Abstract:

Objective　To explore the value of three-dimensional ultrasound imaging in the diagnosis of congenital uterine malformation. Methods　The clinical data of 80 patients with suspected congenital uterine malformation treated at Weihai Municipal Hospital from May 2021 to April 2023 were retrospectively analyzed. They were 22 to 38 years old, with a median age of 28.34. Among them, 32 cases were infertile, 28 cases had primary abortion, and 20 cases had recurrent abortion. All of them were examined by two-dimensional ultrasound and three-dimensional ultrasound, and the combined diagnosis results of hysteroscopy and laparoscopy were regarded as the gold standard. The diagnostic efficiencies of two-dimensional ultrasound and three-dimensional ultrasound were compared, and the classification accuracy of three-dimensional ultrasound was calculated. χ² test was used. Results　A total of 80 patients with suspected congenital uterine malformation were screened out. The gold standard (hysteroscopy combined with laparoscopy) showed that there were 60 cases of congenital uterine malformation and 20 cases of non-congenital uterine malformation. Two-dimensional ultrasound showed that there were 50 cases of congenital uterine malformation and 30 cases of non-congenital uterine malformation. Three-dimensional ultrasound showed that there were 58 cases of congenital uterine malformation and 22 cases of non-congenital uterine malformation. The accuracy and sensitivity of three-dimensional ultrasound in diagnosing congenital uterine malformation were higher than those of two-dimensional ultrasound, and the missed diagnosis rate was lower than that of two-dimensional ultrasound (χ²=4.80, 4.91, and 4.91; P<0.05), but there was no statistical difference in specificity and misdiagnosis rate between the two methods (both P>0.05). The accuracies of three-dimensional ultrasound in diagnosing complete mediastinal uterus and incomplete mediastinal uterus were 94.74% (18/19) and 96.67% (29/30), respectively, and the accuracies in diagnosing other different types of congenital uterine malformations were 100.00%. The accuracies of two-dimensional ultrasound in diagnosing complete mediastinal uterus and incomplete mediastinal uterus were 78.95% (15/19) and 86.67% (26/30), respectively, and the accuracy in diagnosing arcuate uterus and residual horn/single horn uterus was only 66.67%(2/3), while the accuracies in diagnosing other different types of congenital uterine malformations were 100.00%. Conclusions　Three-dimensional ultrasound imaging is of great value in the diagnosis of congenital uterine malformation, with high sensitivity and accuracy. At the same time, it can accurately classify diseases and has good clinical diagnostic value.

Key words:

Congenital uterine malformation, Two-dimensional ultrasound, Three-dimensional ultrasound, Laparoscopy, Uteroscope

摘要：

目的　探讨三维超声成像技术对先天性子宫畸形的诊断价值。方法　回顾性分析2021年5月至2023年4月威海市立医院收治的80例疑似先天性子宫畸形患者临床资料。年龄22～38岁，年龄中位数28.34岁。其中，32例不孕、28例原发流产、20例复发性流产。均行二维超声及三维超声检查，并将宫腔镜及腹腔镜联合诊断结果作为“金标准”，对两种检查方式的诊断效能进行对比，并统计三维超声的分型准确率。统计学方法采用χ²检验。结果　本次共筛查出80例疑似先天性子宫畸形的患者，金标准（宫、腹腔镜联合检查）诊断结果显示，60例为先天性，20例为非先天性；二维超声检查显示50例为先天性，30例为非先天性；三维超声检查显示58例为先天性，22例为非先天性；三维超声诊断先天性子宫畸形的准确率、灵敏度高于二维超声，漏诊率低于二维超声（χ²=4.80、4.91、4.91，均P<0.05），而两种诊断方式诊断先天性子宫畸形特异度及误诊率差异均无统计学意义（均P>0.05）；三维超声诊断完全纵隔子宫及不完全纵隔子宫的准确率分别为94.74%（18/19）及96.67%（29/30），诊断其他不同类型先天性子宫畸形的准确率均为100.00%；而二维超声诊断完全纵隔子宫及不完全纵隔子宫的准确率分别为78.95%（15/19）及86.67%（26/30），诊断弓形子宫及残角/单角子宫的准确率也仅为66.67%（2/3），诊断其他不同类型先天性子宫畸形的准确率均为100.00%。结论　三维超声成像技术诊断先天性子宫畸形敏感度及准确度高，可对疾病进行准确分型，具有良好的临床诊断价值。

关键词:

先天性子宫畸形, 二维超声检查, 三维超声检查, 腹腔镜, 宫腔镜