| 摘要: |
| 目的 分析中晚孕期宫内条索状结构的二维及三维超声表现，提高临床对该类疾病的认识和诊断水平。方法 回顾性分析224例中晚孕期超声检查发现宫内条索状回声病例的临床资料，收集并记录正常分娩后或术中所见子宫纵隔、宫腔粘连带及胎盘情况，随访妊娠结局，结合病理组织学检查结果与声像图表现，总结不同类型条索状结构的二维及三维超声特征。结果 本研究中晚孕期宫腔内发现条索状结构的224例病例中：宫腔粘连带最多见，共170例，可出现在宫腔任意地方，三维超声可显示宫腔粘连带的数目、厚薄和形态；单纯羊膜皱襞19例，二维超声表现为羊膜边缘向羊膜腔内延伸形成条索状回声,远端呈游离状，三维超声示单纯羊膜皱褶呈薄膜状；不全纵隔子宫12例,位于宫腔底部或上部，三维超声可显示其分隔较厚，并可显示胎盘附着的位置关系；轮廓胎盘11例，二维超声示条状回声出现在胎盘边缘部，三维超声表现为胎盘边缘部环带状突起或局部山脊状突起；绒毛膜羊膜分离4例，二维超声表现为羊膜呈可飘动的线形回声，与绒毛膜分离，三维超声成像示羊膜似“薄纱”样膜状结构；斜隔4例，二维超声显示回声类似不完全纵隔子宫，但斜隔的基底部均位于宫腔侧壁，三维超声可清晰显示宫腔内斜行分隔回声；羊膜带综合征2例，二维超声表现为宫腔内多条纤细杂乱光带回声，并粘附于胎儿，与胎儿肢体分界不清。三维超声示胎儿肢体表面杂乱的膜状结构。结论 二维超声联合三维超声可全面观察中晚孕期宫腔内条索状回声，分析其不同的超声影像学表现，有利于提高对中晚孕期宫腔内条索状回声的诊断水平。 |
| 关键词: 超声，二维，三维，孕期，条索状结构 |
| DOI： |
| 投稿时间：2023-03-22修订日期：2023-09-15 |
| 基金项目:四川省出生缺陷临床医学研究中心 2019YSF0531-6 |
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| Clinical Application of Two-Dimensional Ultrasound Combined with Three-Dimensional Ultrasound in the diagnosis of Cord-like Structures in Gravid Uterus |
| wangsaijun,limingxing,luozhijian,lizhimeng,xuanjiqing |
| (Department of Ultrasound, The Affiliated Hospital of Southwest Medical University) |
| Abstract: |
| Objective To explore the two-dimensional and three-dimensional ultrasonographic features of cord-like structures in gravid uterus during the second and third trimester of pregnancy and improve the understanding and accuracy of diagnosis of these disease.Methods The characteristics of two-dimensional and three-dimensional ultrasound imaging and clinical data of 224 cases of intrauterine cord-like echos during the second and third trimester of pregnancy were retrospectively analyzed.Results In this study, among the 224 cases with intrauterine cord-like echo during the second and third trimester of pregnancy，the most common is uterine synechia bands ,with 170 cases，which can appear anywhere in the uterine cavity. The number，thickness and shape of intrauterine adhesions could be demonstrated by three-dimensional ultrasound. There were 19 cases of amniotic sheet, which two-dimensional ultrasound showed that the edge of the amniotic membrane extended into the amniotic cavity to form a strip like echo，with free distal end, and three-dimensional ultrasound showed that the amniotic sheet were reflective membrane. There were 12 cases of incomplete mediastinal uterus, which thick septum always located at the bottom or upper part of the uterine cavity. The morphology of septum and its position relationship with placenta attachment could be identified by three-dimensional ultrasound. There were 11 cases of circumvallate placenta，which cord-like echo was detected at the margin of the placenta in two dimensional ultrasound and can be shown as ring-shaped protrusions or local ridge shaped protrusions at the edge of the placenta in three-dimensional pattern. There were 4 cases of chorioamniotic separation, which amniotic membrane exhibits a flapping linear echo, separated from the chorion. On 3D ultrasound, it has an appearance similar to a layer of gauze. There were 2 cases of amniotic cord syndrome, which showed multiple thin and disordered light bands echoing in the uterine cavity, adhering to the fetus, and with unclear boundaries with the fetal limbs in in two dimensional ultrasound. Three dimensional ultrasound shows a disordered membranous structure on the surface of fetal limbs. Conclusion Two-dimensional ultrasound combined with three-dimensional ultrasound can comprehensively observe intrauterine cord-like echo in the second and third trimester of pregnancy，and analyze its different ultrasound imaging characteristics，which is conducive to improving diagnostic accuracy of intrauterine cord-like echo in the second and third trimester of pregnancy. |
| Key words: Ultrasound,two-dimensional ,three-dimensional,pregnancy,cord-like structures |
