未破裂型输卵管妊娠阴道超声诊断的临床意义

目的:观察并探讨阴道超声(TVS)对诊断未破裂型输卵管妊娠的临床应用及其意义。方法:对未破裂型输卵管妊娠108例的TVS检查资料进行分析。结果:实质回声型39例,胚囊型69例,子宫直肠陷窝见液性暗区39例。59例经手术及病理证实均为未破裂型输卵管妊娠,49例经药物保守治疗,痊愈。结论:TVS检查对未破裂型输卵管妊娠可早期确诊,有助于临床处理方法的选择,增加年轻无生育史患者保守治疗的机会,避免手术及术后并发症,提高今后的生育率。     

Transvaginal Bladder Neck Suspension to Cooper’s Ligament: A Review of the Literature

The aim of this paper was to review the surgical technique and clinical experience of transvaginal bladder neck suspension to Cooper’s ligament. A computerized MEDLINE search identified five English-language articles published between January 1990 and December 1998. The success rate obtained with this procedure is comparable to that obtained with the traditional Burch procedure and ranges between 86.4% and 100%. Postoperative de novo detrusor instability occurs infrequently, with an incidence ranging between 0% and 20%. Complications occur infrequently and postoperative voiding dysfunction is rare. Limited postoperative urodynamic data are available. Transvaginal suspension of the bladder neck to Cooper’s ligament combines the technique of a needle suspension with the anatomic effect of the Burch procedure.     

Laparoscopic management of ovarian pregnancy.

BACKGROUND: Ovarian pregnancy (OP) comprises 0.15% of all pregnancies and 1% to 3% of ectopic gestations. CASE REPORT: Two cases of OP detected and treated during laparoscopy for suspected ectopic pregnancy are described. We used clinical examination, serum beta-hCG levels, and transvaginal ultrasonography (TVS) preoperatively to confirm the suspected diagnosis of extrauterine pregnancy. In the first patient, oophorectomy was performed, whereas the second patient was treated by an ovarian wedge resection to restore and preserve ovarian integrity. Postoperative recovery periods were normal in both patients, with no further therapeutic intervention in the follow-up course. CONCLUSION: Primary OP may occasionally occur in patients with a suspected ectopic pregnancy. Signs and symptoms suggestive of extrauterine pregnancy, TVS, and serum beta-hCG dynamics can be a useful adjunct to allow the preoperative diagnosis of OP prior to the use of the diagnostic gold standard, diagnostic laparoscopy. Preservation of ovarian tissue should be the therapeutic goal to maintain ovarian reserve and preserve fertility in young women with OP.     

Hair as a sonographic marker of ovarian teratomas: improved identification using transvaginal sonography and simulation model.

An in vitro sonographic model was developed to simulate the transvaginal sonographic appearance of hair-containing cystic teratomas of the ovary. Two groups of patients with ovarian teratomas were compared: group A--consisting of 32 patients scanned before the simulation model was used, and group B--consisting of 25 patients in whom the diagnosis of hair-containing ovarian teratomas was made after the simulation model experience. The positive predictive value of transvaginal sonography in correctly diagnosing this type of tumor was 27/32 (84%) in group A and 25/25 (100%) in group B. By using this simple in vitro simulation model, the preoperative diagnosis of ovarian cystic teratomas by transvaginal sonography was made very accurate, enabling prospective planning of the type of operation and its timing.     

Ultrasound in gynecology

This paper reviews the various examination thechniques, the clinical indications, and the imaging findings for US studies of the female pelvis in patients with gynecological problems. Ultrasound, in fact, is the preferred imaging modality in the study of the female pelvis, and provides information of basic importance in detecting and characterizing pelvic masses of uterine, ovarian, or adnexal origin, providing also criteria useful in predicting their benign vs malignant nature. In patients with abnormal bleeding, transvaginal US helps in determining the presence of morphological and structural changes of the endometrium and, with the use of sonohysterography, provides excellent delineation of the endometrial cavity, guiding appropriate planning of therapeutic procedures. Ultrasound plays a very important role in the evaluation of patients with acute pelvic pain. It allows identification of ovarian torsion and has both diagnostic and therapeutic capabilities in patients with pelvic inflammatory disease through guidance of abscess drainage via the transvaginal route. In suspected ectopic pregnancy, US, together with quantitative measurements of hCG levels, can be considered the best imaging procedure to guide to the diagnosis. Ultrasound has an important role also in the study of female infertility. In this field it can be used to identify and document the integrity of the reproductive tract as a conduit for the passage of gametes and embryos, to detect pathological changes that may be causes or contributing factors of female infertility, to monitor cyclic changes of pelvic organs to document normal physiology or pathological situations, and to guide infertility treatment. Electronic Publication     

