妊娠黄体的超声识别在输卵管妊娠诊断中的价值

目的探讨经阴道超声对妊娠黄体的正确识别在输卵管妊娠诊断中的价值。方法对80例经临床手术及病理证实的输卵管妊娠病例进行回顾性分析,观察妊娠包块和卵巢内妊娠黄体的形态结构及两者位置关系,并将输卵管妊娠中“输卵管环”型包块及厚壁囊肿型妊娠黄体的囊壁分别与子宫内膜回声作比较。结果80例输卵管妊娠患者,检测出妊娠黄体76例,输卵管妊娠包块与妊娠黄体在同侧者65例（86％）,不同侧者11例（14％）。妊娠黄体主要形态特征为薄壁囊肿型、厚壁囊肿型、低回声型、薄壁囊肿内部点状回声型,输卵管妊娠包块主要为“输卵管环”型及低回声型。输卵管妊娠包块中的“输卵管环”囊壁大多是高于（38％）或等于（42％）子宫内膜回声;而厚壁囊肿型妊娠黄体其囊壁回声大多是低于子宫内膜回声（82％）,两者比较差异有统计学意义（P〈0．01）。结论正确认识妊娠黄体的形态结构及其与输卵管妊娠包块的不同点在输卵管妊娠的诊断中有重要的意义。     

经阴道彩色多普勒超声对妊娠卵巢黄体和宫外孕的鉴别诊断

目的：探讨采用经阴道彩色多普勒超声对妊娠卵巢黄体疾病以及宫外孕疾病进行鉴别诊断的临床价值。方法选择80例宫外孕患者以及80例妊娠卵巢黄体患者作为实验的研究对象。针对所有患者临床实施经阴道彩色多普勒超声检测。在对患者实施宫外孕测量的过程中,主要对患者的附件包块大小进行测量,对血流频谱实施测量。在对患者实施妊娠黄体测量的过程中,针对患者的黄体大小以及血流频谱实施测量。结果对于宫外孕患者,其包块大小表现有所不同。对患者实施超声检查,最终检查结果体现为妊娠囊型以及不均质回声包块型。宫外孕时,包块以条状、点状血流为主,频谱多为极低阻力,流速为7～27 cm／s,血流来自卵巢外。患者妊娠黄体上下径的尺寸为（18.40±2.66）毫米;前后径为（16.49±2.87）毫米;左右径尺寸为（18.07±3.15）毫米。对超声表现类型进行观察发现,主要体现为低回声型、薄壁囊肿型以及厚壁双环。妊娠黄体周边可见明亮粗大、连续的环形或半环形血流信号,频谱多为低阻力和高阻力,流速为18～38 cm／s,血流来自卵巢内。结论临床选择经阴道彩色多普勒超声的方法对宫外孕疾病以及妊娠黄体疾病加以鉴别,能够发挥显著价值,针对疾病类型可以有效确诊,进而研究有效方法加以临床治疗,将两种疾病患者的生活质量显著提高,表现出彩色多普勒超声临床应用价值。     

经阴道彩色多普勒超声检测先兆流产妊娠黄体的形态和血流变化

目的 :探讨妊娠黄体形态、大小、血流变化与先兆流产预后的关系。材料和方法 :选择门诊先兆流产患者 67例 ,将其分为能维持妊娠组和不能维持妊娠组 ,正常宫内早孕 86例作为对照组 ,分别测定三组患者的黄体平均直径、回声特点、流速峰值、阻力指数 ,并对先兆流产的孕妇进行跟踪随访妊娠结果。结果 :先兆流产不能维持妊娠组 ,妊娠黄体多呈低回声团块型 ,直径平均值最低 1.6cm ,流速峰值平均值最高 3 9cm ,阻力指数平均值最大 0 .5 9,与正常宫内妊娠组、先兆流产能维持妊娠组有显著差异 (p <0 .0 1)。结论 :经阴道彩色多普勒超声测定妊娠黄体大小、形态、流速峰值、阻力指数可用于评价黄体功能 ,对判断先兆流产的预后具有重要的价值。     

