阴道超声检查诊断早期宫外孕

目的：探讨阴道超声诊断早期宫外孕的价值。方法；对285例经腹部和阴道超声诊断为宫外孕的资料进行分析，并与手术及病理诊断进行对比。结果：宫外孕共分成破裂型、胎囊型、流产型、陈旧型四种类型，其中破裂型245例，占86％；胎囊型和流产型33例，占11.6%；陈旧性宫外孕4例，占1.4%。误诊3例，占1％。结论：宫外孕的阴道超声诊断，当病例典型时结合临床诊断并不难，不典型病例需与附件炎性包块、黄体破裂、阑尾脓肿等疾病鉴别。阴道超声检查对于早期诊断及指导治疗仍重大意义。     

经阴道超声诊断无症状输卵管妊娠26例分析

目的探讨经阴道超声诊断早期无症状、未破裂、未流产输卵管妊娠的临床价值。方法回顾性分析26例经腹腔镜手术、外科手术及病理检查确诊的早期无症状、未破裂、未流产输卵管妊娠经阴道超声声像图特征及临床资料，探讨经阴道超声诊断早期宫外孕的价值。结果经阴道超声检查26例早期无症状输卵管妊娠确诊率达84.6％，其中显示输卵管环征22例，典型孕囊型15例，不典型孕囊型7例。结论经阴道超声检查显像对输卵管妊娠的早期诊断与鉴别诊断具有很高的临床价值。     

经阴道彩色多普勒超声诊断早期宫外孕价值

目的:探讨经阴道彩色多普勒超声诊断早期宫外孕的价值.方法:回顾性分析83例经阴道彩色多普勒超声检查诊断为早期宫外孕患者的临床资料,并与手术结果进行对照.结果:手术诊断早期宫外孕81例,其中胚胎存活完整38例,输卵管流产32例,输卵管破裂9例,陈旧性宫外孕2例,输卵管出血和黄体破裂各1例超声误诊为宫外孕,超声诊断符合率97.6%.66例包块内彩色多普勒可检测到滋养层血流及低阻型动脉频谱.结论:经阴道彩色多普勒超声对早期宫外孕的诊断有一定价值.     

宫外孕经腹与经阴道超声诊断的临床应用价值

目的：探讨经腹超声和经阴道超声在宫外孕诊断中的应用价值。方法：对183例宫外孕患者的手术结果及药物治疗后p—HCG值下降结果与经腹超声和经阴道超声检查结果进行对比分析。结果：宫外孕的经腹超声、经阴道超声表现为附件区非特异性包块；经腹超声检出附件包块的敏感性与包块大小相关；经阴道超声对未破裂型和流产型宫外孕的诊断明显优于经腹超声，对破裂型宫外孕的诊断二者无明显差异。结论：经腹超声和经阴道超声结合应用，可以相互补充，进一步提高宫外孕诊断准确率。     

经阴道超声检查对早期宫外孕的诊断价值

目的 探讨应用经阴道超声检查对早期宫外孕的诊断价值。方法对临床疑诊为宫外孕但经腹部超声检查不明确的186例患者进行经阴道超声检查，记录宫外孕肿块超声图像、彩色血流特点及彩色血流阻力指数。结果经阴道超声诊断结合血液HCG检查结果诊断早期宫外孕179例，漏诊7例，超声诊断符合率96．2％。结论经阴道超声检查，对早期宫外孕的诊断具有重要的价值，为诊断早期宫外孕的首选方法。     

经阴道超声在宫外孕保守治疗60例分析

目的：探讨经阴道超声检查在宫外孕早期诊断及保守治疗检测中的价值。方法：应用阴道超声检查对60例宫外孕患者进行早期诊断，并对其保守治疗（甲氨蝶呤-MTx）过程进行动态监测。结果：经阴道超声检查对60例宫外孕患者的早期确诊率达100％。宫外孕保守治疗成功45例（75％），失败15例。结论：经阴道超声检查对宫外孕早期诊断及保守治疗过程的动态监测具有重要的临床意义。     

