妊娠子宫嵌顿的超声诊断及结局分析

目的：总结妊娠子宫嵌顿的超声特征、诊断经验及妊娠结局。方法：回顾性收集我院10例产前超声检查提示妊娠子宫嵌顿的孕妇资料，分析其临床资料、超声特征、妊娠结局等。结果：6例在早孕期诊断，4例在中孕期诊断；10例中2例合并子宫肌瘤，7例既往有腹部或盆腔手术史，4例为辅助生殖技术受孕；8例临床表现为尿道梗阻症状，3例表现为直肠压迫症状，4例表现为其他非特异性症状；9例宫颈受压变薄拉长，长约3.9～7.3 cm;10例均采取手法复位和（或）膝胸卧位复位，其中1例接受手术复位；最终8例足月娩出活产儿，1例孕24周胎儿停止发育，1例目前孕26周+6无异常表现。结论：早期诊断对于产科管理和临床干预至关重要，亦有助于成功释放嵌顿的子宫；应注重对宫底、宫体与宫颈位置关系以及子宫与周边脏器关系的扫查。     

超声在瘢痕妊娠诊断中的价值分析

目的:探究超声在瘢痕妊娠诊断中的应用价值。方法:选取我院瘢痕妊娠患者56例,分别给予腹部超声检测及阴道超声检测,分析两种检测结果检出率、漏诊率及阴道超声检测结果分型。结果:阴道超声检测结果检出率94.64%(53/56)、漏诊率5.36%(3/56);腹部超声检测结果检出率75.00%(42/56)、漏诊率25.00(14/56);经阴道超声检测53例瘢痕妊娠患者中,单纯孕囊型21例(39.62%)、宫腔型13例(24.53%)、包块型22例(41.51%),与病理诊断结果一致。结论:在瘢痕妊娠患者的检测过程中,超声诊断具有较高的检出率,其中阴道超声检测检出率高于腹部超声检测,且能准确判断瘢痕妊娠类型,具有较高诊断价值。     

三维腔内超声诊断宫内节育器异常的临床价值

目的:应用三维腔内超声成像探讨宫内节育器是否异常。方法:对1080例来我院检查宫内节育器患者先进行腔内二维超声检查子宫及双侧附件,再用三维腔内超声成像,显示各种类型节育器在宫内的情况。结果:1080例患者均获得满意的三维腔内成像图片,节育器正常900例,节育器异常(包括节育器下移、节育器下移并嵌顿、节育器嵌顿、节育器斜置、节育器变形、带环妊娠)180例,结论:腔内二维超声对宫内节育器位置下移观察还比较敏感,但对于宫内节育器的嵌顿、斜置及节育器变形是无法完全做出正确超声诊断的,三维腔内超声不但可以显示宫腔的冠状切面,还能很好显示节育器在宫内的具体位置及形态,给临床医生提供了重要的直观信息。     

成功复位妊娠子宫嵌顿病例分析

妊娠子宫嵌顿（incarceration of the gravid uterus ，IGU）是一种罕见的产科并发症。随孕周增长，妊娠子宫由盆腔器官上升为腹腔器官，大多数后位子宫可在12-14周自行纠正宫底位置，向头侧上升移动，到达腹腔。极少数病例子宫持续后倾后屈被局限在骶岬与耻骨联合之间的盆腔内（子宫直肠陷窝或子宫膀胱陷窝），即称为妊娠子宫嵌顿。子宫嵌顿如未能及时处理，可出现胎膜早破、流产、甚至子宫破裂、膀胱破裂、肾功能衰竭等严重并发症。因此，早期诊断是降低IGU并发症的关键。     

经阴道三维超声检查在诊断宫内节育器(IUD)嵌顿中的价值分析

目的:探讨经阴道三维超声检查在诊断宫内节育器(IUD)嵌顿中的价值。方法:纳入2017年10月~2019年3月期间本院收治的60例宫内节育器(IUD)嵌顿患者作为实验对象,按照诊断方法的不同分为对照组、研究组,每组各列入30例,对照组单纯使用阴道二维超声检查,研究组首先采用二维超声检查,之后再采用经阴道三维超声检查,对比2组患儿的IUD显形异常、IUD定位的检出情况、IUD异常类型检出类型,研究组IUD经阴道三维超声影像学表现及IUD异常表现。结果:研究组(96.67%)、(93.33%)相对于对照组患者IUD显形异常检出率(66.67%)及IUD定位的检出率(63.33%)明显较高,P<0.05;研究组相对于对照组患者IUD异常类型检出类型例数较多;P<0.05。结论:文献报到,宫内节育器(IUD)嵌顿患者结合二维超声、三维超声诊断符合率可提高至100%⑴,与二维超声相比,三维超声在IUD显形异常、IUD定位的检出及IUD异常类型检出类型更具有优势,值得临床推广与借鉴。     

