Переоценить значение ультразвуковой диагностики в современной медицине не возможно. Метод постоянно усовершенствуется не только в отношении улучшения технических характеристик используемых УЗИ-аппаратов, но и методик проведения исследования. Одной из разновидностей данной диагностической процедуры является трансвагинальное УЗИ (сокращенная аббревиатура ТВУЗИ).
Что такое трансвагинальное УЗИ
Исследованию ультразвуком доступны любые органы и ткани человеческого организма. В большинстве случаев средой разграничения между УЗИ датчиком и исследуемой областью служит кожа. Но в некоторых ситуациях, когда возникает необходимость осмотра и оценки глубоко лежащих внутренних органов малого таза, стандартная процедура исследования через стенку живота не может быть достаточно информативной. Получить достоверную и ценную информацию о внутритазовых структурах (яичниках, матке, маточных трубах и т.д.) поможет трансвагинальное УЗИ.
Сущность метода заключается в том, что осмотр проводится при помощи специального датчика, который вводится во влагалище исследуемой женщины. Это дает возможность осмотреть органы малого таза изнутри через влагалищную стенку. Поскольку датчик будет находится в непосредственной близости от их анатомического расположения, то и возможности их визуализации на ультразвуковом мониторе очень хорошие. По сути, трансвагинальное УЗИ отличается от стандартного УЗИ (трансабдоминального) только видом датчика и местом его контакта с исследуемыми тканями.
Какие органы обследуются
Трансвагинальное УЗИ выполняется половозрелым особям женского пола, ведущим половую жизнь. Беременность является относительным противопоказанием для исследования, так как в некоторых случаях возникает необходимость в его проведении и у данной категории пациенток. С помощью влагалищного УЗИ могут быть исследованы такие органы малого таза:
- Шейка матки (дина, структура, размеры, диаметр цервикального канала, расположение);
- Матка (размеры, положение, характеристики маточной полости, структура и состояние мышечного слоя, толщина и функциональная активность эндометрия, наличие дополнительных включений в стенках и полости матки);
- Маточные трубы (расположение, размеры, структура, наличие расширений и дополнительных образований, частично может быть оценена проходимость);
- Яичники (размеры, структура, функциональная активность и способность к овуляции, дополнительные образования на поверхности и внутри яичниковой ткани);
- Тазовый карман брюшины (наличие жидкости в Дугласовом пространстве и полости малого таза);
- • Забрюшинные структуры таза (состояние сосудов, лимфатических узлов, наличие дополнительных опухолевидных разрастаний).
Когда назначается
Несмотря на свою безопасность трансвагинальное УЗИ должно проводится лишь в определенных случаях. Показания к его применению связаны с наличием любых подозрений на патологические состояния со стороны органов малого таза или необходимостью оценки эффективности проводимого лечения по поводу гинекологической патологии. Это могут быть:
- Диагностика ранних сроков беременности и ее нарушений, если результаты стандартного УЗИ сомнительны или не информативны;
- Частые боли в животе, локализованные в нижних отделах;
- Женское бесплодие;
- Нерегулярность менструального цикла (задержка или преждевременность месячных);
- Подозрение на отсутствие овуляции или ее нерегулярность;
- Кровянистые или любые другие патологические выделения из влагалища;
- Подозрения на доброкачественные опухолевидные образования и злокачественные опухоли тазовой локализации;
- Диагностика воспалительных заболеваний внутренних половых органов женщины
- Контроль за состоянием яичников на фоне приема гормональных таблетированных контрацептивов;
- Мониторинг за внутриматочной спиралью;
- Необходимость ультразвукового контроля в ходе экстракорпорального оплодотворения (ЭКО);
- Проблемы с мочеиспусканием (задержка, учащенное, болезненное и т.д.);
- Необходимость УЗИ органов малого таза у женщин с избыточной массой и ожирением. У данной категории женщин только трансвагинальное УЗИ может дать информацию о состоянии внутритазовых структур.