经阴道彩色多普勒超声诊断早期宫外孕的临床价值

回顾分析102例宫外孕患者,治疗前均行经腹二维与经阴道彩色多普勒超声检查,手术后经病理证实。与经腹超声比较,经阴道彩超检查诊断早期宫外孕明显高于腹部。经阴道彩色多普勒超声诊断早期宫外孕有重要临床应用价值,为诊断早期宫外孕的首选方法。     

经阴道超声诊断宫外孕的临床价值

目的探讨经阴道超声对诊断宫外孕的临床价值。方法回顾性分析60例宫外孕患者的临床诊断情况,其中未破裂型45例,流产及破裂型15例,术前均行经腹二维超声及经阴道超声对比检查,术后均经病理证实。结果与经腹超声比较,经阴道超声更易发现附件包块,包块边缘呈环状、半环状的彩色血流图,彩色脉冲多普勒测及附件包块内滋养动脉血流频谱呈低阻型,阻力指数（RI）为0．45±0．08。结论阴道超声检查对宫外孕的诊断,特别是早期检查具有重要意义。     

经腹与经阴道超声诊断早期宫外孕的对比研究

目的：探讨经阴道超声在提高早期破裂宫外孕的早期诊断与鉴别诊断的价值。方法：用46例临床上怀疑宫外孕的患进行经腹壁超声和经阴道超声检测对照分析。结果：通过经阴道与经腹壁超声检查早期宫外孕的对比，发现经阴道超声检查有着明显的优势，其确诊率达90％，其可见附件包块100％，结论：经阴道超声检查。可有效提高早期宫外孕确诊率，防止宫外孕破裂有着重要的临床意义。     

经阴道超声诊断早期宫外孕的临床价值

目的探讨经阴道超声诊断早期宫外孕的应用价值。方法105例宫外孕患者经腹部超声和阴道超声检查结果及手术结果对照分析。结果早期宫外孕经阴道超声检查明显高于腹部超声检查。结论阴道超声诊断早期宫外孕准确率高。     

First trimester bleeding evaluation

First trimester bleeding is a common presentation in the emergency room. Ultrasound evaluation of patients with first trimester bleeding is the mainstay of the examination. The important causes of first trimester bleeding include spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease; 50% to 70% of spontaneous abortions are due to genetic abnormalities. In normal pregnancy, the serum beta hCG doubles or increases by at least 66% in 48 hours. The intrauterine GS should be visualized by TVUS with beta hCG levels between 1000 to 2000 mIU/mL IRP. Visualization of the yolk sac within the gestational sac is definitive evidence of intrauterine pregnancy. Embryonic cardiac activity can be identified with CRL of >5 mm. A GS with a mean sac diameter (MSD) of 8 mm or more without a yolk sac and a GS with an MSD of 16 mm or more without an embryo, are important predictors of a nonviable gestation. A GS with a mean sac diameter of 16 mm or more (TVUS) without an embryo is a sonographic sign of anembryonic gestation. A difference of <5 mm between the mean sac diameter and the CRL carries an 80% risk of spontaneous abortion. Approximately 20% of women with first trimester bleeding have a subchorionic hematoma. The presence of an extra ovarian adnexal mass is the most common sonographic finding in ectopic pregnancy. Other findings include the tubal ring sign and hemorrhage. About 26% of ectopic pregnancies have normal pelvic sonograms on TVUS. Complete hydatidiform mole presents with a complex intrauterine mass with multiple anechoic areas of varying sizes (Snowstorm appearance). Twenty-five percent to 65% of molar pregnancies have associated theca-leutin cysts. Arteriovenous malformation of the uterus is a rare but life-threatening cause of vaginal bleeding in the first trimester. The sonographic findings in a patient with first trimester bleeding should be correlated with serum beta hCG levels to arrive at an appropriate clinical diagnosis.     