子宫角妊娠的超声特征与误诊分析

目的总结子宫角妊娠超声声像图特征和鉴别诊断要点.方法 与手术病理检查结果对比,对常规腹部超声及经阴道超声诊断的93例子宫角妊娠患者的术前超声声像图表现及超声分型特征进行总结.结果 与手术病理诊断结果对比显示,术前超声诊断子宫角妊娠与手术病理诊断符合66例(82.5%,66/80),其中妊娠囊型子宫角妊娠55例,混合包块型子宫角妊娠11例;误诊为输卵管间质部妊娠11例、残角子宫妊娠2例、绒癌1例;术前超声误诊率为17.5%(14/80);术前超声表现为附件区异位妊娠包块13例,术中显示为子宫角妊娠包块破裂,超声未定位和分型诊断.子宫角妊娠的超声特征为妊娠囊位于膨隆的一侧子宫角,周边有薄层肌壁包绕,子宫角妊娠包块与宫内膜相连.14例子宫角妊娠误诊原因:(1)超声显示子宫角包块与子宫内膜不连接、包块不为子宫肌层包绕,误诊为输卵管间质部妊娠.(2)子宫角外侧肌层厚,误诊为残角子宫妊娠.(3)子宫角包块血流丰富,肌层菲薄,误诊为绒癌.结论 经腹部联合经阴道超声能对子宫角妊娠病变做出准确诊断,依据超声诊断要点综合评估有助于子宫角妊娠的鉴别诊断.     

超声对女性婴儿腹股沟疝伴子宫或卵巢嵌顿的诊断价值

目的 探讨超声对女耍腹股沟籼伴子宫或卵巢嵌顿的早期诊断价值。方法 分析38例经手术证实的女婴腹股沟疝患者的二维及彩色多普勒超声图象特征。结果 超声确诊的38例搞例中，20例伴有子宫或卵巢嵌顿，超声表现为典型的子宫、卵巢声像图，且嵌顿的子宫或卵巢外形大于不伴有子宫或卵巢嵌顿者。结论 女婴腹股沟疝患者，尤其是60d以下的小婴儿，超声检查对其早期诊断具有重要价值。     

超声对少见部位异位妊娠的诊断及鉴别诊断

目的探讨输卵管间质部、宫角、宫颈及子宫瘢痕处异位妊娠病灶的超声图像特征。方法采用常规腹部超声及经阴道超声对94例临床疑诊为异位妊娠的患者进行检查,并与手术后病理诊断结果进行对照分析。结果病理诊断证实94例异位妊娠患者中输卵管间质部妊娠33例,宫角妊娠24例,宫颈妊娠12例,子宫瘢痕处妊娠25例。术前常规超声及经阴道超声诊断异位妊娠与病理诊断符合87例(92.6%,87/94),误诊7例(7.4%,7/94)。其中诊断输卵管间质部妊娠30例(30/33,3例宫角妊娠误诊为输卵管间质部妊娠),诊断宫角妊娠20例(20/24,4例输卵管间质部妊娠误诊为宫角妊娠),诊断宫颈妊娠12例(12/12),诊断子宫瘢痕处妊娠25例(25/25)。结论超声检查在少见部位异位妊娠诊断与鉴别诊断中有重要作用。     

宫腔镜联合超声诊治不孕症的临床护理体会

目的:分析宫腔镜联合超声诊治不孕症临床价值。方法:回顾性分析2015年8月~2016年7月我院不孕症患者94例临床资料,总结超声联合宫腔镜诊治不孕症的1 a妊娠率以及临床护理。结果:宫腔镜检出子宫异常77例(81.91%)高于对照组17例(45.74%),差异有统计学意义(P<0.05);宫腔镜治疗后1 a内妊娠48例,妊娠率达51.06%。结论:应用宫腔镜联合超声检查可有效检出不孕症患者子宫内病变情况,指导临床合理治疗,加上规范临床护理的实施,能够确保患者治疗后妊娠率的进一步提高,值得推广。     

