子宫腺肌病与子宫肌瘤的临床对比分析

目的探讨子宫腺肌病与子宫肌瘤的临床区别 ,以提高术前诊断率。方法选择 42例子宫腺肌病患者和 5 7例子宫肌瘤患者为研究对象 ,并对发病年龄、临床表现、B超结果及血清CA12 5、CA199水平进行比较。结果两组患者发病年龄及临床表现相近 ,但子宫腺肌病痛经症状明显 (P <0 0 1) ,B超有特征性改变 ,血清CA12 5水平明显升高 ,阳性率为 78 5 7% ,显著高于子宫肌瘤 (阳性率为 5 2 6% ) (P <0 0 5 ) ,而两组CA199水平无统计学意义 (P >0 0 5 )。结论鉴别子宫腺肌病和子宫肌瘤主要依靠临床表现及B超所见 ,测定血清CA12 5水平对鉴别诊断有一定参考价值。     

囊性肾癌的影像学诊断

目的 提高囊性肾癌的影像学诊断水平。方法 对15例囊性肾癌病人的B超、CT检查和治疗结果进行回顾性分析。结果 15例患者经健康体查B超发现肾囊性病变12例，因其他疾病而发现3例。初次B超拟诊囊性肾癌8例、单纯性肾囊肿7例。螺旋CT扫描全部病灶为囊性病变，增强扫描后囊壁内侧面不规则密度增高或结节样密度改变。全部病人经手术治疗，病理检查为肾细胞癌。结论 对于肾脏的囊性病变，如果B超或CT检查不能确立为单纯性囊肿，临床上应考虑为囊性肾癌并积极处理。     

经阴道超声对子宫肌腺病的诊断价值评价

目的 探讨经阴道超声在子宫肌腺病诊断中的价值。方法 52例子宫肌腺病患者均行经阴道超声检查,其中9例加做经腹部超声检查,将超声结论与手术及病理诊断进行对照分析。结果 超声诊断与病理诊断符合者35例（67．3％）,不符者17例（32．7％）。其中误诊7例,漏诊10例。结论 经阴道超声是临床诊断子宫肌腺病的主要依据之一,可作为首选检查方法。     

子宫恶性中胚叶混合瘤二例报告

子宫恶性中胚叶混合瘤（MMMT）非常罕见。该文报道2例MMMT患者的诊治经过。2例患者均为绝经女性,1例因阴道不规则流血入院,经超声检查初步诊断为子宫肌瘤、子宫内膜癌;另1例因卵巢癌术后发现盆腔包块入院,初步诊断为卵巢癌复发。2例患者最终均经病理学检查确诊为MMMT。该2例的诊治经过提示,MMMT的临床表现无特异性,容易误、漏诊,患者的病史、临床症状及影像学检查可有助发现病灶,但最终确诊需依赖病理学检查。     

甲状腺舌管囊肿的超声诊断

目的　探讨甲状腺舌管囊肿的超声及病理基础。方法　分析2 0例甲状舌管囊肿的临床、超声表现及病理资料。结果　甲状腺舌管囊肿超声表现为圆形、椭圆形的囊性肿块,大多数位于中线,也可偏于一侧;15例囊肿内为无回声区,囊壁均匀、光滑,后方回声增强,5例内部为弱回声,囊壁均匀光滑。结论　超声对甲状腺舌管囊肿的定性具有较好的诊断价值。     

囊性肾癌的诊断与治疗（附19例报告）

目的探讨囊性肾癌的诊断与治疗,以提高对该病的认识及诊断准确率。方法回顾性分析19例囊性肾癌的临床及影像学资料。结果19例患者均经病理证实为囊性肾癌,随访3～61个月,未见肿瘤复发与转移。结论综合运用B超、CT等各种检查,可以提高囊性肾癌的术前诊断率,但仍有一定的误诊率,术中再行快速冷冻切片及术后细致的常规病理切片可更进一步提高诊断准确率。行肾癌根治术或肾部分切除术,囊性肾癌的预后较好。     

