目的：研究四维超声子宫造影对内膜病变的诊断效能。 方法：选取2020年6月至2022年8月因异常子宫出血于内蒙古自治区妇幼保健院妇科门诊就诊的病人共105例，平均年龄39.819±8.391岁。所有病例先于门诊行经阴道超声检查，随后依次进行生理盐水灌注四维超声子宫造影和宫腔镜检查，依据病情，后续行宫腔镜下内膜活检或病损切除或行子宫切除术，对切除组织进行病理检查，以病理诊断为金标准，对比以上三种检查方法对异常子宫出血患者内膜病变的诊断精确性。 结果：经病理诊断，105例中包括弥漫性内膜病变（子宫内膜增生及内膜癌）7例，局限性内膜病变89例（其中子宫内膜息肉61例，子宫肌瘤22例，内膜息肉合并子宫肌瘤6例），增殖期或分泌期内膜9例。综合所有病理类型对TVS、4D-SIS、HS与病理诊断一致性检验Kappa值分别为0.437、0.675、0.696。4D-SIS 、HS与病理诊断结果一致性达到了较好的程度， HS诊断效能优于4D-SIS，而4D-SIS优于TVS。分别从不同的病理类型分析三种诊断方法的诊断效能，对于子宫内膜息肉，HS的灵敏度为0.967，4D-SIS为0.918,均高于TVS的0.754，HS与TVS有统计学差异；4D-SIS的特异度最高为0.864，但与其他两者没有统计学意义上的差别；4D-SIS阳性预测值为0.903高于HS的0.855；而HS的阴性预测值0.938高于4D-SIS的0.884。 对于内膜增生及内膜癌等内膜广泛性病变，三种方法的灵敏度均较低（TVS、4D-SIS、HS分别为0.429，0.571和0.286），4D-SIS、HS特异度均较高，分别为0.929，0.989，均高于TVS的0.786，并且二者的阴性预测值均较好4D-SIS 为0.968，HS为0.949。 结论：对内膜病变的诊断中，4D-SIS和HS均显示出较好的诊断效能，可以作为内膜病变常规检查手段。对于广泛性内膜病变目前尚无最佳的诊断方式，仍推荐4D-SIS或HS结合内膜活检作为确诊方式。

Objective: The aim of this study was to assess the diagnostic value of four-dimensional saline infusion sonohysterography(4S-SIS) to diagnose endometrial lesion. Methods: This study was conducted on patients, who visited to gynecologic department at the Inner Mongolia Maternity and Child Health Care Hospital from June 2020 to August 2022. A total of 105 patients, with an average age of 39.819 ± 8.391 years, were selected. All cases underwent transvaginal ultrasound(TVS) at the outpatient department, followed by 4D-SIS and hysteroscopy(HS). Based on the condition, endometrial biopsy or lesion resection under hysteroscopy or hysterectomy will be performed. The gold standard was the histopathology of excised tissue. The diagnostic accuracy of the above three examination methods for endometrial lesions in patients with abnormal uterine bleeding will be compared. Result: According to pathological diagnosis, among the 105 cases, there were 7 cases of diffuse endometrial lesions (endometrial hyperplasia and endometrial cancer), 89 cases of localized endometrial lesions (including 61 cases of endometrial polyps, 22 cases of uterine fibroids, and 6 cases of endometrial polyps combined with uterine fibroids), and 9 cases of proliferative or secretory endometrial lesions. The Kappa values of TVS, 4D-SIS, HS and pathological diagnosis consistency test for all pathological types were 0.437, 0.675, and 0.696, respectively. The consistency between 4D-SIS, HS and pathological diagnosis results has reached a good level, and the diagnostic efficacy of HS is better than 4D-SIS, while 4D-SIS is better than TVS. Analyze the diagnostic efficacy of the three diagnostic methods from different pathological types. For endometrial polyps, the sensitivity of HS is 0.967, and the 4D-SIS is 0.918, both higher than 0.754 of TVS. There is a statistical difference between HS and TVS; The highest specificity of 4D-SIS is 0.864, but there is no statistically significant difference compared to the other two; The positive predictive value of 4D-SIS is 0.903, which is higher than the 0.855 of HS; The negative predictive value of 0.938 for HS is higher than 0.884 for 4D-SIS.For extensive endometrial lesions such as endometrial hyperplasia and endometrial cancer, the sensitivity of the three methods is low (TVS, 4D-SIS, and HS are 0.429, 0.571, and 0.286, respectively), and the specificity of 4D-SIS and HS is high (0.929, 0.989, respectively), which is higher than TVS's 0.786. Moreover, the negative predictive values of 4D-SIS are 0.968, and HS is 0.949. Conclusion: 4D-SIS and HS both show good diagnostic efficacy for endometrial lesions and can be used as routine examination methods for endometrial lesions. There is currently no optimal diagnostic method for widespread endometrial lesions, and 4D-SIS or HS combined with endometrial biopsy is still recommended as the diagnostic method.