en صحت سونوگرافی ترانس واژینال و ترانس رکتال در تشخیص اندومتریوز: یک مطالعه کوهورت گذشته‌نگر Reproductive Surgery Original Article Original Article <div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">تشخیص زودرس و درمان مناسب آندومتریوز بسیار مهم است و ممکن است از عوارض بعدی آن جلوگیری کند.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">بررسی دقت سونوگرافی ترانس واژینال و ترانس رکتال برای تشخیص آندومتریوز با توجه به سن و نمایه توده بدنی بیماران.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مواد و روش&shy; ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">این مطالعه کوهورت گذشته</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نگر بر روی 119 زن که برای جراحی آندومتریوز به بیمارستان زنان و زایمان آرش مراجعه کرده بودند، انجام شد. زنان ازدواج</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">کرده و ازدواج&shy;نکرده، به ترتیب ترانس واژینال و ترانس رکتال انجام دادند و سپس ضایعات اندومتریوزیس با استفاده از جراحی لاپاروسکوپیک خارج شدند.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">دقت سونوگرافی ترانس واژینال برای تشخیص آندومتریوما راست در زنان با نمایه</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ی توده</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ی بدنی نرمال (۶/۹۵</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) در مقایسه با زنان با نمایه</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ی توده</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ی بدنی بالاتر از۳۰ (۳/۷۵</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) بالاتر بود (۰۰۱/۰</span></span><span dir="LTR" style="font-size:10.0pt">p</span> <span dir="LTR" style="font-size:10.0pt"><</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">). حساسیت (۹/۹۶</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) و ارزش اخباری منفی (۹/۹۲</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) سونوگرافی ترانس واژینال برای تشخیص آندومتریوما چپ در زنان با وزن نرمال در مقایسه با زنان چاق بیشتر است (حساسیت: ۴/۷۷، ارزش اخباری منفی: 6/58). دقت سونوگرافی ترانس واژینال در تشخیص آندومتریوم چپ در زنان زیر 35 سال نسبت به زنان بالای 35 سال بیشتر بود (2/93</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> در مقابل 9/77</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">؛ 04/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">). همچنین، صحت سونوگرافی ترانس واژینال در تشخیص آندومتریوم راست در زنان زیر 35 سال در مقایسه با زنان بالای 35 سال برتر بود (5/86</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> در مقابل 3/73</span></span><span lang="FA" style="font-size:11.0pt"><span majalla="" sakkal="" style="font-family:">٪</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">؛ 04/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">).</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتیجه &shy;گیری:</span></span></b> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">سونوگرافی زمانی که همراه با شرح حال و یافته&shy;های فیزیکی بیمار، به ویژه سن و نمایه</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ی توده</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ی بدنی استفاده می</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">شود، می</span></span><span lang="FA" style="font-size:11.0pt"><span cambria="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">تواند یک روش روا و پایا برای تشخیص آندومتریوز باشد.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Background:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> Early diagnosis and appropriate treatment of endometriosis are vital and may prevent subsequent complications.</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Objective:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> To investigate the diagnostic accuracy of transvaginal ultrasound sonography (TVUS) and </span></span><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">transrectal ultrasound sonography</span></span><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> for detecting endometriosis considering the age and body mass index (BMI).</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Materials and Methods:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> This was a retrospective cohort study of 119 women scheduled for surgery in a tertiary health care center for clinically suspected endometriosis. Married and virgin women underwent TVUS and </span></span><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">transrectal ultrasound sonography</span></span><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">, respectively, before laparoscopic excision of endometriotic lesions. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Results:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> The accuracy of TVUS in the diagnosis of right endometrioma in women with a normal BMI was superior to that in women with a BMI &ge; 30 (95.6% vs. 75.3%; p < 0.001). For the detection of left endometrioma in women with a normal BMI, TVUS demonstrated a sensitivity of 96.9% and a negative predictive value of 92.9%, which was significantly superior to TVUS in women with obesity (sensitivity: 77.4%, negative predictive value: 58.6%). The accuracy of TVUS in the diagnosis of left endometrioma in women under 35 yr was superior to that in women older than 35 yr (93.2% vs. 77.9%; p = 0.04). Similarly, the accuracy of TVUS in the diagnosis of right endometrioma in women under 35 yr was superior to TVUS in women older than 35 yr (86.5% vs. 73.3%; p = 0.04). </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Conclusion:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> Ultrasound can be a useful technique for detecting endometriosis when used adjunctively with the patient&rsquo;s history and physical findings, especially age and BMI.</span></span></span></span></span></span></div> <br> <span dir="RTL"></span><gdiv></gdiv><gdiv></gdiv><gdiv></gdiv> آندومتریوز, آندومتریوز عمیقاً نفوذ کننده, سونوگرافی ترانس واژینال, سونوگرافی. Endometriosis, Ultrasonography, Diagnostic imaging, Body mass index. 365 376 http://ijrm.ir/browse.php?a_code=A-10-1566-1&slc_lang=en&sid=1 Zahra Asgari dr.zahra.asgari@gmail.com 0000-0003-1180-1965 No Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Reyhaneh Hosseini rayh_h@yahoo.com 0000-0003-4017-1421 No Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mahdi Sepidarkish mahdi.sepidarkish@gmail.com 0000-0003-4732-6684 No Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Azar Nabati azar.nabati1399@gmail.com 0000-0002-5793-9065 Yes Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.