Diagnosis and laparoscopic excision of accessory cavitated uterine mass in a young woman: A case report

BACKGROUNDAccessory and cavitated uterine mass (ACUM) is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women, which presents as chronic periodic pelvic pain and severe dysmenorrhea. The entity is often underdiagnosed due to a broad differential diagnosis, including rudimentary uterine horn, true cavitated adenomyosis and degenerating fibroids.CASE SUMMARYA 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis. Gynecological examination and ultrasonography were performed. The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis. Postoperatively, the patient did well, with no further dysmenorrhea.CONCLUSIONACUM is difficult to diagnose. A correct diagnosis can be made only after excision and histopathological evaluation. Surgical excision is necessary and can be carried out by laparoscopy.     

子宫腺肌病87例诊治分析

目的：分析近年来子宫腺肌痛的发病情况、临床表现、诊断和治疗。方法：回顾性分析2000年1月-2002年12月本院收治的87例子宫腺肌痛患者的临床资料。结果：87例子宫腺肌痛患者占我院同期妇科住院人数的9．6％、妇科子宫切除手术的21．3％。术前痛经者58例(66．7％)，月经过多者35例(40．2％)，人流后急性腹疼3例(3．4％)。术前诊断为子宫腺肌病51例，诊断符合率为58．6％，B超诊断符合率为49．4％，血CA125测定阳性率为69．2％。除3例行腺肌瘤剔除术外，其余均行全子宫切除术，其中32例术前曾使用内美通、丹那唑、米非司酮、避孕1号等治疗达3个月以上，76．0％痛经明显缓解，但73．7％患者停药后第1个月经周期痛经即复发。结论：子宫腺肌病目前仍以手术治疗为主，治疗子宫内膜异位症的常用药物对子宫腺肌病痛经均有效，但停药后易复发。     

经食管超声在心脏瓣膜囊性病变围术期的应用价值

目的探讨经食管超声在心脏瓣膜囊性病变围术期的应用价值。方法回顾性分析5例经胸超声及(或)经食管超声诊断为心脏瓣膜囊性病变的患者资料,总结其超声影像学特征;以手术及病理结果为对照,比较分析术前经食管超声测量病变大小与术中所见病变大小的差异性。结果 5例心脏瓣膜囊性病变患者均有特征性的超声影像学表现,所有病例均经食管超声检出瓣膜囊性病变,2例经胸超声检查未检出瓣膜囊性病变。3例手术及病理诊断为心脏瓣叶囊肿,2例手术诊断为瓣叶囊状病变。术前经食管超声测得病变大小与术中测量大小有较好的相关性(r=0.998,P0.01)。结论经食管超声在心脏瓣膜囊性病变围术期的定位及定性诊断中具有重要价值。     

胆道闭锁的高频彩色多普勒超声诊断分析

目的探讨高频彩色多普勒超声检查对胆道闭锁早期诊断的价值和意义。方法以手术和病理证实的8例胆道闭锁的患儿为研究对象,总结分析婴儿胆道闭锁的超声图像表现特征。结果 8例胆道闭锁患儿超声诊断7例(7/8),漏诊1例(1/8);其中6例的超声表现为左右肝管汇合部可见梭形高回声区,1例的超声表现为左右肝管汇合部可见低回声区。结论先天性胆道闭锁常见的超声表现为肝门部梭形高回声,而对于肝门部的低回声区也不可忽视,以免漏诊误诊,需结合胆囊萎缩发育不良等其他相关超声表现,对提高胆道闭锁早期诊断率具有重要的临床价值。     