41例异位妊娠声像图分析及超声诊断价值探讨

目的 探讨异位妊娠的超声表现及超声诊断价值。方法 对我院近四年来经B超检查、保守治疗或手术及病理检查证实的41例异位妊娠声像图表现作回顾性分析。结果 胎囊型7例（占17．07％）;宫旁非特异性包块21例（占51．22％）;盆腔、腹腔积液36例（占87．8％）;手术病例的超声诊断符合率88．2％（30／34）。结论 B超诊断异位妊娠准确性较高,可作为首选的辅助诊断方法;充分掌握异位妊娠的各种超声表现、鉴别诊断要点和临床诊断依据,可以提高B超诊断率。     

未破裂输卵管妊娠的超声诊断

目的探讨未破裂输卵管妊娠的超声图像诊断依据。方法对经手术和病理证实的31例未破裂输卵管妊娠的临床症状、超声图像、术中所见及病理结果进行对照分析。结果超声检查11例探及囊样无回声;14例探及稍强回声环,其中13例见血流信号环绕;6例见异常回声团。共有7例探及盆腔无回声。手术病理证实31例均系未破裂型输卵管妊娠。结论未破裂型输卵管妊娠超声图像可分为孕囊型、彩环型及包块型,诊断中除应熟练确认未破裂型输卵管妊娠的超声图像特点,还应对未破裂型输卵管妊娠注意识别各种假囊。     

Ultrasound diagnosis of interstitial pregnancy: findings and pitfalls.

The diagnosis of an unruptured interstitial gestation can be made by means of ultrasound examination. The most specific finding is an incomplete myometrial mantle around the sac. An eccentrically placed sac and failure to demonstrate the sac within the uterine cavity, i.e., near the internal os on the longitudinal scans, may be helpful ancillary findings. The differential diagnosis must take into consideration a pregnancy within one horn of a bicornuate uterus and a pregnancy within a myomatous uterus. Although this is a rare condition, it carries significant mortality if it ruptures. Diagnosis prior to rupture will reduce mortality and offer the possibility of preserving reproductive capabilities.     

Vaginal sonography in ectopic pregnancy. A prospective evaluation

Among 404 first-trimester pregnancies examined with vaginal sonography in a prospective study, there were 21 ectopic gestations. Considering only the initial scans, the endometrial canal showed a linear echo surrounded by an echogenic zone in 18 cases, but in three cases the uterine cavity demonstrated a small echo-free area representing blood. Free fluid within the cul-de-sac was seen in 17 patients. An adnexal tumor representing the extrauterine gestation, was detected in 19 cases. Fifteen of these masses exhibited a thick-walled ring characteristic of a gestational sac with a viable embryo in five cases and a yolk sac in one. Other cystic adnexal masses, such as corpus luteum cysts, seen in 14 of the 21 patients were not confused with the ectopic pregnancy. A correct tentative diagnosis of ectopic gestation was made in 18 patients (86%) after the initial scan and in 20 cases (95%) including four controls. There was one false-positive suspicion of ectopic gestation in a patient who actually had a spontaneous abortion. Interpretation of the sonographic image should generally be done in correlation with laboratory and clinical data. The results of the study indicate that vaginal sonography is a valuable diagnostic procedure in the evaluation for ectopic pregnancy.     

超声显像在异位妊娠诊断中应用价值探讨

目的 探讨异位妊娠的超声诊断特点。方法 ５８例异位妊娠病人采用超声显像仪探测子宫、附件、腹腔、盆腔等,进行测量,综合分析。结果 异位妊娠术前超声显像检测符合率为９３．１０％,误诊率为６．９０％。结论 应用超声检查异位妊娠,对诊断和鉴别诊断具有很大的实用价值。     

经阴道超声在诊断异位妊娠中的应用

目的：探讨阴道超声诊断异位妊娠在临床治疗中的价值。方法：对疑为早期异位妊娠的病人经阴道超声检查和随访。结果：48例经阴道超声诊断出的异位妊娠，破裂型9例，未破裂型38例，宫内宫外同时妊娠1例，而未破裂型异位妊娠的诊断尤为重要，占总数79％，其声像图为附件区可见妊娠囊、空妊娠囊、Dount征和混合性回声四种。结论：经阴道超声检查，特别对未破裂型异位妊娠的检查，使异位妊娠的诊断时间大大提高，从而减少失血性休克，降低死亡率，指导临床治疗有着极其重要的意义。     

