輸液前後陰道超音波掃描對於評估已經由子宮鏡檢證實之不孕婦女子宮腔內異常之比較研究

欲以陰道超音波掃描，而求能清楚並確切診斷子宮腔內之異常及病變大小，實在困難，如果，子宮腔能被液體充滿，則可能提供較佳視覺對比，以利陰道超音波偵測，因此，在不孕症門診中，對經陰道超音波初次掃描後之婦女，立刻以5% G/W（同時充當對比劑及填充劑）經由軟性子宮鏡輸入子宮腔，同時作腔內鏡檢並確立診斷在”輸液效應”之幫助下，緊接著作第二次超音波檢查，以比較陰道音波在輸液前和輸液後，對子宮腔內異常之檢測能力有何差異。　　從1991年10月至1994年6月間，總共有739位不孕者在濾泡期間受檢，其中經子宮鏡診斷為異常者，計有:內膜息肉47例，黏膜下肌瘤21例，息肉樣子宮內膜增生20例，子宮腔內沾黏17例，子宮中隔12例，4例異物及1例雙角子宮等，共122例。　　輸液後，陰道超音波掃描對子宮腔異常之平均檢測率為74.8%，高於傳統式的38.5%，其中以息肉（91.5% vs 10.6%）和肌瘤（95.2% vs 42.9%）之差別，最為明顯，傳統式的敏感度18%亦低於輸液法的74.6%，雖然兩者均有同樣高的精確度99.5%.　　結論：借助簡單，經濟，又方便之子宮輸液法，就可提供較具對比性且意想不到的影像，而能使陰道超音掃描更加成為診斷子宮腔內異常的好工具。

Transvaginosonographic image of uterus is sometimes not so clear that make the actual diagnosis and measurement of the intrauterine abnormalities more difficult. If the uterine cavity can be distended by fluid that might provide good visual contrast for easier ultrasonic detection. Therefore in an office-based infertility practice, infusion of 5% G/W (used as contrast and also distention medium) through the flexible hysteroscope was performed following the first transvaginal scanning. The second vaginosonography were immediately done right after the hysteroscopy under the help of " infusion effect". With hysteroscopic findings as the standard, the comparison of the infusion and non-infusion vaginosonography in the evaluation of intrauterine abnormalities can then be made.　　From October 1991 to June 1994, 739 infertile women had received this procedure in their follicular phase. Among them, 122 hysteroscopically confirmed abnormalities were as follows: endometrial polyp (47), submucous myoma (21), polypoid endometrial hyperplasia (20), synechia (17), uterine septum (12), foreign body (4) and bicornuate uterus(1).　　The mean detection rate of infusion sonography (74.8%) was higher than that of conventional sonography (38.5%). Especially, the detection rate of endometrial polyp and submucous myoma between these two scannings (91.5% vs 10.6%); (95.2% vs 42.9%) were significantly different. The non-infusion sonography had a sensitivity of 18% which was lower than infusion ones of 74.6%, Although both have the same specificity of 99.5%.　　In conclusion, the infusion vaginosonography can provide good contrast and fantastic vision that make transvaginal ultrasound examination become a more sensitive and effective tool to identify the intrauterine abnormalities.