卵巢子宫内膜异位囊肿的超声表现及误诊分析

医师论坛 卵巢子宫内膜异位囊肿的超声表现及误诊分析

唐丽娜 尚志红 阎若元 沈友洪 任永富

摘要! 目的 探讨卵巢子宫内膜异位囊肿二维及彩色多普勒超声特征性表现,分析超声误诊原因。方法 对手术病理证实为卵巢子宫内膜异位囊肿93例患者的术前超声表现进行回顾性分析并行超声分型。结果 93例107个囊肿超声分型表现:∀型囊肿(正常卵巢型)表现为稍增大卵巢内可见小无回声区,术前超声均未检出(0/3),仅提示卵巢稍增大或含液性改变;#型囊肿(单纯囊肿型)表现为无回声区,边界清晰,伴后方回声增强;术前超声仅检出1个囊肿,误诊10个囊肿(10/11);∃型囊肿(囊内点状高回声型)表现为无回声区,内部见均匀点状高回声,似云雾状;术前超声检出26个囊肿,仅误诊2个囊肿(2/28);%型囊肿(多囊型)表现为无回声区,内部见带状间隔或伴密集点状高回声;术前超声检出16个囊肿,误诊13个囊肿(13/29);&型囊肿(混合型)表现为无回声区内见稍高回声或伴密集点状高回声及带状间隔,或表现分层征;术前超声检出22个囊肿,误诊11个囊肿(11/33);∋型囊肿(实质型)表现为低回声,内部可见稍高回声;术前超声均未检出囊肿(0/3)。107个囊肿术前超声以∃型囊肿检出个数居多(26/28),误诊个数少(2/28);6型中共误诊42个囊肿(39.3%),分别为∀型(3/3)、#型(10/11)、%型(13/39)、&型(11/33)和∋型(3/3)。其中误诊为卵巢单纯囊肿15个、卵巢囊腺瘤7个、卵巢畸胎瘤2个、卵巢肿瘤6个、子宫浆膜下肌瘤2个、炎性包块2个、囊肿性质待定5个,卵巢稍大或含液性改变3个。结论 ∃型卵巢子宫内膜异位囊肿声像图表现为无回声区,边界清晰,壁毛糙或稍增厚,内部可见点状高回声,结合临床表现超声易于作出正确诊断;∀、#、%、&及∋型卵巢子宫内膜异位囊肿均易误诊,需与卵巢单纯囊肿、畸胎瘤、囊腺瘤、子宫浆膜下肌瘤及盆腔炎性肿块声像图相鉴别。

关键词! 卵巢囊肿;超声检查

The ultrasonic m anifestati on and m isdiagnosis anal ysis of ovarian endo m etrial cysts TANG L i na,S HANG Zhi hong,Y AN Ruo yuan,SH EN You hong,REN Yong fu.D epart m ent of U ltrasound D i agnosis,Fuji an Provinci al Tu m or H os p ital,Fuzhou 350001,China

Abstract! Objective To i n vestigate sonographic features of ovari an endo m e tri al cysts(OEC)and diagnosis value of t w o d i m ensi onal and color D opp ler flo w i m a g i ng and anal yse the reasons o fm isd i agnosis.M ethods A t o tal of n i net y t hree(107)

作者单位:350014 福州,福建省肿瘤医院超声科

cases patients w it h pat hol ogicall y proved OEC w ere retrospecti ve l y eval uated by the sonograph ic i m ages and pre operati on d i agnosis.R esults The107OEC sonograph ic represents w ere cl assifi ed as si x types:type1(3nor m a l ovary types were sho wn as s m all anecho ic zones w it h i n a littler b i g ovary;type2(11si m p le cyst types were sho wn as w ell defi ned anecho i c zones;type3(28ho m ogeneous dot hyperecho ic i nsi de cyst t ypes were shown as anecho i c zone w it h ho m ogeneous dot hyperecho;t ype4(29m u lti bursa t ypesw ere shown as anecho ic zonesw ith zona l i nterval or dot hyperecho;t ype5( 33m i xed t ypes were sho wn as hyperecho i c anecho i c zones;type6(3so li d t ypes w ere sho wn as anterior l o w echo zone w ith hyperecho.The type3w it h rel ati ve typ i ca l fea t ures had h i gher d i agnostic accuracy(92.9%,26/28).The other typesw ere d ifficu lt to be di agnosed.Fort y t w o cases i n107OEC w ere m isd i agnosed as15ovary cysts,7 cystadeno m as,2terato m a,6ovari an tu m ors,2subserous m yo m as,2i nfla mm at ory m asses,5non confir m ed m asses,3littl e bi g ovary or li qui dti c lesions before opera ti on,respectivel y.Conclusi ons The re l ative typical features of t ype3w as sho wn as anechoic zone w it h ho m ogeneous dot hyperecho and w ell defi ned and had h i gher d i ag nostic accuracy.The other types were d ifficu lt to be d i agnosed and should be d ifferen ti ated fro m other ovary lesions,such as ovari an si m ple cys,t terato m a,cystadeno m a, subserousm yo m a and i nfla mm atory m ass i n pelvic cav ity.

K ey w ords! O varian cysts;U ltrasonography

子宫内膜异位症是女性常见病,病灶多位于盆腔内,其中80%发生于卵巢[1]。卵巢子宫内膜异位囊肿早期在卵巢表面及生发上皮层可见紫褐色斑点或小泡,随着反复出血而形成单个或多个囊肿[2]。超声是卵巢子宫内膜异位囊肿首选的检查方法,应用经阴道彩色多普勒超声可提高卵巢子宫内膜异位囊肿的诊断准确性。但在临床实践中,对不典型卵巢子宫内膜异位囊肿仍有一定的误诊。本研究对手术病理证实为卵巢子宫内膜异位囊肿93例患者的声像图表现及病理特点进行分析,探讨超声误诊原因,以提高卵巢子宫内膜异位囊肿的术前诊断准确性。

资料与方法

一、研究对象

2003年1月至2008年4月经我院手术病理证实为卵巢子宫内膜异位囊肿的患者93例,年龄24~59岁,平均(36.61)14.67)岁。临床表现为痛经34例,伴盆腔肿块9例,无痛经59例,以盆腔肿块为主诉38例;合并月经紊乱8例、经量增多5例、腹痛、坠胀、腰酸14例,不孕15例。术前行腹部二维超声检查61例,彩色多普勒超声检查6例,经阴道彩色多普勒超声检查26例。

二、仪器与方法

使用Ph ili p sHD I5000、U i22和N a m i10彩色多普勒及二维超声诊断仪,经腹