三维超声在不同类型宫内节育器定型定位中的应用价值
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摘要
目的探讨经阴道三维超声(3D-TVS)检查在不同类型宫内节育器(IUD)定型定位中的应用价值,为1次顺利取出IUD提供参考。方法对500例欲取出IUD的围绝经期妇女进行经阴道二维超声(2D-TVS)及3D-TVS检查,观察IUD的形态及其在宫腔内的位置、与子宫肌壁的关系等;超声检查结果与常规手术取器、超声引导下及宫腔镜下取器结果进行比较分析。结果 2D-TVS检查500例IUD,形态完整显示256例,IUD完整显示率51. 20%; 3D-TVS检查IUD形态完整显示492例,IUD完整显示率98. 40%,有8例内膜薄IUD无法清晰完整显示。麻花环组和曼月乐环组2D-TVS、3D-TVS检查IUD完整显示率比较差异无统计学意义(P>0. 05),其余组2D-TVS、3D-TVS检查IUD完整显示率比较差异有统计学意义(P<0. 05)。500例IUD 2D-TVS检查418例位置正常、53例下移,均经3D-TVS检查证实,另外有8例IUD下移由于内膜薄2D-TVS、3D-TVS均不能完整显示; 10例IUD嵌顿或断裂,11例带器妊娠(其中IUD位置3例正常、6例下移、2例嵌顿或断裂),2D-TVS均不能显示完整声像图,3D-TVS可以完整清晰显示。500例IUD经常规手术、超声引导下及宫腔镜下取器均成功,术中所见IUD形态、位置与3D-TVS检查结果一致。结论 3D-TVS检查对IUD形态完整显示率优于2D-TVS,3D-TVS对不同类型IUD的定型和定位诊断具有很高的临床应用价值,对决定取器方案有重要的指导意义。
Objective To explore the application value of transvaginal three-dimensional ultrasonography in form and location of different intrauterine device( IUD) types,provide a reference for smooth removal of IUD once. Methods A total of 500 perimenopausal women preparing for IUD removal underwent transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography. IUD shape and location in uterine cavity,the relationship with uterine muscle wall were observed. The results of ultrasonography and conventional operation,the results of ultrasound-guided IUD removal and IUD removal under hysteroscope were compared and analyzed retrospectively.Results A total of 500 cases underwent transvaginal two-dimensional ultrasonography,complete IUD form was observed in 256 cases,the rate was 51. 20%; a total of 500 cases underwent transvaginal three-dimensional ultrasonography,complete IUD form was observed in492 cases,the rate was 98. 40%,IUD was not observed clearly in 8 cases with thin endometrium. There was no statistically significant difference in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography between Mahua ring group and Mirena group( P > 0. 05). There were statistically significant differences in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography among the other groups( P<0. 05). During transvaginal two-dimensional ultrasonography,418 cases of normal position of IUD and 53 cases of declined position of IUD were observed,which were verified by transvaginal three-dimensional ultrasonography,IUD was not observed clearly by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography in 8 cases with declined position of IUD. Complete IUD form was not observed by transvaginal two-dimensional ultrasonography in 10 cases with IUD incarceration or fracture and 11 cases with pregnancy with IUD in situ( 3 cases with normal location of IUD,6 cases with declined position of IUD,2 cases with IUD incarceration or fracture),which were all observed clearly by transvaginal three-dimensional ultrasonography. IUD was removed successfully in 500 cases via conventional operation,ultrasound-guided IUD removal and IUD removal under hysteroscope. IUD shape and location observed during operation were the same as results of transvaginal three-dimensional ultrasonography. Conclusion The display rate of complete IUD by transvaginal three-dimensional ultrasonography is superior to transvaginal two-dimensional ultrasonography,the clinical application value of transvaginal three-dimensional ultrasonography for form and location of different IUD types is high,which has important guiding significance for operation mode of IUD removal.Objective To explore the application value of transvaginal three-dimensional ultrasonography in form and location of different intrauterine device( IUD) types,provide a reference for smooth removal of IUD once. Methods A total of 500 perimenopausal women preparing for IUD removal underwent transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography. IUD shape and location in uterine cavity,the relationship with uterine muscle wall were observed. The results of ultrasonography and conventional operation,the results of ultrasound-guided IUD removal and IUD removal under hysteroscope were compared and analyzed retrospectively.Results A total of 500 cases underwent transvaginal two-dimensional ultrasonography,complete IUD form was observed in 256 cases,the rate was 51. 20%; a total of 500 cases underwent transvaginal three-dimensional ultrasonography,complete IUD form was observed in492 cases,the rate was 98. 40%,IUD was not observed clearly in 8 cases with thin endometrium. There was no statistically significant difference in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography between Mahua ring group and Mirena group( P > 0. 05). There were statistically significant differences in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography among the other groups( P<0. 05). During transvaginal two-dimensional ultrasonography,418 cases of normal position of IUD and 53 cases of declined position of IUD were observed,which were verified by transvaginal three-dimensional ultrasonography,IUD was not observed clearly by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography in 8 cases with declined position of IUD. Complete IUD form was not observed by transvaginal two-dimensional ultrasonography in 10 cases with IUD incarceration or fracture and 11 cases with pregnancy with IUD in situ( 3 cases with normal location of IUD,6 cases with declined position of IUD,2 cases with IUD incarceration or fracture),which were all observed clearly by transvaginal three-dimensional ultrasonography. IUD was removed successfully in 500 cases via conventional operation,ultrasound-guided IUD removal and IUD removal under hysteroscope. IUD shape and location observed during operation were the same as results of transvaginal three-dimensional ultrasonography. Conclusion The display rate of complete IUD by transvaginal three-dimensional ultrasonography is superior to transvaginal two-dimensional ultrasonography,the clinical application value of transvaginal three-dimensional ultrasonography for form and location of different IUD types is high,which has important guiding significance for operation mode of IUD removal.
