉显示形状各异的彩色血流，常见有L、V、U或S形，频谱呈现快速向上陡直的收缩期高峰和舒张期低速的高阻型血流频谱，舒张期开始处有切迹。子宫肌瘤、子宫腺肌瘤及正常对照组子宫动脉阻力参数详见表1。子宫肌壁内弓状动脉分布均匀，呈环形走行，靠近周边要比中央的血流明显，子宫肌壁正常情况下无明显血流或仅在浆膜下见少许点状血流。
2.2.2 子宫腺肌瘤声像图及血流特征 子宫腺肌瘤大多呈稍强回声团块，呈球状感，边界模糊，病灶内肌层光点增粗增强，有筛孔样小暗区，肌壁可见较正常宫壁丰富的点、条状血流信号。其周边无环形或半环形血流。频谱多普勒于子宫内膜附近病灶子宫肌壁内记录到类似子宫动脉的高阻性频谱，收缩期呈尖峰状，舒张期成分少，可见舒张期切迹。并在肌壁的片状物回声区内多见静脉形频谱。