子宫骶韧带深部内膜异位症的超声诊断

目的:探讨经阴道超声对子宫骶韧带深部内膜异位症的诊断价值并分析总结其超声图像特征。方法:选取我院2018年10月—2020年6月收治的110例经病理证实为深部浸润型子宫内膜异位症(Deep infiltrated endometriosis,DIE)患者作为研究对象。收集所有患者的手术病理结果、超声图像、临床资料等,分析经阴道超声对骶韧带深部内膜异位的诊断价值,并总结超声图像特征。结果:110例患者中,经手术及病理证实骶韧带受累的54例,双侧累及25例,单侧累及29例(左侧19例,右侧10例),合并卵巢囊肿占56%(30/54);超声图像发现骶韧带受累42例,合并卵巢囊肿占64%(27/54);经阴道超声诊断子宫骶韧带D I E的灵敏度、特异度、阳性预测值和阴性预测值分别是78%、84%、82%、80%。子宫骶韧带DIE患者的超声图像主要表现为骶韧带部位回声减低、增厚,19例患者超声图像可见宫颈两侧骶韧带部位结节状或条索状的低回声,内可有小囊性暗区,边缘规则或不规则;彩色多普勒血流成像(color Doppler flow imaging,CDFI)显示未及明显血流信号。结论:DIE中骶韧带受累的超声图像具有一些特征的表现;阴道超声在骶韧带子宫内膜深部浸润中具有很好的诊断价值。     

Sonographic findings in acute urinary retention secondary to retroverted gravid uterus: pathophysiology and preventive measures.

OBJECTIVES: To explore the pathophysiology of acute urinary retention in women with a retroverted gravid uterus and to suggest measures to prevent its recurrence. METHODS: In five women with a retroverted gravid uterus and acute urinary retention necessitating catheterization, the morphology of the genitourinary system was assessed by using transabdominal, transvaginal and introital sonography. RESULTS: In the supine resting position, the cervix was displaced superiorly and anteriorly by the impacted and retroverted uterus so that it compressed the lower bladder, leading to obstruction of the internal urethral orifice. The upper bladder extended superiorly and overlay the uterus. During straining, urethral motion was not limited and there was an average rotational angle of the bladder neck of 32 degrees, ranging from 21 degrees to 44 degrees. Increasing abdominal pressure further compressed the lower bladder. Measures suggested to the women for the prevention of urinary retention included limiting fluid intake before sleep, changing from the supine to the prone position before getting up and avoiding a Valsalva maneuver but performing a Credé maneuver during voiding. In all except one case these measures successfully prevented recurrence. CONCLUSIONS: Acute urinary retention secondary to a retroverted gravid uterus is caused by a displaced cervix compressing the lower bladder and interfering with drainage to the urethra. The urethra itself is not compressed or distorted. Understanding the pathophysiology of the lower urinary tract may allow maneuvers which prevent acute urinary retention.     

Sonographic and magnetic resonance imaging findings in uterine incarceration

We show the sonographic and magnetic resonance imaging features of uterine incarceration. Clinical data and imaging findings were retrospectively reviewed for 8 confirmed cases identified by sonography from 2000 to 2010. Two patients had magnetic resonance imaging. Seven of 8 patients (87.5%) presented with abdominal pain; 4 of 8 (50.0%) also had urinary symptoms. All had a retroverted uterus with an elongated anterosuperiorly displaced or poorly visualized cervix on sonography. Magnetic resonance imaging showed similar features, but in both cases, the placental position was misinterpreted because of severe uterine retroversion. Radiologists should be aware of this condition and its imaging features to reduce associated morbidity and mortality.     

Sonographic findings of acute urinary retention secondary to an impacted pelvic mass.