Когда лучше проводить трансвагинальное УЗИ
В экстренных случаях УЗИ-исследование органов малого таза может быть проведено в любое время, не зависимо от дня менструального цикла или других обстоятельств. Что касается обследований, проводимых в плановом порядке, для повышения их информативности обязательно нужно придерживаться таких правил:
- Связь с фазой менструально-овуляторного цикла – через день после окончания месячных. Наиболее часто это время соответствует 6-8 дню менструального цикла (с первого дня начала месячных). Допустимо проводить исследование и в более поздние сроки (до 12-13 дня), если имеет место продолжительный цикл (более 28-30 дней) и поздняя овуляция;
- Вид патологии. Наличие подозрений на пролиферативные заболевания эндометрия (эндометриоз) требует проведения исследования после наступления овуляции (вторая половина менструального цикла);
- Необходимость мониторинга за функциональной активностью яичников и созреванием фолликулов. В таких случаях трансвагинальное УЗИ проводят 3-4 раза в месяц (7-10, 13-15, 21-24 дни цикла).
Трансвагинальное УЗИ при беременности
Даже УЗИ, проводимое через стенку живота, назначается лишь на определенных сроках беременности при отсутствии экстренных показаний. Ввиду того, что трансвагинальное УЗИ сопряжено с необходимостью раздражения влагалища и органов малого таза, в первую очередь матки, его проведение у беременных ограничено. Это также вязано с тем, что получить исчерпывающую информацию о наличии беременности и состоянии плода можно путем исследования трансабдоминальным датчиком.
Бывают исключительные случаи, когда необходимо провести дифференциальную диагностику между внутриматочной и внематочной беременностью, наличием плодного яйца или патологического образования в полости матки, жизнеспособностью и внутриутробной гибелью плода (замершей беременностью), особенно на ранних сроках гестации (первый триместр). Во всех этих случаях на помощь приходит трансвагинальное УЗИ. Его осторожное и аккуратное выполнение не принесет никакого дискомфорта и редко приводит к возникновению осложнений. Поэтому беременность на сроке от 4-5 до 12-13 недель не является абсолютным противопоказанием к ТВУЗИ.
Нормы и расшифровка показателей трансвагинального УЗИ
Для того, чтобы уметь правильно оценить результаты исследования необходимо знать общепринятые нормы, которые служат ориентиром. Главные нормативные показатели, которые включает в себя трансвагинальное УЗИ, приведены в таблице.
| Показатель | Как выглядит норма |
| Матка | |
| Положение | Должен быть небольшой перегиб кпереди, которые называют anteflexio. Перегиб кзади не является патологией, но может влиять течение некоторых патологических состояний и препятствовать наступлению беременности. |
| Контуры | В норме описываются, как четкие и ровные. При наличии бугристостей и размытости контуров можно думать о воспалительном или опухолевом поражении органа. |
| Размеры | Усредненные показатели параметров длины матки составляют 65-75 мм, ширины – 55-65 мм при диаметре 39-43 мм. |
| Структура стенок (эхогенность) | Слои четко разграничиваются между собой, каждый из них имеет однородную эхогенность и не содержит дополнительных включений. |
| Маточная полость | При УЗИ должна четко просматриваться и быть однородной. Если имеется размытость контуров, это может говорить о воспалительных процессах в эндометрии и миометрии. Наличие неровностей и разрастаний свидетельствует об опухолевых или полипозных разрастаниях. Они описываются, как образования и включения гиперэхогенного характера. |
| Эндометрий | |
| Толщина | Трансвагинальное УЗИ имеет такие нормы в зависимости от фазы цикла: |
- до 4 суток – эндометрий практически не визуализируется или виден в виде полоски 1-2 мм;
- к концу первой недели – от 3-4 до 7-8 мм;
- вторая неделя – от 7-8 до 15-16 мм;
- третья неделя – от 10-11 до 17-18 мм;
- период перед менструацией – около 20 мм.