阴道彩色多普勒超声对早期异位妊娠和妊娠黄体的鉴别诊断

目的：探讨早期异位妊娠与妊娠黄体的经阴道彩色多普勒超声声像图特点,以提高诊断符合率。方法：回顾性分析48例异位妊娠与50例早孕卵巢黄体的二维声像图及彩色多普勒超声表现。结果：异位妊娠声像图表现为宫旁不均质包块,周围均无小卵泡样回声,妊娠黄体中31例（62.00%）周围可见小卵泡回声;45例（93.75%）异位妊娠患者血流呈点状血流及带状血流,2例（4.17%）呈环状血流,1例（2.08%）无明显血流信号,48例（96.00%）妊娠黄体呈环状及半环状血流,2例（4.00%）呈点线状血流;异位妊娠患者较宫内早孕妊娠黄体收缩期峰值流速（PVS）低,而RI、搏动指数（PI）、收缩期与舒张期比值（S/D）高。结论：经阴道超声在早期异位妊娠与妊娠黄体的鉴别诊断中有较高的价值。     

输卵管妊娠血液动力学改变的彩色多普勒超声研究

目的对比分析输卵管妊娠（tubal pregnancy，TP）时双侧输卵管动脉血流，探讨彩色多普勒血流显像（color Doppler flow imaging，CDFI）诊断输卵管妊娠的价值。方法临床拟诊宫外孕患者40例，于术前行经阴道超声（transvaginal scanning，TVS）检查，CDFI显示双侧子宫动脉输卵管支血流，用脉冲多普勒检测收缩期最大流速（peak systolic velocity，PSV）、舒张末期流速（end diastolic velocity，EDV）、平均流速（time averge mature，TAMAX）、搏动指数（pulsatility index，PI）及阻力指数（resistivity index，RI），并进行统计学处理。结果40例均确诊为TP，其中33例黄体位于患侧，输卵管动脉血流信号较健侧丰富，色泽明亮鲜艳，血流频谱呈单向高舒张期、低阻特征，EDV、TAMAX明显高于健侧，PI、RI则明显低于健侧（P〈0．05），PSV双侧差异无统计学意义（P〉0．05）；5例黄体位于健侧者，所有参数差异无统计学意义（P〉0．05）。2例TP破裂出血者，患侧EDV、TAMAX均低于健侧，且PI、RI高于健侧。结论经阴道CDFI监测输卵管动脉血流有助于TP的早期定性和定位诊断。     

输卵管间质部妊娠与宫角妊娠的超声诊断与鉴别诊断

目的探讨经阴道超声检查诊断输卵管间质部妊娠与宫角妊娠的价值。方法回顾分析我院3a来收治的经手术或病理证实的28例输卵管间质部妊娠与宫角妊娠的术前超声表现。结果输卵管间质部妊娠与宫角妊娠的术前声像图表现为胚囊型、不典型孕囊型和破裂型3种类型。术前超声正确诊断为输卵管间质部妊娠7例,宫角妊娠13例,笼统诊断为宫外孕未准确定位5例,术前超声误诊3例,超声检查准确率71%(20/28)。结论经阴道超声显像对输卵管间质部妊娠和宫角妊娠具有较高的诊断及鉴别诊断价值。     

经阴道彩色多普勒超声对异位妊娠及宫内早孕妊娠黄体的对比研究

目的 探讨正常宫内早孕及异位妊娠黄体的经阴道彩色多普勒超声表现.资料与方法 对比分析经手术及病理证实的异位妊娠(A组,64例)及宫内早孕(B组,71例)妊娠黄体的经阴道彩色多普勒超声表现.结果 黄体类型:A组低回声型33例,厚壁囊肿型19例,薄壁囊肿型6例,薄壁囊肿内部回声点型5例;B组低回声型39例,厚壁囊肿型21例,薄壁囊肿型5例,薄壁囊肿内部回声点型6例;两组回声类型比较,差异无统计学意义(x2=0.663,P=0.882).A、B组黄体平均直径分别为( 1.70±0.51)cm和(1.84±0.37) cm,差异无统计学意义(t=-1.887,P=0.061).A、B组黄体阻力指数(RJ)分别为(0.48±0.09)和(0.45±0.06),差异有统计学意义(t=2.605,P=0.011).结论 经阴道彩色多普勒超声观察黄体回声类型及大小不能反映妊娠黄体功能,而血流显像对估测黄体功能有较高的价值.     

