HSG和经阴道超声诊断先天性子宫畸形的对比研究

目的探讨子宫输卵管造影(Hysterosalpingography,HSG)和经阴道超声对于先天性子宫畸形的诊断价值。方法回顾性分析2014年1月~2015年6月在潍坊医学院附属生殖医学中心行子宫输卵管造影发现先天性子宫畸形的84例患者,均经阴道超声检查,最终经宫腔镜或宫腹腔镜联合证实,比较两种检查方式诊断先天性子宫畸形的临床符合率和误诊率。结果子宫输卵管造影和阴道超声用于先天性子宫畸形诊断符合率分别为94.05%(79/84),78.57%(66/84);误诊率分别为3.57%(3/84),13.09%(11/84)。子宫输卵管造影对于先天性子宫畸形诊断符合率显著高于阴道超声,差异有统计学意义(P0.05)。结论 HSG较阴道超声诊断子宫畸形的临床符合率高,可作为首选方法,但对于不典型的,复杂的子宫畸形,仍需结合宫腔镜或腹腔镜以提高诊断的准确性。     

经阴道三维超声诊断子宫畸形的价值

目的探讨经阴道三维超声对子宫畸形的诊断价值。方法选择已临床确诊的130例子宫畸形患者,年龄26~42岁,平均年龄33岁。单角和/或残角子宫均经过宫腔镜和/或腹腔镜检查确诊,双子宫、双角子宫、鞍形子宫均经过MRI检查确诊,纵隔子宫经过宫腔镜检查确诊。回顾分析其经阴道二维和三维超声图像资料。结果经阴道三维超声诊断单角子宫和/或残角子宫11例,双子宫6例,双角子宫7例,纵隔子宫80例,鞍形子宫25例。经阴道二维超声诊断单角子宫和/或残角子宫5例,双子宫6例,双角子宫6例,纵隔子宫73例,鞍形子宫5例。经阴道三维超声诊断与宫腔镜结果符合率99.23%,显著高于二维超声诊断73.08%;两者相比,差异有统计学意义(P0.005)。结论经阴道三维超声图像可以显示不同子宫畸形的宫腔结构及宫底的外观形态,是诊断先天性子宫畸形的无创性可靠方法之一。     

经阴道三维超声在诊断子宫先天性发育畸形中的应用

目的探讨经阴道三维超声检查在诊断子宫先天性发育畸形中的应用价值。方法回顾性分析2014年10月-2017年2月来我院就诊、二维彩超诊断子宫先天发育畸形的患者,进一步经阴道三维超声检查,所有病例通过宫腔镜或腹腔镜或子宫输卵管碘油造影证实。结果二维彩超诊断子宫先天发育畸形的患者65例,经阴道三维超声检查确诊子宫先天发育畸形57例,与宫腔镜、腹腔镜及碘油造影结果一致,准确率100%,其中纵隔子宫30例、双角子宫12例、双子宫8例、残角子宫3例、单角子宫1例、弓形子宫3例。结论纵隔子宫在子宫先天发育畸形中最常见,经阴道三维超声检查在诊断子宫先天发育畸形中准确率高,简便无创,值得推广应用。     

经阴道三维超声诊断不全纵隔子宫和弓形子宫的价值

目的探讨经阴道三维超声对不全纵隔子宫和弓形子宫的诊断价值。方法对宫腔镜和腹腔镜联合检查后确诊的不全纵隔子宫和弓形子宫各30例患者的经阴道二维和三维超声图像进行分析比较。结果宫腔镜和腹腔镜联合检查确诊的各30例不全纵隔子宫和弓形子宫中,术前经阴道二维超声准确诊断24例不全纵隔子宫和22例弓形子宫,诊断符合率分别约80．0％和73．3％;经阴道三维超声对不全纵隔子宫和弓形子宫的诊断符合率均为100％,二者比较差异有统计学意义（P〈0．05）。结论经阴道三维超声能获得二维不能获得的冠状切面,可直观、准确地显示子宫外形轮廓及宫腔内膜形态。为诊断提供量化标准,明显提高了对不全纵隔子宫和弓形子宫的诊断符合率,可作为两者首选的检查方法。     