OBJECTIVE: To describe the sonographic findings in a series of cases of acute urinary retention due to an impacted pelvic mass. METHODS: The anatomic changes of the lower urinary tract in 6 patients with impacted pelvic masses and acute urinary retention (3 cases of an impacted uterine leiomyoma and 3 cases of a retroverted gravid uterus) were evaluated with transabdominal and transvaginal sonography. RESULTS: When patients were in the supine position, the impacted pelvic masses displaced the cervix superiorly and anteriorly, compressing the lower bladder, leading to obstruction of the internal urethral orifice. During straining, there was no limitation of urethral mobility, but the increased abdominal pressure further compressed the lower bladder. When the subjects stood, the lower bladder filled with urine. There was descent of the bladder neck, and obstruction was relieved. CONCLUSIONS: Acute urinary retention in cases of an impacted pelvic mass is caused by a displaced cervix compressing the lower bladder, obstructing the internal urethral orifice. The urethra itself is not compressed or distorted.     

Uterine incarceration during the third trimester: a rare complication of pregnancy

Uterine incarceration that manifests during the third trimester or at term is a serious and rare complication of pregnancy. The pregnant patient may complain of low-abdominal pain, low-back pain, urinary retention, and constipation, or the patient may be asymptomatic until labor begins. The diagnosis is difficult, and physical findings can be misleading. Ultrasonography and magnetic resonance imaging can be helpful if the anteriorly displaced cervix is clearly depicted. If incarceration of the retroverted uterus persists until term, a cesarean section is necessary. Recurrent uterine incarceration has been reported; therefore, the patient should be monitored closely during subsequent pregnancies. Herein we describe three cases of uterine incarceration during the third trimester and review the literature with respect to incidence, differential diagnosis, management, and complications of this condition.     

中隔子宫的三维超声诊断分析

目的总结中隔子宫三维超声冠状切面超声声像图特征.方法对经阴道二维超声显示为中隔子宫的87例患者行经阴道三维超声检查,获取子宫冠状切面声像图后在子宫冠状切面对子宫外形,宫腔形态,宫颈管形态进行观察,并对宫底部凹陷深度,两侧分开的子宫内膜夹角进行测量.结果87例患者经阴道二维和三维超声检查后行子宫输卵管碘油造影、宫腔镜、宫腔镜联合腹腔镜手术或磁共振诊断为完全中隔子宫21例(其中正常宫颈9例,伴宫颈中隔12例),不全中隔子宫56例,弓状子宫5例,双角子宫3例,正常子宫伴宫腔粘连带2例.术前经阴道二维超声与手术或磁共振诊断符合75例(75/87),误诊12例(5例弓状子宫、3例双角子宫及2例正常子宫伴宫腔粘连带误诊为不全中隔子宫,2例完全中隔子宫伴宫颈中隔误诊为完全中隔子宫伴正常宫颈);术前经阴道三维超声与手术或磁共振诊断符合87例(87/87).87例患者子宫三维超声冠状切面声像图表现:(1)中隔子宫77例,其中71例子宫底稍向外凸,6例子宫底轻微凹陷,凹陷深度均≤1.0 cm,平均(0.6±0.2) cm;子宫体中央均见低回声的分隔将子宫内膜分为左右两部分,两侧子宫内膜夹角均<90°,平均(49.6±13.9)°,分隔从子宫底部向宫颈方向延伸;其中不全中隔子宫56例,分隔未达宫颈内口,内膜呈“Y”形,完全中隔子宫21例,分隔达宫颈内口,内膜呈“V”形(9例宫颈管正常,12例宫颈管内见分隔,其分隔由宫颈内口延至宫颈外口).(2)弓状子宫5例,宫底中央部内膜均呈弧形凹陷,两侧子宫内膜夹角均>90°,平均(135.6±16.3)°.(3)双角子宫3例,子宫底部均融合不全,外缘凹陷呈分开的两个角,凹陷深度均>1.0 cm(分别为1.8 cm、2.5 cm、2.7 cm).(4)正常子宫伴宫腔粘连带2例,宫腔均呈正常的倒置三角形,宫腔内粘连带形态不规则,未始于宫底部,而连于子宫前、后壁.结论经阴道三维超声可在二维超声基础上获取满意的子宫冠状切面超声图像而清晰显示子宫外形和宫腔形态,并可准确测量宫底凹陷的深度及两侧子宫内膜夹角,为中隔子宫诊断和鉴别诊断提供更多诊断信息.     