Objective To explore the application value of transvaginal three-dimensional ultrasonography in form and location of different intrauterine device( IUD) types,provide a reference for smooth removal of IUD once. Methods A total of 500 perimenopausal women preparing for IUD removal underwent transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography. IUD shape and location in uterine cavity,the relationship with uterine muscle wall were observed. The results of ultrasonography and conventional operation,the results of ultrasound-guided IUD removal and IUD removal under hysteroscope were compared and analyzed retrospectively.Results A total of 500 cases underwent transvaginal two-dimensional ultrasonography,complete IUD form was observed in 256 cases,the rate was 51. 20%; a total of 500 cases underwent transvaginal three-dimensional ultrasonography,complete IUD form was observed in492 cases,the rate was 98. 40%,IUD was not observed clearly in 8 cases with thin endometrium. There was no statistically significant difference in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography between Mahua ring group and Mirena group( P > 0. 05). There were statistically significant differences in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography among the other groups( P<0. 05). During transvaginal two-dimensional ultrasonography,418 cases of normal position of IUD and 53 cases of declined position of IUD were observed,which were verified by transvaginal three-dimensional ultrasonography,IUD was not observed clearly by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography in 8 cases with declined position of IUD. Complete IUD form was not observed by transvaginal two-dimensional ultrasonography in 10 cases with IUD incarceration or fracture and 11 cases with pregnancy with IUD in situ( 3 cases with normal location of IUD,6 cases with declined position of IUD,2 cases with IUD incarceration or fracture),which were all observed clearly by transvaginal three-dimensional ultrasonography. IUD was removed successfully in 500 cases via conventional operation,ultrasound-guided IUD removal and IUD removal under hysteroscope. IUD shape and location observed during operation were the same as results of transvaginal three-dimensional ultrasonography. Conclusion The display rate of complete IUD by transvaginal three-dimensional ultrasonography is superior to transvaginal two-dimensional ultrasonography,the clinical application value of transvaginal three-dimensional ultrasonography for form and location of different IUD types is high,which has important guiding significance for operation mode of IUD removal.Objective To explore the application value of transvaginal three-dimensional ultrasonography in form and location of different intrauterine device( IUD) types,provide a reference for smooth removal of IUD once. Methods A total of 500 perimenopausal women preparing for IUD removal underwent transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography. IUD shape and location in uterine cavity,the relationship with uterine muscle wall were observed. The results of ultrasonography and conventional operation,the results of ultrasound-guided IUD removal and IUD removal under hysteroscope were compared and analyzed retrospectively.Results A total of 500 cases underwent transvaginal two-dimensional ultrasonography,complete IUD form was observed in 256 cases,the rate was 51. 20%; a total of 500 cases underwent transvaginal three-dimensional ultrasonography,complete IUD form was observed in492 cases,the rate was 98. 40%,IUD was not observed clearly in 8 cases with thin endometrium. There was no statistically significant difference in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography between Mahua ring group and Mirena group( P > 0. 05). There were statistically significant differences in display rates of complete IUD form observed by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography among the other groups( P<0. 05). During transvaginal two-dimensional ultrasonography,418 cases of normal position of IUD and 53 cases of declined position of IUD were observed,which were verified by transvaginal three-dimensional ultrasonography,IUD was not observed clearly by transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasonography in 8 cases with declined position of IUD. Complete IUD form was not observed by transvaginal two-dimensional ultrasonography in 10 cases with IUD incarceration or fracture and 11 cases with pregnancy with IUD in situ( 3 cases with normal location of IUD,6 cases with declined position of IUD,2 cases with IUD incarceration or fracture),which were all observed clearly by transvaginal three-dimensional ultrasonography. IUD was removed successfully in 500 cases via conventional operation,ultrasound-guided IUD removal and IUD removal under hysteroscope. IUD shape and location observed during operation were the same as results of transvaginal three-dimensional ultrasonography. Conclusion The display rate of complete IUD by transvaginal three-dimensional ultrasonography is superior to transvaginal two-dimensional ultrasonography,the clinical application value of transvaginal three-dimensional ultrasonography for form and location of different IUD types is high,which has important guiding significance for operation mode of IUD removal.