腹膜假性黏液瘤的声像图特征及超声诊断价值

目的探讨腹膜假性黏液瘤（PMP）的声像图表现。方法对11例PMP患者的临床、病理及声像图表现进行回顾性分析,观察低频与高频探头扫查的声像图特征及腹水特征,确定病灶形态、部位和范围及彩色血流情况;观察腹壁、病灶内部结构及其与毗邻脏器的关系,并行超声分型。结果11例PMP中10例术前超声诊断基本符合或对临床诊断有提示作用,误诊1例,9例出现明显腹水。超声分型表现：以蜂窝状增厚型表现为主3例,分隔多房型表现为主4例,以实块型表现为主3例,3型间有交叉表现;2例表现为全腹病变,4例显示原发灶。11例均未显示血流;高频显示病灶内呈囊泡状表现且对周围脏器有特征性压迹。结论PMP超声声像图表现有一定特异性：PMP的腹水流动性差,病灶内部多呈囊泡状或可见分隔,典型的病例还可见到絮状或蜂窝样网膜组织包裹腹腔脏器,超声诊断不困难,诊断符合率较高。可作为临床明确诊断的有效检查方法。对于影像学诊断有一定困难的病例,可进行超声引导下穿刺活检以明确诊断。     

超声造影在低位胆道梗阻诊断中的应用价值

【目的】探讨超声造影在低位胆道梗阻诊断中的应用价值。【方法】回顾性分析53例低位胆道梗阻病例的超声造影诊断结果,并与病理结果及 CT 诊断结果比较,分析超声造影对低位胆道梗阻的诊断符合率。【结果】53例中有25例病理诊断为恶性病例,其中超声造影确诊24例,敏感性为92.3%;CT 检查38例,其中病理诊断为恶性病例18例,CT 确诊9例,敏感性为50%;超声造影与 CT 检查对低位胆道梗阻恶性病变的敏感性存在统计学差异。【结论】超声造影对低位胆道梗阻的定性诊断具有一定的应用价值,可为低位胆道梗阻的定性诊断提供可靠的信息。     

Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

A cystic lesion arising from the myometrium of the uterus,termed as cystic adenomyosis,has chocolate-like,thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium.It is an extremely rare type of adenomyosis.CASE SUMMARY Herein,we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy.The patient complained of abnormal uterine bleeding and severe dysmenorrhea.After a levonorgestrel-containing intrauterine device(LNG-IUD)was inserted,her symptoms were greatly alleviated.However,the LNG-IUD was detected in the cystic cavity during the follow-up.For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed.Therefore,laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.CONCLUSION We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.     

超声对卵巢子宫内膜异位囊肿的鉴别诊断

目的:探讨卵巢子宫内膜异位囊肿与卵巢其它囊性肿物的超声鉴别诊断.方法:对比分析279个术前超声或术后病理诊断为卵巢子宫内膜异位囊肿的卵巢囊性肿物的声像图表现与病理结果.结果:卵巢子宫内膜异位囊肿超声诊断与病理诊断的符合率为94.3%.结论:超声对卵巢子宫内膜异位囊肿诊断率高,但仍需与其它囊性肿物相鉴别,部分病例有与卵巢黄体囊肿出血、卵巢脓肿、囊性畸胎瘤、粘液性囊腺瘤、卵巢子宫内膜异位囊肿合并感染相似的声像图表现.     

高强度聚焦超声消融治疗子宫腺肌症的临床研究

目的探初步观察高强度聚焦超声治疗子宫腺肌症的疗效。方法对我院采用高强度聚焦超声消融治疗的25例子宫腺肌症患者进行定期症状随访,随访痛经及月经改善情况。结果25例患者均完成治疗,随访至6个月,痛经缓解率86%,月经减少率84%,近期疗效显著。结论高强度聚焦超声消融治疗是一种保留子宫的无创治疗技术,能够有效治疗子宫腺肌症病灶,缓解痛经、月经量多等症状,近期效果确切,远期疗效尚需进一步临床观察验证。     