Criteria for transvaginal sonographic diagnosis of ectopic pregnancy

Transvaginal ultrasonography was performed in 1150 patients suspected of having an ectopic gestation. The criteria for transvaginal sonographic diagnosis of ectopic pregnancy were established by targeted scanning of the pelvic organs and spaces. Sonographic assessment of tubal pregnancy and its differential diagnosis were based on six criteria: (1) the presence or absence of gestational structures within the fallopian tube, (2) the presence or absence of amorphous material in a dilated fallopian tube, (3) the presence or absence of indirect signs of ectopic pregnancy within the pelvis, (4) the echogenicity of a suspected finding relative to the ovary, (5) the presence or absence of flow (of lacunar origin) within the suspected sonographic finding, and (6) the relationship of a suspected sonographic sign to an intentionally displaced ovary. The latter 3 criteria help differentiate between tubal gestation and a corpus luteum. We believe these diagnostic criteria should be applied when performing transvaginal sonographic scanning of patients suspected of having an ectopic gestation.     

经阴道彩色多普勒超声诊断不典型子宫肌瘤

目的:探讨经阴道彩色多普勒血流显像诊断不典型子宫肌瘤准确率,及其与盆腔内疑似病变鉴别的要点.方法:选经腹部超声检查不能明确诊断的不典型子宫肌瘤46例,改经阴道彩色多普勒超声检查,对病变进行形态结构的观察和血流分析,并与病理结果相对照.结果:经阴道彩色多普勒超声对不典型子宫肌瘤的诊断符合率为91.3%(42/46).结论:经阴道彩色多普勒超声能较准确将不典型子宫肌瘤与盆腔其它病变相鉴别,具有较高的诊断准确率.     

Transvaginal imaging: applied physical principles and terms

In this article the properties of ultrasound in tissues and the factors governing image quality are discussed. Particular emphasis is placed on the vaginal probe. The virtues of transvaginal scanning both in gynecology and obstetrics are well described in subsequent articles in this symposium. Only by understanding the properties of ultrasound can the capabilities and limitations of this technique be appreciated. A comprehensive knowledge of the basic physical principles is mandatory for the clinician as well the investigator to attain the highest quality results. The technical aspects of operating ultrasound instruments, e.g., machine controls, electronic image formation, scan converters and techniques for preprocessing and postprocessing, are not discussed.     

Definition of anatomical planes for use in transvaginal sonography

Planes frequently used to identify radiologic and abdominal ultrasonographic images such as transverse, coronal, and sagittal are generally not anatomically correct when applied to transvaginal ultrasonographic planes and images. More appropriate terminology specific for the planes imaged during transvaginal ultrasonography, such as TRANS-pelvic and AP-pelvic planes, are suggested. A TRANS-pelvic plane refers to a plane imaged when the sound beam is directed across or from side to side in the pelvis. An AP-pelvic plane refers to an image obtained when the sound beam is directed anteriorly and posteriorly.     

阴道注水腹腔镜与不同方法对不孕症诊断价值的临床比较

目的比较子宫输卵管造影（hysterosalpingography，HSG）、标准腹腔镜（hparoscopy，LAP）及阴道注水腹腔镜（transvaginal hydrolaparoscopy，THL）在输卵管性不孕上的诊断价值。方法分别采用子宫输卵管造影、阴道注水腹腔镜及标准腹腔镜检查输卵管性不孕58例，将观察结果进行比较。结果HSG与LAP比较手术时间短，平均所需费用低，诊断符合率为65．52％（38／58），差异有显著性。THL与LAP比较手术时间短，平均所需费用低，诊断符合率为94.83％（55／58）。平均所需费用HSG最低，LAP为最高，三者两两比较，差异有显著性。结论子宫输卵管造影虽简单、经济，但准确性不理想，标准腹腔镜具有准确、微创的优点，但存在费用较高、需要住院、需要接受全身麻醉等缺点，阴道注水腹腔镜是一种既准确、微创，又简单、安全、快速、经济、不需住院和全身麻醉的全新方法，可作为不孕症早期检查的常规方法。