超声引导下异常节育器取出的应用价值

目的评估超声引导下取环的价值,指导临床工作,减少盲目性,减轻患痛苦。方法膀胱适度充盈,对３２例置节育环妇女超声监测,观察各种节育器异常与子宫位置。超声引导下行取环术。结果３２例节育环变形、断裂、嵌顿、宫颈狭窄、子宫先天性畸形等病因,在超声引导取环成功率１００％。结论超声引导下取环术具无创伤、简便、易操作的优点。     

MRKH综合征的超声影像学特征及其诊断价值

目的分析MRKH综合征的超声影像学特征，探讨超声在诊断及鉴别诊断MRKH综合征中的临床价值。 方法回顾性分析2021年1月至12月深圳市罗湖区人民医院经手术证实的75例MRKH综合征患者的超声表现，并与手术结果进行对比分析，总结MRKH综合征典型及非典型的超声影像学特征。 结果本组75例MRKH综合征患者均经腹腔镜手术证实，其术前超声检查结果均与手术结果一致，诊断符合率为100%。62例（82.7%）MRKH综合征表现为典型的“四联征”超声特征：在盆腔左右两侧分别可见梭形或长条形肌性回声的始基子宫，未见宫颈和子宫内膜回声；可见连接两侧始基子宫下缘条带状的低回声索状带；双侧卵巢紧邻同侧始基子宫；膀胱尿道后壁与直肠前壁之间未见正常阴道结构，仅见低回声结缔组织。13例（17.3%）MRKH综合征表现为非典型的超声特征：4例始基子宫位置异常，位于腹股沟区；5例始基子宫内有功能性子宫内膜回声；2例索状带静脉扩张；4例卵巢位置异常。其他伴发异常：2例单侧始基子宫肌瘤，3例双侧始基子宫腺肌病，18例合并卵巢病变，4例合并肾脏发育异常。 结论大部分MRKH综合征具有典型的“四联征”超声特征，准确识别MRKH综合征典型及非典型的超声表现，可为临床诊治MRKH综合征提供可靠的影像学诊断依据。     

Incarceration of the retroverted gravid uterus: report of four patients managed with uterine reduction

Incarceration of the retroverted gravid uterus may have an adverse effect on pregnancy. To evaluate these effects, we reviewed obstetric records to identify parturients with the diagnosis of incarceration of the retroverted uterus during the years 1977 to 1987. Four such patients were identified by this retrospective review, for a calculated incidence in our primary population (patients not referred for evaluation who also received prenatal care at only one hospital) of one case per 10,384 live births. The incarceration was successfully reduced in all four patients without surgical intervention, and all had a normal infant of appropriate weight at term.     

阴道超声检查节育环异常8例

目的：探讨阴道超声检查节育环异常的价值。方法：用5MHZ的阴道探头对计划生育门诊的病人作超声检查和筛选。结果：在阴道超声检查中发现有8例节育环异常。其中5例为断裂环残留并伴有嵌顿,2例为完全性嵌顿在子宫肌层内,1例节育环游离于膀胱子宫陷凹处。5例断裂环伴嵌顿中有2例残留在宫颈管内;3例残留在子宫内。结论：阴道超声检查节育环异常,方法简便并能准确定性定位。     

人宫颈癌DNA与HPV16型核酸分子杂交的研究

本文以人乳头状瘤病毒(HPV)16型-PBR_(322)重组质粒,对大肠杆菌HB101进行转化实验。经筛选、扩增、酶切、电泳鉴定。获得满意的电泳图谱及kb值,HPV-16Bam HI DNA为7.2kb,其260/280O.D比值为1.9-2。纯度合乎要求,可用以制备探针。以HPV-16DNA7.2kb片段为探针,应用~(32)P(α)-dATP标记进行了点杂交及Southern印迹杂交实验。结果表明38例宫颈癌组织DNA,其点杂交阳性率为76.3％,Southern杂交阳性率为65.7％。点杂交与Southern杂交结果基本符合。上述结果说明了在人宫颈癌组织中,存在着HPV-16相关的基因组,Southern杂交表明其以整合形式存在。说明宫颈癌的发病可能与HPV-16型的感染有密切关系。从分子水平进一步探讨了宫颈癌的病毒病因。