妊娠滋养细胞疾病误诊为异位妊娠三例临床分析及文献复习

目的探讨误诊为异位妊娠的妊娠滋养细胞疾病(gestational trophoblastic disease, GTD)患者的临床特点、诊治方法、误诊原因及防范措施。方法回顾性分析曾诊断异位妊娠、经术后病理检查确诊的GTD 3例临床资料。结果本组2例因急腹症就诊,经常规查体、超声及血人绒毛膜促性腺激素(HCG)和尿妊娠试验初诊为异位妊娠,经手术后病理检查确诊为输卵管绒毛膜癌和输卵管侵蚀性葡萄胎各1例;1例因下腹痛、自测尿妊娠试验阳性、突然晕倒诊断为异位妊娠,行左侧输卵管切除术后出现恶心呕吐、盆腔积血、血压升高,取手术标本病理会诊修正诊断为输卵管侵蚀性葡萄胎。3例确诊后经标准联合化疗治愈。结论特殊部位的GTD早期临床表现不典型,类似异位妊娠时易误诊,通过手术获取病理组织送检,重视监测血HCG变化,可避免延误诊治。     

Clinical effectiveness and potential long-term benefits of high-intensity focused ultrasound therapy for patients with adenomyosis

ObjectivesAdenomyosis is a common and refractory disease in gynecology. Preserving the uterus during treatment for adenomyosis remains a problem. High-intensity focused ultrasound (HIFU) is widely used in treatment of solid tumors. This study aimed to analyze patients with adenomyosis who were treated by HIFU and to preliminarily examine the characteristics of patients who are more suitable for HIFU to treat adenomyosis with reliable efficacy.MethodsOver 2 years, 67 women who were diagnosed with adenomyosis and treated with HIFU at our gynecology department were included in this study. We investigated outcomes of their symptoms (dysmenorrhea and hypermenorrhea) and the volume of their uterine lesions. We also compared the patients’ clinical profiles.ResultsThe women had a mean follow-up duration of 11.6 ± 0.46 months. In the numerical rating scale, used to assess the degree of dysmenorrhea, the score was significantly lower (mean difference: −1.94, 95% confidence interval: −2.704 to −1.176) 3 months after HIFU treatment compared with before treatment, then it remained stable for 3 to 12 months. Hypermenorrhea was reduced to a certain degree, with a mean difference of −0.54 (−1.01–0.02).ConclusionsHIFU is a new noninvasive treatment method for adenomyosis that may help relieve dysmenorrhea.     

Imaging,endoscopy, and pathologic findings of primary gastritis cystica polyposa: description of a rare entity in a small case series

Objective

The purpose of this study is to describe a small case series of primary gastritis cystica polyposa (GCP) and explore its imaging features, endoscopic findings, and pathological manifestations.

Methods

In this institutional review board-approved, HIPAA-compliant, retrospective study, an electronic pathology database in our hospital was searched for all cases of GCP from July 2008 to December 2015, yielding five cases with both radiological and endoscopic examination. The characteristics of imaging and gastroscopy were explored, and the pathological basis was analyzed.

Results

All five cases of GCP occurred in a previously unoperated stomach, which underwent unenhanced CT and enhanced CT, and one of which underwent unenhanced MRI and enhanced MRI as well. Gastroscopy or gastroscopic ultrasound was performed on all five patients. Four submucosal cystic lesions were displayed, including three with low-attenuation liquid, and one with high-attenuation liquid on CT. Another lesion showed soft tissue mass attenuation protruding into the gastric cavity. The surface mucosal layers of all five lesions were smooth and obviously enhanced, with unenhanced cystic component inside. Four submucosal lesions were confirmed by gastroscopy. Gastroscopic ultrasound indicated anechoic area in the center of the lesion. A large mass-like lesion had protruded into the gastric cavity, and gastroscopic ultrasound indicated dispersed anechoic areas in the lesion. All Histopathological analyses indicated mild or moderate epithelial dysplasia, and cystic dilation of the gastric glands in the submucosal layers and lamina propria, surrounded by the infiltration of inflammatory cells.

