2022 年第 5 期 第 17 卷

超声诊断在子宫内膜癌和子宫内膜增生症鉴别诊断中的临床应用价值

Clinical value of ultrasonography in differential diagnosis between endometrial carcinoma and endometrial hyperplasia

作者：武艳娇冯金凤陈宇翔郭瑞平翟江陈宝霞

英文作者：Wu Yanjiao Feng Jinfeng Chen Yuxiang Guo Ruiping Zhai Jiang Chen Baoxia

单位：河北北方学院附属第二医院功能科，张家口075100

英文单位：Department of Functional the Second Affiliated Hospital of Hebei North University Zhangjiakou 075100 China

关键词：子宫内膜癌；子宫内膜增生症；时间-空间相关成像超声技术；鉴别诊断

英文关键词：Endometrialcarcinoma;Endometrialhyperplasia;Spatio-temporalimagecorrelationultrasoundtechnology;Differentialdiagnosis

• 摘要：

• 目的 探讨超声检查对子宫内膜癌和子宫内膜增生症的鉴别诊断价值。方法 收集2016年1月至2020年12月因阴道不规则出血于河北北方学院附属第二医院就诊的120例患者的临床资料进行回顾性分析。根据病理活检结果将患者分为子宫内膜癌组（27例）与子宫内膜增生症组（93例）。患者均行常规超声检查（腹部二、三维，阴道二、三维及彩色多普勒超声）以及时间-空间相关成像检查。比较2组超声检查的影像学特征参数（子宫内膜厚度、子宫内膜体积、子宫血流显示率、血流阻力指数）和超声诊断的符合率。结果子宫内膜增生症组患者超声声像图主要特征为子宫体大小、形态无异常，子宫内膜回声均匀、厚径增加均匀，少数可见少量点状血流信号，血流阻力指数0.53~0.73；子宫内膜癌组患者主要特征为内膜体积增大，子宫体回声不均匀，子宫内膜厚径增加不均匀，边缘不清晰，均可见丰富彩色信号，血流阻力指数0.33~0.42。子宫内膜增生症组子宫内膜厚度、子宫内膜体积、子宫血流显示率小于/低于子宫内膜癌组，血流阻力指数大于子宫内膜癌组，差异均有统计学意义(均P<0.001)。子宫内膜增生症组的超声诊断符合率低于子宫内膜癌组［89.2%（83/93）比92.6%（25/27）］，差异有统计学意义（P<0.05）。结论  在常规二维、三维经腹、阴道超声基础上联合时间-空间相关成像超声技术，能够较好地鉴别诊断子宫内膜癌及子宫内膜增生症，对子宫内膜癌的诊断率更高。

• Objective  To explore the value of ultrasonography in the differential diagnosis between endometrial carcinoma and endometrial hyperplasia. Methods The clinical data of 120 patients with irregular vaginal bleeding in the Second Affiliated Hospital of Hebei North University from January 2016 to December 2020 were analyzed retrospectively. According to the results of pathological biopsy, patients were divided into endometrial carcinoma group(27 cases) and endometrial hyperplasia group(93 cases). All patients underwent routine ultrasound examination(abdominal two- or three-dimensional, vaginal two- or three-dimensional and color Doppler ultrasound), and spatio-temporal image correlation examination. The imaging characteristic parameters(endometrial thickness, endometrial volume, uterine blood flow display rate, blood flow resistance index) of the two groups were compared. The coincidence rate of ultrasound diagnosis was compared between the two groups. Results  Under ultrasound, the sonogram of endometrial hyperplasia was mainly characterized by normality in the size and shape of the uterine body, uniform endometrial echo and uniform increase in thickness. Punctate blood flow signals were seen in a few patients, and the blood flow resistance index was 0.53-0.73. Endometrial carcinoma was mainly characterized by increased endometrial volume, uneven echo of uterine body, uneven increase of endometrial thickness, unclear edge and rich color signals, and the blood flow resistance index was 0.33-0.42. The endometrial thickness, endometrial volume and uterine blood flow display rate in endometrial hyperplasia group were less/lower than those in endometrial carcinoma group, and the blood flow resistance index was higher than that in endometrial carcinoma group(all P<0.001). The coincidence rate of ultrasound diagnosis in endometrial hyperplasia group was lower than that in endometrial carcinoma group［89.2%(83/93) vs 92.6%(25/27)］, and the difference was statistically significant(P<0.05). Conclusions On the basis of conventional two-dimensional, three-dimensional transabdominal and vaginal ultrasound, combined with spatio-temporal image correlation ultrasound technology can better differentiate and diagnose endometrial carcinoma and endometrial hyperplasia, and the coincidence rate of ultrasound in the diagnosis of endometrial carcinoma is higher.