摘要
目的 系统评价经阴道超声(TVS)检查对宫骶韧带、直肠阴道隔、子宫直肠陷凹及直肠乙状结肠深部浸润型子宫内膜异位症(DIE)的诊断价值。方法 系统检索关于TVS诊断DIE的中英文文献,根据诊断准确性试验质量评价工具-2(QUADAS-2)评价文献质量,采用Meta-Disc 1.4软件分析TVS对不同部位DIE的诊断效能;绘制综合受试者工作特征(SROC)曲线分析TVS诊断宫骶韧带、直肠阴道隔、子宫直肠陷凹、直肠乙状结肠DIE的曲线下面积。结果 最终纳入文献20篇,其中6篇文献在病例选择方面存在较高偏倚风险,8篇文献在病例流动和时间方面存在较高偏倚风险。TVS诊断宫骶韧带、直肠阴道隔、子宫直肠陷凹及直肠乙状结肠DIE的合并敏感性分别为0.77[95%可信区间(CI):0.65~0.86]、0.55(95%CI:0.42~0.67)、0.89(95%CI:0.80~0.94)、0.86(95%CI:0.75~0.93),合并特异性分别为0.92(95%CI:0.89~0.94)、0.98(95%CI:0.95~0.99)、0.96(95%CI:0.83~0.99)和0.94(95%CI:0.90~0.97),合并阳性似然比分别7.74(95%CI:5.80~10.34)、14.27(95%CI:7.28~27.95)、10.56(95%CI:4.90~22.76)和10.94(95%CI:6.17~19.39),合并阴性似然比分别为0.25(95%CI:0.16~0.38)、0.48(95%CI:0.34~0.66)、0.14(95%CI:0.08~0.24)和0.17(95%CI:0.09~0.31),合并诊断比值比分别为37.02(95%CI:21.71~63.11)、34.87(95%CI:16.35~74.36)、117.97(95%CI:37.34~372.69)和70.78(95%CI:26.99~185.59);SROC曲线下面积分别为0.94(95%CI:0.91~0.96)、0.88(95%CI:0.85~0.91)、0.96(95%CI:0.94~0.98)、0.97(95%CI:0.95~0.98)。结论 TVS对宫骶韧带、直肠阴道隔、子宫直肠陷凹及直肠乙状结肠DIE的整体诊断效能均良好,可作为其常规检查方法。
Objective To systematically evaluate the diagnostic value of transvaginal ultrasound(TVS)in uterosacral ligament,rectovaginal septum,hysterorectal depression and rectosigmoid colon of deep infiltrating endometriosis(DIE).Methods The literature on TVS diagnosis of DIE was systematically searched in Chineses and English.The literature quality was evaluated according to diagnostic test accuracy quality assessment tool-2(QUADAS-2).Meta-Disc 1.4 software was used to analyze the diagnostic efficacy of TVS for DIE in different location.Summary receiver operating characteristic(SROC)curve was drawn to analyze the area under the curve of TVS for the DIE of uterosacral ligament,rectovaginal septum,hysterorectal depression and rectosigmoid colon.Results Twenty articles were included.Among them,6 literatures had a high risk of bias in case selection,and 8 literatures had a high risk of bias in case flow and time.The pooled sensitivity of TVS in diagnosing the DIE of uterosacral ligament,rectovaginal septum,hysterorectal depression and rectosigmoid colon were 0.77(95%CI:0.65~0.86),0.55(95%CI:0.42~0.67),0.89(95%CI:0.80~0.94)and 0.86(95%CI:0.75~0.93),respectively.The pooled specificity were 0.92(95%CI:0.89~0.94),0.98(95%CI:0.95~0.99),0.96(95%CI:0.83~0.99)and 0.94(95%CI:0.90~0.97),respectively.The pooled positive likelihood ratio were 7.74(95%CI:5.80~10.34),14.27(95%CI:7.28~27.95),10.56(95%CI:4.90~22.76)and10.94(95%CI:6.17~19.39),respectively.The pooled negative likelihood ratio were 0.25(95%CI:0.16~0.38),0.48(95%CI:0.34~0.66),0.14(95%CI:0.08~0.24)and 0.17(95%CI:0.09~0.31),respectively.The pooled diagnostic odds ratio were 37.02(95%CI:21.71~63.11),34.87(95%CI:16.35~74.36),117.97(95%CI:37.34~372.69)and 70.78(95%CI:26.99~185.59),respectively.The areas under SROC curve were 0.94(95%CI:0.91~0.96),0.88(95%CI:0.85~0.91),0.96(95%CI:0.94~0.98)and 0.97(95%CI:0.95~0.98),respectively.Conclusion TVS has good performance in the overall diagnosis of DIE in uterosacral ligament,rectovaginal septum,hysterorectal depression and rectosigmoid colo
作者
李丽鹏
唐枝
陈丽荣
张步林
LI Lipeng;TANG Zhi;CHEN Lirong;ZHANG Bulin(Department of Ultrasound,Liuzhou People’s Hospital Affiliated to Guangxi Medical University,Guangxi Zhuang Autonomous Region 545006,China)
出处
《临床超声医学杂志》
CSCD
2022年第11期847-853,共7页
Journal of Clinical Ultrasound in Medicine
基金
广西壮族自治区卫生健康委员会自筹基金(Z20210052)。