RT-3D-HyCoSy对子宫发育异常不孕症患者输卵管通畅性的评估价值

目的 探讨经阴道实时三维子宫输卵管超声造影（RT-3D-HyCoSy）在不同类型子宫发育异常不孕症中的诊断效果及对患者输卵管通畅性及受孕情况的评估价值。方法 选择不孕症患者145例，年龄21～36岁，平均年龄29.21岁；原发性不孕85例，继发性不孕60例。均接受RT-3D-HyCoSy检查、X射线子宫输卵管碘油造影，以腹腔镜检查为金标准。评估RT-3D-HyCoSy检查子宫畸形类型，以及输卵管通畅性的诊断符合率，观察治疗后的受孕情况。结果 145例患者中，纵隔子宫52例（35.86%），单角子宫48例（33.10%），双子宫24例（16.55%），弓形子宫12例（8.28%）。RT-3DHyCoSy、X射线子宫输卵管碘油造影诊断输卵管通畅性异常的灵敏度分别为90.91%、77.27%，特异度分别为93.24%、84.46%，准确度分别为92.14%、81.07%。超声引导输卵管造影诊断输卵管阻塞（88.46%vs 73.08%）、输卵管通而不畅（92.50%vs 80.00%）、输卵管通畅（93.24%vs 84.46%）符合率均高于X射线子宫输卵管碘油造影诊断符合率（P <0...     

HSG、三维超声和MRI在先天性子宫畸形中的诊断价值

目的探讨HSG、三维超声和MRI在先天性子宫畸形中的诊断价值。方法回顾性分析经临床或手术证实,有完整HSG、三维超声和MRI影像资料的37例先天性子宫畸形病例。结果 HSG将双子宫误诊为单角子宫1例、误诊为完全纵隔子宫2例,将弓形子宫误诊为不完全纵隔子宫1例、误诊为双角子宫1例,且对残角子宫未能作出诊断,准确率约为64.9%。三维超声将双角子宫误诊为不完全纵隔子宫1例,将弓形子宫误诊为不完全纵隔子宫2例,准确率约为91.9%。MRI将双角子宫误诊为不完全纵隔子宫1例,准确率约为97.3%。结论 HSG诊断子宫畸形的准确率最低,但其可同时评估双侧输卵管通畅与否的优点是其他检查无法替代的;三维超声简便、明确、准确率高,可作为诊断子宫畸形的首选检查方法;MRI可清晰显示先天性子宫畸形的解剖结构,并可通过2D-haste序列轻松判断是否同时伴有泌尿系统畸形,是三者中准确率最高、诊断先天性子宫畸形的最可靠方法,可作为进一步检查。     

经阴道超声检查在子宫动静脉瘘临床诊断中的应用分析

目的:分析经阴道超声检查在子宫动静脉瘘临床诊断中的应用价值.方法:选取本院自2017年2月-2022年5月期间接收的102例疑似子宫动静脉瘘患者为研究对象.患者均分别采用经阴道超声、二维超声检查,并根据子宫动脉造影作为诊断的金标准.分析对比经阴道超声检查和二维超声检查结果.结果:102例患者均行子宫动脉造影,证实98例为子宫动脉瘘.二维超声诊断结果显示真阳性61例,真阴性3例,漏诊37例,误诊2例.经阴道彩色多普勒超声检查结果显示真阳性94例漏诊4例,误诊1例.二维超声诊断符合率61.76％,漏诊率为37.76％,误诊率为50.00％.经阴道彩色多普勒超声检查诊断符合率为95.10％,漏诊率为4.08％,误诊率为25.00％.经阴道彩色多普勒超声检查诊断符合率明显高于二维超声检查(P<0.05).结论:经阴道超声检查在子宫动静脉瘘临床诊断中的应用价值高,能显著降低漏诊和误诊的发生.     