Какие болезни можно распознать
Трансвагинальное УЗИ информативно для диагностики таких заболеваний органов малого таза:
Современная гинекология имеет несколько очень точных и безопасных методов исследования. Один из них — трансвагинальное УЗИ. К сожалению, женщины недостаточно информированы о его особенностях, не знают как подготовиться к вагинальному УЗИ, некоторые с предубеждениям относятся к процедуре. Рассмотрим что такое и как делают трансвагинальное УЗИ, какие результаты можно получить этим методом.
Особенности процедуры
УЗИ трансвагинально (ТВ) по сути не отличается от традиционной сонографии. На ткани воздействуют ультразвуковыми волнами. Они «отражаются» от объектов с разной плотностью и фиксируются специальным приёмником, который трансформирует их в изображение. Чем меньше слоев будут преодолевать волны до исследуемого объекта, тем меньше искажений будет иметь «картинка» на мониторе.
УЗИ вагинальным датчиком, который помещается непосредственно во влагалище, позволяет максимально сократить расстояние до исследуемых органов. Главное преимущество метода перед традиционным трансабдоминальным (через брюшную стенку) исследованием это получение более качественного и четкого изображения. Исследование органов малого таза трансвагинально позволяет диагностировать самые незначительные отклонения от нормальной структуры тканей.
Показания
УЗИ малого таза трансвагинальным датчиком позволяет выявить заболевания, которые еще не проявили себя развернутой клинической картиной. Это расширяет возможности ранней диагностики в гинекологии и урологии. Показаниями являются:
- Боль внизу живота любой интенсивности, которая в сочетании с другими симптомами позволяет заподозрить заболевания органов малого таза.
- Патология, связанная с менструальным циклом: обильные кровотечения, нерегулярные, чрезмерно болезненные и длительные менструации.
- Появление кровотечений в середине цикла.
- Дискомфорт и боль внизу живота во время полового акта.
- Диагностика причин бесплодия у женщин (один из немногих методов, который визуально оценивает проходимость маточных труб).
- Для контроля за искусственным оплодотворением.
- Показанием для допплерографического исследования в сочетании с трансабдоминальным УЗИ являются подозрения на опухолевые изменения. Особенно важно это для ранней диагностики новообразований в яичниках, когда оперативное лечение не только сохраняет жизнь пациентке, но и дает ей шанс стать матерью.
- При подозрении на внематочную беременность, причем, УЗИ вагинально может с большой достоверностью определить локализацию прикрепления плодного яйца.
- Контроль за различными методами контрацепции: спираль, вагинальное кольцо. При длительном приеме гормональных противозачаточных средств исследование их влияния на состояние эндометрия.
- Заболевания других тазовых органов: цистит, уретрит. Выяснение органических причин энуреза.
Достоинством процедуры является безопасность для здоровья женщины (впрочем, как и при обычной сонографии). Ультразвуковое исследование можно делать столько раз, сколько необходимо в каждом конкретном случае.
Какие заболевания определяют с помощью ТВ УЗИ
Что показывает исследование? Этот вопрос, конечно, интересует больше профессиональных гинекологов и урологов.
Мы дадим список основных патологий, чтобы показать насколько важно и информативно влагалищное ультразвуковое исследование:
- Опухолевый процесс как злокачественный, так и доброкачественный (миома матки, рак яичников, хорионэпителиома).
- Патология беременности (пузырный занос, внематочная беременность).
- Заболевания яичников и маточных труб (поликистоз, разрыв кисты яичника, жидкость в трубах).
- Отклонения в строении внутреннего слоя матки (полипоз эндометрия) или его распространение на соседние органы (эндометриоз).
- Наличие жидкости в малом тазу или нижних отделах живота.
Исследование проводится при планировании беременности (оценивают количество и качество созревающих фолликулов) и для ранней диагностики беременности, так как позволяет обнаружить плодное яйцо минимальных размеров.
Трансвагинальное УЗИ при беременности
Многие женщины задают вопрос можно ли делать трансвагинальное УЗИ при беременности? Им кажется, что процедура, проводимая через влагалище, может навредить развитию ребенка. На самом деле метод абсолютно безопасен.