经阴道超声诊断异位妊娠的价值

目的探讨(早期)异位妊娠(EP)的经阴道超声(TVS)诊断应用价值.方法对146例不规则少量阴道流血(或)下腹痛的育龄妇女或停经后经腹B超(TAS)提示宫腔内未见孕囊者疑EP的均行TVS检查,观察宫内是否有孕囊,仔细寻找识别卵巢及肿块结构并分清其关系,必要时结合彩色多普勒,观察肿块血流成像,分晰其血流频谱.结果 TVS能很好地显示子宫、卵巢、未破孕囊及含血(块)肿块的声像结构.识别出完整的卵巢,是输卵管异位妊娠确诊的关键;彩色多普勒血流成像(CDFI)所记录的滋养层血流频谱或怪异频谱是二维TVS的补充,二者结合诊断EP的准确性高达97%.结论 TVS诊断EP简单、无创、准确性高,是诊断早期异位妊娠的首选方法.     

经阴道超声对未破裂型宫外孕的诊断应用

目的 探讨经阴道超声(TVS)及时准确诊断未破裂型宫外孕的检查方法.方法 回顾性分析我院2004年1月-2005年1月确诊的64例未破裂型宫外孕患者的超声检查资料.具体方法是先行常规超声检查显示子宫及卵巢后注意追踪显示输卵管;后行TVS扫查子宫以上部位,并与肠管回声鉴别;用探头反复轻推,根据可疑病灶与卵巢是否同步运动以辨别其与卵巢的关系. 结果 64例均显示附件区妊娠囊样环状回声.根据声像图显示中妊娠囊样环状回声与输卵管及卵巢的关系分为3型:Ⅰ型:输卵管可显示型(29例):较清楚显示输卵管,管内可见妊娠囊样环状回声;其中5例于初检漏诊后注意追踪显示输卵管而提示宫外孕诊断;Ⅱ型:与卵巢分界清型(27例):6例于初检漏诊后注意扫查子宫底以上部位、并与肠管回声鉴别而提示宫外孕诊断;Ⅲ型:与卵巢分界不清型(8例):7例在反复轻推探头后辨别与卵巢是否同步运动而提示宫外孕诊断.结论 TVS在检查方法上的完善有助于更及时、准确地诊断未破裂型宫外孕.     

Diagnosis of early intramural ectopic pregnancy

Intramural ectopic pregnancy is a very rare diagnosis. Establishing a diagnosis is difficult and is often made intraoperatively. Demonstration of a live extrauterine gestation is the only specific sign of such a pregnancy. A small number of ectopic pregnancies are interstitial or cornual pregnancies. Rupture of an intramural ectopic pregnancy is a serious clinical complication. Diagnosis of this ectopic pregnancy can sometimes be made using 2-dimensional transvaginal ultrasound (TVS), but it may also require 3-dimensional TVS. We present the case of a 25-year-old gravida 0, para 0 woman with amenorrhea lasting 6(+5) weeks. Previous surgery included a right adnexectomy for torsion of a right dermoid cyst. The patient's serum hCG was elevated. TVS provided a detailed view of the endometrial cavity. The results of 2-dimensional TVS suggested the presence of an ectopic pregnancy. The sonogram showed a gestational sac with an embryonic pole and a yolk sac, which was separated from the endometrium. Use of 3-dimensional TVS demonstrated a live embryo in a gestational sac surrounded by myometrium below the right cornu lying outside the endometrium. This finding was confirmed by laparotomy and the conceptus was excised. The patient had an uneventful postoperative course and was discharged 7 days after surgery. In our case, the previous adnexectomy was an identifiable risk factor. Nonetheless, making a diagnosis of an intramural pregnancy was challenging. Suspicion may arise when sonography has revealed an intramural gestational sac.