【作者】 李娟；

【导师】 宫桂兰；

【作者基本信息】 吉林大学 ， 妇产科学， 2005， 硕士

【摘要】 子宫平滑肌瘤是妇科超声检查中最常见的肿瘤,由于有许多肌瘤在生长过程中受各种因素影响会发生变性,所以超声声像很复杂。这样,就给子宫肌瘤性质的超声诊断带来了一定困难。虽然,子宫肌瘤发生恶性变的几率极低,但是由于其恶性程度高、预后差。所以,一旦当子宫肌瘤有发生肉瘤变倾向时,如果能够做到早期诊断,就会明显提高生存率。本文通过采用彩色多普勒超声经腹或经阴道检查的方法,对子宫平滑肌瘤、富于细胞型子宫平滑肌瘤和子宫肉瘤的超声声像特征进行分析和总结。旨在为以后的超声诊断做出一些帮助,以对子宫平滑肌瘤肉瘤变做出早期诊断。本研究中发现在RI 方面:富于细胞型子宫平滑肌瘤较普通型子宫平滑肌瘤更多地分布在数值较低组(P<0.05),而子宫肉瘤与前两者也均有明显差别(P<0.05)。这就给临床诊断子宫平滑肌瘤是否有肉瘤变倾向提供了一个新的指标。更多还原

【Abstract】 Objective:In order to make a early diagnosis for the malignanttransformation of leiomyoma by color Dopplerultrasound,we have paitients with leiomyoma ,cellularleiomyoma and uterine sarcoma examined by color Dopplerultrasound and analysis and summarize these diseases’ssonogram feature.Methods:Make a analysis of 2 patients of uterine sarcoma and 268patients of leiomyoma,who are all diagnosed and operatedin our hospital.Verified through hitopathology,192 ofthese cases are leiomyoma ,76 are cellular leiomyoma and2 are uterine sarcoma.Transabdomenal and transvaginalsonogram were performed using a company Agilent’sAgilent Image Point HX ultrasound scanner with 3～5HZ.The sonogram manify uterus,endometrium,texture andcapsule of tumor and the relation with other pelvicorgans.Manify the distribution of tumor’s vessel andmeasure flow by the Pourcelot Resisitance index(RI).Results:1.The RI of 192 patients of leiomyoma is RI=0.604± 0.076,76 patients of cellular leiomyoma is RI=0.567 ±0.063.They have no obvious difference(P>0.05).The RI’s distribution format of them are different obviously. The latter distributs in the lower group much more than the frontier(P<0.05).2.The RI for two patients of uterine sarcoma(RI=0.353 and 0.374 respectivly)is obviously lower than that of leiomyoma and cellular leiomyoma,and their sonogram have eviedent difference. Leiomyoma of the uterus is the most common tumor in theultrasound examination.Because of many factors,leiomyomamay degenerate during its growth,the echo of the diseaseis very complicate.Thus,it is difficult to give adefinitive diagnosis.The incidence of malignanttransformation of leiomyoma is very low,(only about0.4～0.8%).But if malignant transtormation can be diagnosedin the early time,the survive rate would be raisedevidently.In these years ,“uterine smooth muscle tumorof uncertain malignant potential”is put forwarded.Itmakes us pay more attention to the feature ofultrasonogram for leiomyoma.Uterine sarcoma is rarelyin the woman genital tumor and leiomyosarcoma(LMS) makesup about 45% of it.The cause of uterine sarcoma is notknown.It usually occurs at about age 50,who are inperimenopausal period.Because the symptoms and signs ofuterine sarcoma are similar to the other uterine malignanttumor and there is absent of special examination,it isdifficult to discriminate from leiomyoma in early time andendometrial carcinoma in late time.It is hard to make anearly and preoperative diagnosis.However,the 5-yearsurvival rates are inversely proportionate to the stageof LMS.So,it is important for prognosis of uterine sarcomato make a early and correct diagnosis.Uterine sarcoma is so rare that there are few report aboutsonogram for it.US’sonogram manifies:uterine artery isfull of blood and there are many new vessels around thetumor and(or) inside the tumor. There is evidentstatistical difference between the average RI of US andleiomyoma.Thus,we can make a tentative discriminationbetween US and leiomyoma through ultrasonography.There istissue relation between LMS and leiomyoma ,so that it isdifficult to distinguish LMS from a lot of leiomyoma.Butif the sonogram feature and the sign of color Doppler ofUS can be analysised comprehensively,we would raise thediagnostic rate obviously.When the tumor is more biggeror it grows more quicker during regular check-ups,or thechange of the internal structure is not even,or there isliguid darkness inside of the tumor and the RI is low ,weshould think about US or degeneration.Above all,colorDoppler ultrasound has important value at the diagnosisand differential diagnosis of the tumor of uterine smoothmuscle.Conclusions:更多还原