经阴道彩色多普勒超声评价药物治疗输卵管妊娠的价值

目的:探讨经阴道彩色多普勒超声(TVCDFI)评价药物保守治疗输卵管妊娠的价值。方法:应用TVCDFI观察中西医结合保守治疗输卵管妊娠30例,患者治疗前及治疗后1周、2周、1月行阴道超声检查,并记录输卵管妊娠包块的二维声像图特征及多普勒血流动力学参数。结果:输卵管妊娠包块治疗前血流信号丰富,治疗后血流信号逐渐减少,差异具有显著性意义(P<0.005)。治疗1月后附件区包块收缩期峰值流速及舒张末期流速较治疗前明显减慢,P<0.001。治疗2周及1月后附件区包块阻力指数较治疗前明显升高,P<0.001。结论:输卵管妊娠包块大小、血流信号的丰富程度、血流流速的降低及阻力指数的增高以及盆腔积液量的多少是疗效评价客观的、有价值的指标。TVCDFI评价输卵管妊娠疗效有临床推广价值。     

经阴道超声对输卵管妊娠药物治疗效果观察的价值

目的探讨经阴道彩色多普勒超声(TVCDS)对输卵管妊娠药物治疗的临床价值。方法选择30例生命体征平稳的输卵管妊娠患者,在行TVCDS检查后接受甲氨蝶呤(MTX)1mg/kg肌内注射,利用TVCDS动态监测治疗前后输卵管妊娠处的图像变化。结果 30例输卵管妊娠给予MTX治疗6~10周内,异位妊娠包块逐渐缩小并消失26例(86.7%),未破裂流产型1例(3.3%),无效3例(10%)。结论 TVCDS可对输卵管妊娠行早期诊断,动态监测输卵管药物治疗、指导临床及时采取有效措施有重要价值。     

异位妊娠未破型孕囊与妊娠卵巢黄体小囊肿的二维超声对比分析

目的利用二维超声对异位妊娠未破型孕囊与妊娠卵巢黄体小囊肿进行对比分析,以提高异位妊娠的早期检出率。方法对32例输卵管妊娠未破型孕囊与40例妊娠卵巢黄体小囊肿的二维超声图像作回顾性对比分析。结果输卵管妊娠未破孕囊有＂输卵管环＂回声,而无1例妊娠黄体小囊肿有此特征;90%的妊娠黄体小囊肿周围可见卵泡回声,而无1例异位妊娠孕囊周围可见卵泡回声;90%的妊娠黄体小囊肿伴有子宫内膜蜕膜样改变。结论通过两组资料的回顾性对比分析,二维超声显示的卵巢附近及子宫旁一侧＂输卵管环＂图像是扩张输卵管内孕囊着床的直接征象,也是早期宫外孕未破型孕囊诊断的重要依据。结合子宫内膜回声和临床症状,二维超声也不难鉴别输卵管妊娠未破孕囊与妊娠黄体小囊肿的诊断。     

经阴道彩色多普勒超声诊断卵巢黄体血肿

目的:探讨经阴道彩色多普勒超声诊断卵巢黄体血肿(ovarian corpus luteum hematoma,OCLH)的价值.材料和方法:回顾性分析45例经手术或随访证实的OCLH患者的超声表现.结果:本组45例OCLH的超声表现可分为3型,其中囊性17例,囊实混合性23例,类实性5例,彩色多普勒显示32例(32/45,71%)OCLH周边可见环状、半环状血流信号,经阴道彩色多普勒超声诊断OCLH的符合率为93%(42/45).结论:经阴道彩色多普勒超声对诊断OCLH具有重要价值.     

