| 武芳彩,胡蓉.基于三维超声以不同标准诊断纵隔子宫[J].中国介入影像与治疗学,2025,22(3):178-182 |
| 基于三维超声以不同标准诊断纵隔子宫 |
| Comparison on diagnosing septate uterus with different diagnostic criteria based on 3D ultrasound |
| 投稿时间：2024-12-23 修订日期：2025-01-28 |
| DOI：10.13929/j.issn.1672-8475.2025.03.006 |
| 中文关键词: 子宫附件疾病 诊断 超声检查 |
| 英文关键词:adnexal diseases diagnosis ultrasonography |
| 基金项目: |
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| 摘要点击次数: 153 |
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| 中文摘要: |
| 目的 对比基于三维超声以美国生殖医学学会（ASRM）-2021、欧洲人类生殖与胚胎学会与欧洲妇科内镜学会（ESHRE/ESGE）-2016、先天性子宫畸形专家小组专家共识（CUME）-2018标准诊断纵隔子宫的价值。方法 回顾性收集三维超声显示宫底内膜明显凹陷（凹陷深度≥0.5 cm）且宫底肌层浆膜面无明显凹陷或轻度凹陷（凹陷深度＜1.0 cm）而疑诊纵隔子宫的164例育龄女性，其中114例既往有不良孕产史，包括不孕、流产、异位妊娠等。观察子宫三维超声表现，测量子宫内膜凹陷深度（纵隔长度）及角度、子宫宫底浆膜面凹陷深度等，分别根据ASRM-2021、ESHRE/ESGE-2016、CUME-2018标准诊断纵隔子宫并进行对比。比较以3种标准针对既往有、无不良孕产史者诊断纵隔子宫的差异，分析3种标准诊断纵隔子宫的纵隔长度及子宫内膜凹陷角度与不良孕产史的相关性。结果 164例中，根据ASRM-2021标准对纵隔子宫的诊断率为43.90%（72/164），其余28.05%（46/164）为非纵隔子宫、28.05%（46/164）为无法明确诊断；以ESHRE/ESGE-2016标准对纵隔子宫的诊断率为96.95%（159/164），另3.05%（5/164）为非纵隔子宫；基于CUME-2018标准对纵隔子宫的诊断率73.78%（121/164），另26.22%（43/164）为非纵隔子宫。基于以上3种标准诊断纵隔子宫结果两两比较差异均有统计学意义（χ2=32.818~81.387，P均＜0.001）。基于ASRM-2021及CUME-2018标准针对既往有不良孕产史患者的纵隔子宫诊断率均高于无不良孕产史者（P均＜0.05），而以ESHRE/ESGE-2016标准诊断结果与针对无不良孕产史者差异无统计学意义（P=0.981）。分别基于ASRM-2021、ESHRE/ESGE-2016及CUME-2018标准检出72、159及121例纵隔子宫，其中分别有57、110及91例有不良孕产史；基于ESHRE/ESGE-2016及CUME-2018标准所诊断纵隔子宫的纵隔长度与不良孕产史均呈正相关，以上述标准所诊断的纵隔子宫的子宫内膜凹陷角度均与不良孕产史呈负相关（P均＜0.05）。结论 相比基于ASRM-2021及ESHRE/ESGE-2016标准，以CUME-2018标准诊断纵隔子宫的临床价值更高；对既往有不良孕产史者，ASRM-2021及CUME-2018标准的诊断价值较高。 |
| 英文摘要: |
| Objective To compare the value of diagnosing septate uterus based on 3D ultrasound using American Society for Reproductive Medicine （ASRM）-2021， European Society of Human Reproduction and Embryology and European Society of Gynecological Endoscopy （ESHRE/ESGE）-2016， Congenital Uterine Malformation by Experts （CUME）-2018 criteria. Methods A total of 164 women of childbearing age with suspected septate uterus due to obvious indentation of endometrium of fundal （indentation depth≥0.5 cm） and no obvious or mild indentation of serous membrane of fundal muscle （indentation depth＜1.0 cm） revealed by 3D ultrasound were retrospectively collected. Among them， 114 cases had previous adverse pregnancy events， including infertility， abortion and ectopic pregnancy， etc. Then 3D ultrasonic manifestations of uterus were observed， the depth （septate length） and angle of endometrial depression and the depth of uterine fundus serosa depression were measured. Septate uterus was diagnosed according to ASRM-2021， ESHRE/ESGE-2016 and CUME-2018 criteria， respectively， and the diagnostic results were compared. For patients with and without previous adverse pregnancy， the diagnostic results of septate uterus using 3 kinds of criteria were compared， and the correlations of septate length and the angle of endometrial depression of septate uterus diagnosed using 3 kinds of criteria and adverse pregnancy events were analyzed. Results Among 164 cases， the diagnosis rate of septate uterus according to ASRM-2021 criteria was 43.90% （72/164）， the remaining 28.05% （46/164） were non-septate uterus and 28.05% （46/164） were not clearly diagnosed. According to ESHRE/ESGE-2016 criteria， the diagnosis rate of septate uterus was 96.95% （159/164）， and the other 3.05% （5/164） was non-septate uterus. The diagnosis rate of septate uterus based on CUME-2018 criteria was 73.78% （121/164）， and 26.22% （43/164） was non-septate uterus. There were significant differences of diagnosing results of septate uterus based on the above three criteria （χ2=32.818—81.387， all P＜0.001）. For patients with previous adverse pregnancy events， the diagnosis rate of septate uterus based on ASRM-2021 and CUME-2018 criteria were both higher than that for patients without adverse pregnancy events （both P＜0.05）. No significant difference was found between patients with or without adverse pregnancy events based on ESHRE/ESGE-2016 criteria （P=0.981）. Among 72， 159 and 121 cases of septate uterus diagnosed according to ASRM-2021， ESHRE/ESGE-2016 and CUME-2018 criteria， respectively， 57， 110 and 91 cases had adverse pregnancy events， respectively. The septate length of septate uterus diagnosed using ESHRE/ESGE-2016 and CUME-2018 criteria were both positively correlated with adverse pregnancy events， and the angle of endometrial depression of septate uterus diagnosed using the above 3 kinds of criteria was negatively correlated with adverse pregnancy events （all P＜0.05）. Conclusion Compared with ASRM-2021 and ESHRE/ESGE-2016 criteria， the clinical value of diagnosing septate uterus using CUME-2018 was higher. For patients with previous adverse pregnancy events， the diagnostic value of both ASRM-2021 and CMEC-2018 criteria were relatively high. |
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