目的 探讨经阴道超声联合三维能量多普勒超声对绝经期子宫内膜增厚性病变的诊断价值。方法 选取于2017.1月-2019.5月在我院诊断的绝经期子宫内膜增厚性病变患者90例。有内膜增厚者均经阴道超声测量内膜厚度(endometrial thickness,ED),可探及血流信号者,测得阻力指数(RI)。然后应用三维能量多普勒超声获得子宫内膜血流指标,即血流指数( flowindex,FI)、血管形成指数( vascularization index,VI) 、和血管形成血流指数( vascularization flow index,VFI)。该90例病例均行诊断性刮宫、宫腔镜检查或妇科手术后得到病理检查结果。以所得病理检查结果为金标准进行分组：分为内膜增生组(36例),内膜良性病变组(29例),内膜恶性病变组(25例)。结果 内膜增生组和良性病变组内膜厚度比较差异无统计学意义(P＞0.05)。良性病变组和恶性病变组内膜厚度比较,差异有统计学意义(P＜0.01)；经阴道彩色多普勒超声血流信号显示数,内膜增生组(0例),内膜良性病变组(26例),内膜恶性病变组(25例),两组间阻力指数(RI)比较差异有统计学意义(P＜0.01)；三组间VI、FI、VFI比较差异有统计学意义(P＜0.01)；结论 经阴道超声联合三维能量多普勒超声能有效的对内膜增生、内膜的良性病变与内膜恶性病变进行初步鉴别,对绝经期内膜增厚性病变的诊断有着重要的临床应用价值。

Objective To evaluate the diagnostic value of transvaginal ultrasound combined with three-dimensional energy doppler ultrasound for endometrial thickening during menopause.Method Totally 90 cases of menopausal endometrial thickening lesions diagnosed in our hospital from January 2017 to May 2019.1 were selected. Endometrial thickening was measured by transvaginal ultrasound. When blood flow signals can be detected, resistance index (RI) is measured. Then the endometrial blood flow parameters were measured by three-dimensional energy doppler ultrasound. Indexes to be measured include vascularization index (VI), flowindex (FI) and vascularization flowindex (VFI). All the 90 patients underwent diagnostic curettage and hysteroscopy or gynecological surgery and received pathological examination results. According to the pathological examination results, the patients were divided into three groups:endometrial hyperplasia group (36 cases), endometrial benign lesions group (29 cases), and endometrial malignant lesions group (25 cases). Results There was no significant difference in intimal thickness between endometrial hyperplasia group and benign lesion group. The difference of intimal thickness between the benign group and the malignant group was statistically significant. Transvaginal color doppler ultrasound blood flow signal display number, endometrial hyperplasia group (0 cases), endometrial benign lesion group (26 cases), endometrial malignant lesion group (25 cases). The difference of resistance index (RI) between the two groups was statistically significant (P<0.01). Comparison of VI 、FI and VFI between the three groups was statistically significant (P<0.01). Conclusion Transvaginal ultrasound combined with three-dimensional energy doppler ultrasound can effectively distinguish benign and malignant intimal hyperplasia. It is of great clinical value in the diagnosis of endometrial thickening during menopause.

内蒙古医科大学科技百万工程联合项目（YKD2020KJBW(LH)072）