腹腔镜手术治疗输卵管妊娠30例临床观察

目的：探讨腹腔镜手术治疗输卵管妊娠的临床应用价值。方法：纳入输卵管妊娠患者60例,随机分为腹腔镜组和开腹组,各30例。腹腔镜组予腹腔镜手术治疗,开腹组按常规开腹手术治疗。观察两组患者的手术时间、术中出血量、术后肛门排气时间、尿HCG转阴时间、术后平均住院时间及手术并发症情况。结果：与开腹组比较,腹腔镜组术中出血量较少、术后肛门排气时间明显减短、平均住院时间明显缩短,经统计学检验,差异有明显统计学意义（P〈0.05）;腹腔镜组和开腹组在手术时间、尿HCG转阴时间比较无显著性差异（P〉0.05）。结论：腹腔镜手术治疗输卵管妊娠,其创伤小、出血量少、术后恢复快、并发症少、疗效确切,可以保留患者的生育功能,提高其生存质量。     

Role of Duplex Power Doppler Ultrasound in Differentiation between Malignant and Benign Thyroid Nodules

Objective

To evaluate the usage of duplex power Doppler ultrasound (PDUS) for the differentiation of benign and malignant thyroid nodules.

Materials and Methods

We prospectively examined 77 thyroid nodules in 60 patients undergoing ultrasound-guided fine needle aspiration biopsy (FNAB). Each nodule was described according to size, inner structure, borders, parenchymal echogenicity, peripheral halo formation, and the presence of calcification (B-mode ultrasound findings). Vascularity as determined by PDUS imaging was defined as non-vascular, peripheral, central, or of mixed type. For each nodule, the pulsatility index (PI) and resistive index (RI) values were obtained. Results of FNAB and surgical pathological examination (if available) were used as a proof of final diagnosis to categorize all nodules as benign or malignant. A receiver operating characteristic (ROC) curve analysis was performed to establish cut-off, sensitivity, and specificity values associated with RI-PI values.

Results

A significant relationship was observed between malignancy and irregular margins, microcalcifications, and hypoechogenicity on ultrasound examination (p < 0.05). The pattern of vascularity as determined by PDUS analysis was not a statistically significant criterion to suggest benign or malignant disease in this study (p > 0.05). The central, peripheral, and mean RI-PI values were higher in malignant nodules when compared to the other cytologies (p < 0.05).

Conclusion

Vascularity is not a useful parameter for distinguishing malignant from benign thyroid nodules. However, RI and PI values are useful in distinguishing malignant from benign thyroid nodules.     

促孕散治疗持久黄体奶牛血清白介素与激素的相关性分析

为探讨促孕散治疗持久黄体不孕奶牛血清生殖激素和白介素含量的关系,应用ELISA法测定了促孕散治疗持久黄体不孕奶牛前后血清中促卵泡素（FSH）、促黄体素（LH）、孕激素（P4）、雌二醇（E2）、IL-1和IL-6的浓度,分析了4种激素和2种白介素间的相关关系与回归方程。结果表明,IL-1和IL-6水平与P呈负相关,与E2、FSH、LH呈正相关,结论：促孕散治疗持久黄体奶牛前后在血清中IL-1和IL-6的变化与生殖激素的分泌具有一定的相关性。     

甲状腺微小癌诊断中应用二维超声、彩色多普勒超声及弹性成像的价值分析

目的：探讨二维超声、彩色多普勒超声及弹性成像对甲状腺微小癌的诊断价值。方法随机选取医院收治的2015年1月～2016年1月50例病理证实为甲状腺微小癌患者,并且依据随机数字表方法,分为研究组（25例）、对照组（25例）。给予对照组患者临床中,应用二维超声诊断,研究组中患者,采取彩色多普勒超声及弹性成像诊断,对比两组临床诊断效果,对两组患者临床资料进行分析。结果对于研究组中,临床经彩色多普勒超声及弹性成像诊断后,诊断准确率达到92．0％,对照组诊断准确率为72．3％,两组对照存在统计学意义（ P＜0．05）;同时,在临床彩色多普勒超声及弹性成像诊断中,可以提升其临床诊断敏感性、特异性,在临床诊断甲状腺微小癌中发挥重要诊断价值。结论在临床对甲状腺微小癌中,应用彩色多普勒超声及弹性成像技术,不仅提升临床诊断准确率,同时还可以提升临床诊断敏感性与特异性,发挥积极诊断价值。     