6 аргументов сделать именно трансвагинальное УЗИ при беременности:
- Диагностика беременности с помощью УЗИ на ранних сроках. Иногда при исследование через брюшную стенку врач сомневается в расположении плодного яйца в матке. Тогда делается дополнительное УЗИ через влагалище, которое является более чувствительным методом.
- Определение многоплодной беременности. На ранних сроках только с помощью трансвагинального УЗИ можно увидеть два и более эмбриона в матке.
- Это незаменимый способ выявления внематочной беременности, и, что самое важное, места атипичного прикрепления плодного яйца. Если такая диагностика проведена вовремя, то оперативное вмешательство по удалению эмбриона будет минимально травмировать ткани и сохранит женщине способность к зачатию в будущем.
- В сочетании с допплерографией позволяет обнаружить самые первые признаки патологии нервной и сосудистой системы плода. Это важно для ранней (в 1 триместре) диагностики пороков развития и генетических заболеваний ребенка.
- Получение более достоверной информации о состоянии эндометрия и толщины хориона (места, из которого в дальнейшем формируется плацента), раннее выявление симптомов выкидыша. Это позволяет принять своевременные меры и сохранить беременность.
- Исследование безопасно и не вызывает дискомфорта.
Следует отметить, что трансвагинальное УЗИ проводится только в 1 триместре беременности. В дальнейшем плод обследуют уже с помощью привычного трансабдоминального способа.
Как проводится процедура
Для того, чтобы развеять все сомнения в безопасности и комфортности этого метода исследования опишем подробно как делают вагинальное УЗИ.
- Женщине придется раздеться до пояса и расположиться на кушетке в позе, традиционной для любого гинекологического обследования.
- Трансвагинальный датчик, который вводят во влагалище, это трубка диаметром 3 см (длина 12 см). Внутри часто имеется канал для расположения биопсийной иглы.
- В целях гигиены на датчик перед исследованием надевают одноразовый презерватив.
- Вагинальный датчик вводится на небольшую глубину, поэтому дискомфорта это обычно не вызывает. В процессе процедуры врач может немного двигать им, но на ощущениях это сказаться не должно. Большинство женщин, прошедших процедуру, отмечали полное отсутствие каких-либо неприятных моментов.
Особой подготовки перед проведением трансвагинального УЗИ органов малого таза не требуется. Если исследование через брюшную стенку требует наполнения мочевого пузыря, что часто вызывает дискомфорт у пациенток, то в данном случае мочевой пузырь должен быть пустым.
Подготовка к трансвагинальному УЗИ сводится в опорожнении толстого кишечника (иногда для этого нужно поставить клизму) и борьбе с избыточным газообразование. Перед процедурой следует ограничить некоторые продукты: молочные, овощи и фрукты, сладости, газировку, грибы, жареные блюда. Можно дополнительно принять лекарственные средства для борьбы с метеоризмом (Эспумизан).
Некоторые пациентки задают вопрос можно ли заниматься сексом перед процедурой. Они привыкли, что при заборе влагалищных мазков такие ограничения уместны. В данном случае секс не влияет на результаты УЗИ.
Оптимальные сроки проведения процедуры
Когда лучше делать трансвагинальное УЗИ? Ответ на этот вопрос лучше узнать у лечащего врача в зависимости от конкретных целей исследования. Мы обозначим несколько общих признаков.
Сроки проведения ТВУЗИ при подозрении на определенные заболевания:
- Подтвердить эндометриоз можно с помощью УЗИ во второй половине цикла.
- При подготовке к зачатию или определении причин бесплодия проводят исследование фолликулов в динамике. На какой день цикла? Лучше трижды — 8-10 день, 15-16 и после 22 дня цикла.
- Если женщина предъявляет жалобы на кровотечение вне месячных, то с диагностикой не медлят, так как это может быть признаком заболеваний, требующих немедленного лечения.
