一项前瞻性研究，探讨经阴道三维超声波检查在诊断和评估阿什曼综合征中的价值。

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online Pub Date : 2024-08-21 DOI:10.1016/j.rbmo.2024.104404

Rui Huang , Sijing Li , Yuting Zhao , YingTao Li , Mingyang Ge , Sotirios Saravelos , Xiaodan Lv , Qi Cheng , Xiaowu Huang , Enlan Xia , Tin-Chiu Li

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引用次数: 0

摘要

研究问题：三维（3D）经阴道超声检查（TVS）在诊断和评估阿什曼综合征中的价值是什么？这是一项在宫腔镜中心进行的前瞻性研究：结果：共招募了 685 名参与者，其中 65 人退出，最终有 620 人加入并接受了分析。三维TVS诊断阿舍曼综合征的总体敏感性、特异性和准确性分别为95.7%、80.7%和93.5%，敏感性和准确性显著高于二维（2D）TVS（P < 0.001）。二维TVS漏诊轻度宫腔内粘连（IUA）的可能性为43.7%，而三维TVS仅为6.2%。各解剖区域受粘连影响的频率依次为子宫左右侧壁（均为 80%）、中央或中腔（31%）、右隅角区（26%）、左隅角区（23%）、宫底壁（15%）和峡部（4.5%）。分别分析了 3D-TVS 和宫腔镜在七个解剖区域的相关性。结果显示，三个子宫壁（宫底、左外侧和右外侧）的相关性良好，卡帕值为 0.678-0.811。当出现五个或更多区域、三个或四个区域、一个或两个区域时，IUA性质严重的可能性分别为82%、37.1%和6.3%（P < 0.001）：结论：三维 TVS 的诊断价值高于二维 TVS。在临床实践中，3D-TVS应尽可能取代2D-TVS作为初步评估方法，以决定是否有必要进行宫腔镜检查，并帮助制定手术计划。

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A prospective study examining the value of three-dimensional transvaginal ultrasonography during the diagnosis and evaluation of Asherman syndrome

Research question

What is the value of three-dimensional (3D) transvaginal ultrasonography (TVS) in the diagnosis and assessment of Asherman syndrome?

Design

This was a prospective study conducted at a hysteroscopy centre.

Results

A total of 685 participants were recruited, 65 dropped out and 620 were finally enrolled and analysed. The overall sensitivity, specificity and accuracy of 3D-TVS in the diagnosis of Asherman syndrome were 95.7%, 80.7% and 93.5%, respectively, and the sensitivity and accuracy were significantly higher than those of two-dimensional (2D) TVS (P < 0.001). The likelihood of 2D-TVS missing a case of mild intrauterine adhesions (IUA) was 43.7%, compared with only 6.2% for 3D-TVS. The frequency of involvement of each anatomical area by adhesions in decreasing order was right and left uterine side walls (both 80%), central or mid-cavity (31%), right cornual region (26%), left cornual region (23%), fundal wall (15%) and isthmus (4.5%). The correlation between 3D-TVS and hysteroscopy in each of the seven anatomical areas was analysed separately. The results showed good agreement with regard to the three uterine walls (fundus, left lateral and right lateral), with kappa values of 0.678–0.811. The likelihood of the IUA being severe in nature when there were five or more areas, three or four areas, or one or two areas was 82%, 37.1% and 6.3%, respectively (P < 0.001).

Conclusions

The diagnostic value of 3D-TVS is higher than that of 2D-TVS. In clinical practice, 3D-TVS should whenever possible replace 2D-TVS as the initial method of assessment to decide if hysteroscopy is necessary and to help with planning surgery.

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来源期刊

Reproductive biomedicine online 医学-妇产科学

CiteScore

7.20

自引率

7.50%

发文量

391

审稿时长

50 days

期刊介绍： Reproductive BioMedicine Online covers the formation, growth and differentiation of the human embryo. It is intended to bring to public attention new research on biological and clinical research on human reproduction and the human embryo including relevant studies on animals. It is published by a group of scientists and clinicians working in these fields of study. Its audience comprises researchers, clinicians, practitioners, academics and patients. Context: The period of human embryonic growth covered is between the formation of the primordial germ cells in the fetus until mid-pregnancy. High quality research on lower animals is included if it helps to clarify the human situation. Studies progressing to birth and later are published if they have a direct bearing on events in the earlier stages of pregnancy.