Conclusion

Primary GCP has relatively particular endoscopy features, which can be accurately diagnosed by gastroscopy when the lesion is small. But endoscopy has its limitations in the diagnosis and differentiation for some large lesions. In contrast to gastroscopy and gastroscopic ultrasound, CT or MRI provides more information about both the gastric wall and the extragastric extent of the disease, which is more helpful for differential diagnosis and surgical planning of GCP before operation.

     

阑尾黏液性肿瘤超声误漏诊分析

目的探讨阑尾黏液性肿瘤的超声表现,以期提高超声对其的诊断能力。 方法回顾性分析2013—2019年在北京市延庆区医院经手术病理证实的10例阑尾黏液性肿瘤病例的超声声像图特征,分析误诊及漏诊情况。 结果10例经手术病理证实为阑尾黏液性肿瘤的患者中,术前3例超声诊断或怀疑为阑尾黏液性肿瘤（30.0%,3/10）,6例超声诊断为急性阑尾炎（60.0%,6/10）,1例超声诊断为右下腹囊性包块,阑尾来源可能（10.0%,1/10）。10例患者的超声表现均为阑尾管径增宽,管壁增厚,其中5例阑尾管腔内可见沉积物,1例管腔内可见块状强回声,4例阑尾管壁结构不清合并周围积液。 结论阑尾黏液性肿瘤是一种少见疾病,超声表现具有一定的特异性,超声医师应掌握其临床及超声特点,提高对该疾病的认识,可提高本病的超声诊断率。     

肿瘤超声、超声造影检查在肾上腺肿瘤中的诊断价值及效能研究

目的:探讨肿瘤超声及超声造影在肾上腺肿瘤患者中的临床价值及可行性。方法：选择2016年5月-2017年12月入院诊断的肾上腺肿瘤患者60例,所有患者均最终经手术病理组织学检查得到确诊。手术前患者均行肿瘤超声、超声造影检查,将肿瘤超声与超声造影检查结果与手术病理检查结果进行比较,分析肿瘤超声及超声造影早肾上腺肿瘤患者中的诊断价值及可行性。结果：60例肾上腺肿瘤均经过手术病理检查最终确诊,53例经手术治疗,7例经超声引导下穿刺活检确诊。肿瘤中,排在前三位的分别为：皮质腺瘤、嗜铬细胞瘤、髓样脂肪瘤,分别占：53.33%、13.33%和10.00%;肾上腺肿瘤患者均完成肿瘤超声与超声造影检查,肿瘤超声最终确诊53例;肿瘤超声联合超声造影检查最终确诊58例;肿瘤超声联合超声造影在肾上腺肿瘤中的诊断敏感性、特异性,均高于单一肿瘤超声和超声造影(P<0.05);常规超声检查下确诊的30例腺瘤直径(9-37)mm,平均(23.14±4.61)mm,内部呈均质细点状回声,边界光滑、整齐,包膜完整;7例嗜铬细胞瘤直径(40-71)mm,平均(56.74±4.51)mm,内部呈均匀低回声,边界呈较高的清晰回声;5例髓样脂肪瘤直径(31-55)mm,平均(38.42±4.62)mm,圆形均质回声,形态规则、边界清。联合超声造影剂检查时造影剂均进入病灶部位,肿瘤边界更加清晰,且腺瘤、嗜铬细胞瘤与髓样脂肪瘤造影剂填充较快,达峰强度低于周围肝实质或与肝实质相当。腺瘤患者超声造影剂下周围均匀增强,内部存在散在造影剂;髓样脂肪瘤超声造影下不均匀增强,中央高而周围回声低。结论：肿瘤超声用于肾上腺肿瘤中能提高临床确诊率,而超声造影能显示肾上腺肿瘤血流灌注情况,能作为肿瘤超声的补充,肿瘤超声及超声造影联合能能实现肾上腺肿瘤的诊断与鉴别,值得推广应用。