Если процедура плановая, то ее, как и абдоминальное УЗИ проводят сразу после окончания месячных кровотечений.
Трактовка результатов
Всех женщин интересует, что можно увидеть с помощью трансвагинального УЗИ. Для удобства дадим некоторые характеристики в таблице ( нажмите на таблицу чтобы увеличить ).
Как меняется картина УЗИ при различных заболеваниях всегда можно уточнить у лечащего гинеколога. Главное, не пытаться трактовать результаты самостоятельно, так как они сильно отличаются в зависимости от цикличности процессов, происходящих в организме женщины.
Трансвагинальное УЗИ — один из самых эффективных способов ранней диагностики в гинекологии. Его безопасность подтверждена даже у беременных женщин.
Наш аппарат УЗИ оснащен трансвагинальным датчиком, обладающим высокой разрешающей способностью для надежной качественной и количественной оценки эндометрия, миометрия, структурных элементов яичников и различных патологических образований.
Значение ТВ-УЗИ особенно велико при исследовании слизистой матки, так как оно обеспечивает, по сравнению с трансабдоминальным сканированием, значительно более высокий уровень детализации изображения слизистой и, следовательно, большую морфологическую достоверность оптико-акустической картины.
ТВ-датчик, в силу более высокой чувствительности и максимально близкого подведения сканирующего устройства к объекту исследования, позволяет получить высококачественную эхокартину всех структурных элементов слизистой, отчетливо увидеть детали размером от 1-2 мм, точно определить их тканевую принадлежность и осуществить скурпулесзый осмотр всех отделов полости матки.
Применение ТВ-способа эхолокации — непременное условие комплексной, грамотной достоверной диагностики функциональных и органических изменений эндометрия.
Кроме того, ТВ-сканирование позволяет выявить наличие плодного яйца в матке на сроке беременности от 2 — 2,5 недель, то есть с первых дней задержки менструации! А диагностика внематочной беременности практически невозможна без ТВ-датчика.
Допонительным плюсом будет отсутствие необходимости наполнять мочевой пузырь перед УЗИ. Трансвагинальное исследование проводится при пустом мочевом пузыре. Диаметр датчика не более 1,5 см. Датчик зачехляется презервативом.
Наш УЗИ-кабинет обеспечен расходными материалами: одноразовыми пеленками, перчатками, презервативами.
Показания к УЗИ органов малого таза очень многочисленны: это не только задержка менструации (подозрение на беременность), но и любые нарушения менструального цикла, обильные или скудные менструации, болезненные менструации, боли внизу живота, патологические выделения, а так же наличие объемных образований (миом матки, кист яичников и др.) выявленных ранее.
Динамическое УЗИ проводится при гиперпластических процессах эндометрия, при гормонозаместительной терапии. Даже при отсутствии каких-либо жалоб всем женщинам детородного возраста следует раз в 1,5 года проходить УЗ-обследование с целью ранней диагностики патологии и своевременного лечения. Для женщин в постклиматическом периоде рекомендуется ежегодное УЗ-исследование. Следует запомнить, что появление кровянистых выделений из половых путей в этом периоде является срочным показанием к обследованию!
При необходимости врач УЗИ рекомендует Вам консультацию гинеколога (которую Вы всегда можете получить в нашем центре, а можете с заключением и снимками, которые выдаются на руки, обратиться в любое лечебное учреждение).
Особое значение имеет ТВ-УЗИ в диагностике различных форм эндометриоза. Данное заболевание годами мучает женщин, зачастую его путают с: "хроническим аднекситом", соответственно, не назначается противовоспалительной терапии, нередко прогрессирует под действием физиотерапии. Доказано, что 50-55% женщин с классическим для России диагнозом "хронический аднексит" в действительности являются носителями разных форм эндометриоза. А не менее чем у 30% больных с "миомой матки" после тщательного комплексного обследования диагностическое заключение меняется на эндометриоз или на сочетание эндометриоза и миомы.
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