彩色多普勒超声对头臂干型多发大动脉炎的诊断价值

目的：探讨彩色多普勒超声在头臂干型多发大动脉炎诊断中的应用价值。方法：对5例头臂干型多发大动脉炎患者行二维及彩色多普勒超声检查,观察其声像图特点及血流动力学变化。结果：5例患者头臂动脉均出现不同程度受累,动脉壁不同程度增厚,出现不同程度狭窄甚至闭塞,部分病例继发血栓及合并动脉瘤形成,并出现相应的血流动力学改变。结论：彩色多普勒超声可以清晰显示头臂干型多发大动脉炎的受累部位、病变程度及血流动力学变化,且具有方便、准确、无损伤等点,因而对本病早期协助诊断具有重要意义,而且是本病疗效评价和随访的重要方法。     

The distribution of microvascular response in Achilles tendonopathy assessed by colour and power Doppler

Objectives To assess the distribution of microvascular response on colour Doppler (CD) and power Doppler (PD) ultrasound (US) of the tendo Achilles (TA) in tendonopathy, and to look for any relationship between tendon morphology and symptoms.Design and patients A retrospective, observational study was carried out on consecutive ambulant US patients with suspected tendonopathy, presenting with pain or an Achilles mass. Exclusion criteria were: use of steroids, and previous or possible rupture or surgery in either tendon or arthropathy. Using a 5–12 MHz linear array probe (ATL HDI 3000) both TAs were scanned. Tendonopathy was defined as tendon swelling and/or hypoechogenicity of the TA. The site, number and distribution of microvascularity, on CD and PD, and the anteroposterior size were recorded, with the analysis masked.Results Fifty-two patients presented with TA pain and six also with swelling. There were 34 males and 18 females, aged from 11 to 78 years (mean 45 years). Fifty-five TAs that showed tendonopathy with hypoechogenic areas were all observed to be over 5.9 mm (mean 11.1 mm, range 5.9–20 mm), of which 45 were symptomatic with abnormal PD and 24 with abnormal CD flow. It was observed that the extent and completeness of vessel branching was more extensive on PD than CD. All TAs demonstrating tendonopathy were over 5.9 mm in adults and all TAs that showed PD flow were over 6.5 mm. All microvessels originated towards the TA from the ventral surface usually into tendonopathy, and were 16-fold more frequent around the margins. There were 49 TAs with normal spectral US, and with no PD flow, with a mean size of 4.5 mm (range 3.0–7.4 mm). For the right and left TAs independently analysed and taking the 40 patients with a paired asymptomatic and symptomatic tendon: (1) There was a highly significant difference in size (P<0.00001) using the paired t-test (parametric) between the asymptomatic tendon (mean 5.2±1.4 mm (1 SD)), and the contralateral morphologically abnormal and symptomatic side (mean 9.7±1.4 mm). (2) There was no linear Pearson correlation (0.25) between TA size and duration of symptoms (P=0.11) for symptomatic tendons. (3) There was a positive Spearman correlation (0.84) between the number of vessels and TA size (P<0.00001). (4) There was a significant difference in the number of PD vessels using the non-parametric Wilcoxon signed test (P<0.00001) between the symptomatic and asymptomatic groups.Conclusions (1) PD shows more tendon microvascularity than CD in TA tendonopathy. (2) All microvessels arise on the ventral side of the TA. (3) There is a non-linear relationship between tendonopathy, TA size and the amount of microvascularity, but not between PD and duration of symptoms. (4) Morphologically abnormal adult TAs were larger than 5.9 mm, and PD flow was only seen in TAs above 6.5 mm.     

经阴道与经腹超声联合应用在诊断异位妊娠中的价值

目的：探讨对联合应用经阴道超声（TVS）与经腹超声（TAS）在异位妊娠诊断中的临床价值。方法：对397例经手术治疗的异位妊娠患者进行回顾性分析,观察TVS加TAS与TAS对了解附件包块、胚芽、原始心管搏动、子宫内假孕囊及双侧卵巢显示情况,综合判断异位妊娠,并与术后病理结果进行印证对比。结果：TVS加TAS与TAS对术后病理验证诊断符合率、附件包块、胚芽、原始心管搏动、子宫内假孕囊及双侧卵巢显示情况的比较中,前者的阳性率高于后者,差异具有显著性。结论：TVS＋TAS联合应用对宫外孕的早期诊断具有重要应用价值。