引文
[1]谢幸,苟文丽.妇产科学[M].第8版,北京:人民卫生出版社,2013:374-376.
[2]张亦心,杜丽荣,张丽,等.宫内节育器200例取出原因分析[J].现代中西医结合杂志,2013,22(11):1160-1162.
[3]吕丽华,刘效群,张亦心,等.三维超声用于宫内节育器检查的研究进展[J].中国计划生育学杂志,2011,19(3):186-188.
[4]徐金锋,毓星.计划生育超声诊断学[M].北京:人民军医出版社,2015:29-36.
[5]金昕,张瞡瞡,朱玲艳,等.经阴道三维超声诊断宫内节育器位置异常的价值[J].医学影像学杂志,2011,21(11):1777-1778.
[6]吴青青,李国正.超声医学专科能力建设专用初级教材,妇产和计划生育分册[M].北京:人民卫生出版社,2016:249-259.
[7]陈桂琴,张策,朱江,等.超声显像在绝经期子宫疑难节育器取出术中的应用价值[J].临床超声医学杂志,2013,15(9):663-664.
[8]陶枫,吴瑛,林琪,等.经阴道三维超声诊断宫内节育器变形及异位[J].中国医学影像技术,2008,24(10):1635-1637.
[9]张利萍,吴雅峰,张淼.三维超声检查宫内节育器应用分析[J].中华医学超声杂志,2005,2(3):172-173.
[10]周琴,黄道中,张玲,等.三维超声检查对宫内节育器异位的临床诊断价值[J].华中科技大学学报(医学版),2008,37(4):529-531.
[11]李丽蟾.应用经阴道三维超声检查宫内节育器分析[J].上海医学影像,2007,16(1):3-5.
[12]王海燕,梁丽萍.经阴道二维及三维超声成像对宫内节育器定位准确性的对比研究[J].宁夏医学杂志,2014,36(7):605-607.
[13]庞东静,胡波.宫内节育器的三维超声诊断临床应用[J].中国计划生育学杂志,2010,27(6):364-365.
[14]刘杨,吴琼,侯莉,等.二、三维超声诊断宫内节育器异位的临床价值[J].中国计划生育和妇产科,2011,3(3):38-40.
[15]刘满平,刘冬梅.绝经后宫内节育器取出困难42例临床分析[J].中国社区医师,2015,31(29):45-47.
[2]张亦心,杜丽荣,张丽,等.宫内节育器200例取出原因分析[J].现代中西医结合杂志,2013,22(11):1160-1162.
[3]吕丽华,刘效群,张亦心,等.三维超声用于宫内节育器检查的研究进展[J].中国计划生育学杂志,2011,19(3):186-188.
[4]徐金锋,毓星.计划生育超声诊断学[M].北京:人民军医出版社,2015:29-36.
[5]金昕,张瞡瞡,朱玲艳,等.经阴道三维超声诊断宫内节育器位置异常的价值[J].医学影像学杂志,2011,21(11):1777-1778.
[6]吴青青,李国正.超声医学专科能力建设专用初级教材,妇产和计划生育分册[M].北京:人民卫生出版社,2016:249-259.
[7]陈桂琴,张策,朱江,等.超声显像在绝经期子宫疑难节育器取出术中的应用价值[J].临床超声医学杂志,2013,15(9):663-664.
[8]陶枫,吴瑛,林琪,等.经阴道三维超声诊断宫内节育器变形及异位[J].中国医学影像技术,2008,24(10):1635-1637.
[9]张利萍,吴雅峰,张淼.三维超声检查宫内节育器应用分析[J].中华医学超声杂志,2005,2(3):172-173.
[10]周琴,黄道中,张玲,等.三维超声检查对宫内节育器异位的临床诊断价值[J].华中科技大学学报(医学版),2008,37(4):529-531.
[11]李丽蟾.应用经阴道三维超声检查宫内节育器分析[J].上海医学影像,2007,16(1):3-5.
[12]王海燕,梁丽萍.经阴道二维及三维超声成像对宫内节育器定位准确性的对比研究[J].宁夏医学杂志,2014,36(7):605-607.
[13]庞东静,胡波.宫内节育器的三维超声诊断临床应用[J].中国计划生育学杂志,2010,27(6):364-365.
[14]刘杨,吴琼,侯莉,等.二、三维超声诊断宫内节育器异位的临床价值[J].中国计划生育和妇产科,2011,3(3):38-40.
[15]刘满平,刘冬梅.绝经后宫内节育器取出困难42例临床分析[J].中国社区医师,2015,31(29):45-47.