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CT对卵巢子宫内膜 异位囊肿的诊断及 鉴别诊断价值分析*

作者:李 莉1 蒋 睿2 马彩玲3

所属单位:1.新疆医科大学第六附属医院妇科 (新疆 乌鲁木齐 830002) 2.新疆医科大学第六附属医院手术 室 (新疆 乌鲁木齐 830002) 3.新疆医科大学第一附属医院妇三 科 (新疆 乌鲁木齐 830054)

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摘要

目的 对比MR、CT鉴别与诊断卵 巢子宫内膜异位囊肿效用,评价CT诊断价 值。方法 选取2011年1月至2015年10月我 院收治确诊的200例卵巢囊性病变的患者 患者作为研究对象,均进行CT、MR诊断, 比较二者的诊断价值。结果 子宫内膜异 位囊肿占38.5%、成熟性畸胎瘤26.0%、浆 液性囊腺瘤17.5%、单纯性囊肿11.0%、粘 液性囊腺瘤7.0%;子宫内膜异位囊肿双侧 发病比重高于其他类型异位囊肿,子宫内 膜异位囊肿年龄低于卵巢囊肿,子宫内膜 异位囊肿长径低于成熟畸胎瘤、浆液性 囊腺瘤、粘液性囊腺瘤,高于单纯性囊 肿,差异具有统计学意义(P<0.05);MR 诊断敏感度89.61%、特异度91.06%、阳性 预测值86.25%、阴性预测值93.33%、符合 率90.50%,CT诊断则为90.91%、88.62%、 83.33%、93.97%、89.50%,差异无统计 学意义(P>0.05);研究中“卫星囊”占 51.95%、有囊内高密度影病灶11.69%、囊 壁增厚25.97%、囊性包块10.39%,粘连占 18.18%,假阴性7例,其中粘连3例、囊性 包块3例、囊壁增厚1例,差异无统计学意 义(P>0.05)。结论 CT鉴别诊断卵巢子宫 内膜异位囊肿效果与MR相近,诊断效用较 MR无明显优势。

Objective To compare the effectiveness of MR and CT in the diagnosis and diagnosis of ovarian endometriosis cyst, and to evaluate the diagnostic value of CT. Methods Two hundred cases of patients with cystic lesions of the ovary from January 2011 to October 2015 were diagnosed in the hospital as the research object, all of which were diagnosed by CT and MR. Results The endometrial cyst accounted for 38.5%, teratoma 26%, 17.5% serous cystadenoma, 11% simple cysts, 7% mucinous cystadenoma, endometrial cyst of bilateral disease proportion is higher than other types of cysts, endometriosis cyst under the age of ovarian cyst, endometriosis cyst diameter lower than mature teratoma, serous cystadenoma above, mucinous cystadenoma, simple cyst, the difference was statistically significant (P<0.05). MR diagnostic sensitivity 89.61%, specificity 91.06%, positive predictive value of 86.25% and negative predictive value of 93.33%, the coincidence rate was 90.50%, CT was 90.91%, 88.62%, diagnosis of 83.33%, 93.97%, 89.50%, the difference was not statistically significant (P>0.05), in the study of "satellite capsule" accounted for 51.95%, sac high density lesions in 11.69%, cystic wall thickening in 25.97%, cystic mass in 10 39%, adhesion accounted for 18.18%, false negative in 7 cases, of which 3 cases of adhesion, cystic mass in 3 cases, 1 cases of cystic wall thickening, the difference was not statistically significant (P>0.05). Conclusion CT differential diagnosis of ovarian endometriosis cyst is similar to MR, and the diagnostic utility of MR has no obvious advantage.

【关键词】卵巢囊肿;子宫内膜异位症;CT

【中图分类号】R711.75

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.08.009

前言

子宫内膜异位症(Endometriosis,EMS,简称内异症)是指具有生 长功能的子宫内膜组织出现在子宫腔被覆内膜及宫体肌层以外其它组 织的一种疾病[1]。EMS是女性常见病,多见于育龄女性,育龄女性发病 率高达3%~10%[2]。卵巢囊肿是临床常见病,是最常见的生殖系统肿 瘤,保守估计25~45岁女性卵巢囊肿发病率约为10%~15%,约80%的 EMS发生于卵巢,卵巢子宫内膜异位囊肿约占卵巢肿瘤的1/3[2]。卵巢子 宫内膜异位囊肿危害较大,可致卵巢功能障碍,急性发作患者以腹痛 为主要症状表现,患者还常合并其他部位内异症,约40%~50%内异症 患者可并发不孕[3]。及早鉴别诊断卵巢子宫内膜异位囊肿,有助于避免 病情恶化,保留卵巢功能,改善患者长远预后。影像学技术是鉴别诊 断卵巢子宫内膜异位囊肿的主要方法,包括B超、CT、MR等技术,各有 优缺,CT显示卵巢囊肿效果较好,但目前相关研究较少,本次研究就 此进行探讨,总结诊断经验。