The Study Of Clinical Application On Endometrial Carcinoma And Uterine Myoma By Means Of Three-Dimensional /Four-Dimensional Ultrasonography

Objective:An analysis was made about the diagnosis of Endometrial Carcinoma and Uterine Myoma and the results of the preoperative clinical staging of Endometrial Carcinoma by two dimensional ultrasonography in contrast with three/ four-dimensional ultrasonography to explore the value of clinical applications of three/ four-dimensional ultrasonography.Material and Method: The study included 88 patients admitted in obstetrics and gynecology department of the first affiliated hospital of Henan university from Apr 2009 to Mar 2011 with postoperative clinical diagnosis of uterine occupied lesions, The apparatuses used were American GE Voluson 730 real time three dimensional color Doppler ultrasonography, 4C-A probe, 2.0~5.0MHZ, RAB4-8L volume probe, 4.0~8.0MHz, Trans.Max+Surface model,50% mixed model and other routine model, respectively examined the patients by 2D and 4D ultrasonography, roughly observing the occupied lesions'number,location,shape,morphology,deformation degree with pressure,the relationship among them and the surrounding tissue, etc. The bladders were filled moderately before being checked so that the bottom of uterine could be seen clearly. The patients were told to be horizontal position , and detect the pelvic cavity from every direction by convex array probe, longitudinally, horizontally, and obliquely to understand the properties of the lesions of uterine and the relationship among the uterine and the uterine appendages, posture change could be made and probe could be pressurized when necessary. To examine by two,three/four dimensional ultrasonography in the same way and analyze the results comprehensively, including preliminary diagnosis of the quality of uterine occupied lesions,the preoperative staging,pathological results and check up results of ultrasonography, then figure out diagnostic accordance rates and made a statistic analysis of them.Result:1.88 cases were diagnosed as uterine occupied lesions with the mean age of 46.7 years±12.9(median age 46 years,34~65 years). The study included 32 endometrial carcinomas, 56 uterine myomas(50 intermural uterine myomas,5 submucosal uterine myomas,1 subserous uterine myoma). Endometrium presented secretion or proliferate in different stages in 56 uterine myomas, 12 among them suffered from endometriosis at the same time, 11 among them suffered from endometrial polyps at the same time. 28 of 32 endometrial carcinoma cases were detected by three/four dimensional ultrasonograph and the detectional accuracy rate was 87.5%(28/32); 22 were detected by two dimensional ultrasonograph and the detectional accuracy rate was 68.8%(22/32). 53 of 56 uterine myoma cases were detected by three/ four dimensional ultrasonograph and the detectional accuracy rate was 94.6%(53/56), 40 were detected by two dimensional ultrasonograph and the detectional accuracy rate was 71.4%(40/56). According to statistic analysis, there existed significance difference (P<0.05), which meant the detectional accuracy rate of endometrial carcinoma and uterine myoma by three /four-dimensional ultrasonography was obviously superior to that by two-dimensional ultrasonography.2. The coincidence rate of diagnosis and pathological diagnosis of endometrial carcinoma was 82.1%(23/28)by three / four-dimensional ultrasonography and it was 54.5% (12/22) by two-dimensional ultrasonography; The coincidence rate of diagnosis and pathological diagnosis of uterine myoma was 84.9% (45/53) by three / four-dimensional ultrasonography and it was 80.0% (32/40) by two-dimensional ultrasonography. According to statistic analysis, there existed significance difference (P<0.05), which meant the diagnostic accuracy rate of endometrial carcinoma by three / four-dimensional ultrasonography was obviously superior to that by two-dimensional ultrasonography and there was no significance difference (P>0.05), which meant the diagnostic accuracy rate of uterine myoma by three/four-dimensional ultrasonography had no obvious difference from that by two-dimensional ultrasonography. The accuracy rate of the preoperative staging of endometrial carcinoma was 75% (21/28) by three/four-dimensional ultrasonography and it was 59.1%(13/22) by two-dimensional ultrasonography , according to statistic analysis, there had no obvious difference between them (P>0.05).Conclusion:The examination was performed routinely in the pelvic cavity by ultrasonography after bladder cavity was appropriately full, and three-dimensional ultrasonography was used to rebuild pathological changes to shape three-dimensional structure dynamically, which was able to show related structures'three-dimensional shapes, interior structure in the color flow imaging, to make a more accurate diagnosis and differential diagnosis of uterine occupied lesions than two-dimensional ultrasonography and to perform more correctly the preoperative staging of endometrial carcinoma compared with two-dimensional ultrasonography.