经阴道三维超声对纵隔子宫诊断与鉴别诊断的价值

目的探讨经阴道三维超声成像对先天性纵隔子宫的诊断与鉴别诊断中的价值。方法对30例阴道二维超声可疑纵隔子宫畸形的患者行阴道三维超声检查,将两种检查方法的结果相对照。结果本组30例病例经阴道三维超声诊断完全性纵隔子宫7例,不完全性纵隔子宫10例,弓形子宫7例,正常子宫6例。结论经阴道三维超声成像能从不同的切面特别是冠状切面在显示子宫外形的同时显示宫腔形态及结构,并且通过对宫底部凹陷的深度及两宫内膜夹角的测量,将纵隔子宫与弓形子宫、双角子宫区分开,并能对纵隔子宫准确分型,对纵隔子宫诊断的准确性明显优于阴道二维超声,是一种简单、易行及无创的诊断纵隔子宫畸形的检查方法。     

MRI与HSG造影在先天性子宫发育异常的诊断中的应用

目的探讨MRI与HSG造影检查对先天性子宫发育异常的检出率。方法 58名经HSG检查和63名经MRI诊断子宫发育异常的病例,分析其HSG和MRI表现及误诊的情况。结果 HSG的误诊率为17.24%,其中对诊断单角子宫,双角子宫以及纵隔子宫的误诊率较高,而MRI检查通过3D扫描能定性定量地诊断先天性子宫发育异常,诊断准确率为95.24%。结论 HSG检查可直观地判断一些常见的子宫发育异常,但对于准确分型与定性不如MRI检查;而MRI检查对诊断幼稚子宫等宫腔较小且内膜较薄的患者不及HSG直观。     

经阴道三维超声成像诊断子宫先天畸形临床应用价值研究

目的研究阴道三维超声成像诊断子宫先天畸形的临床应用价值。方法回顾性分析我院2013年5月~2016年2月的200例子宫先天畸形患者的临床资料,按照检查方式不同分为二维超声组和三维超声组,每组100例,观察两组患者的子宫内膜、外形特点及子宫畸形类型,并两组比较。结果 200例患者中,完全纵膈子宫和不完全纵膈子宫所占比例较高,分别占30.00%、28.00%。三维超声组检查结果中有完全纵膈子宫30例、不完全纵膈子宫28例、弓形子宫8例、单角子宫4例、双角子宫18例、残角子宫12例,其诊断符合率为100.00%;二维超声组中诊断结果为完全纵膈子宫30例、不完全纵膈子宫31例、弓形子宫5例、单角子宫7例、双角子宫18例、残角子宫1例,其诊断符合率为89.00%,二维超声组中将3例双子宫误诊为不完全纵膈子宫,漏诊5例单角子宫和3例残角子宫。三维超声组诊断子宫畸形类型较二维超声组更准确。结论阴道三维超声成像能够清晰显示宫腔结构以及宫底外观,对诊断子宫先天畸形诊断的准确率高,值得临床推广。     

Hysterosalpingo contrast sonography (HyCoSy) with SH U 454 (Echovist) for the assessment of tubal patency

A total of 88 Fallopian tubes from 44 patients was examined with hysterosalpingo contrast sonography (HyCoSy), hysterosalpingogram (HSG), and laparoscopic chromopertubation (LC) in order to assess their relative accuracy for measuring tubal patency. HyCoSy was done by transvaginal ultrasound and the contrast was SH U 454 (Echovist). The flow of multiple fractions of the contrast medium through each Fallopian tube was observed in real time in appropriate imaging planes by means of a transvaginal probe. Compared with laparoscopic results, we found a sensitivity of 85.2%, a specificity of 85.2%, a positive predictive value (PPV) of 71.9%, a negative predictive value (NPV) of 92.9% and concordance (HyCoSy/LC) of 85.2%, while the corresponding values for HSG were sensitivity = 85.2%, specificity = 83.6%, PPV = 69.7%, NPV = 92.7% and concordance (HSG/LC) of 84.1%. Compared with HSG results, HyCoSy obtained a co-positivity of 66.7%, a co-negativity of 81.8% and a concordance of 76.1%. In conclusion, HyCoSy with SH U 454 proved to be a reliable and safe modality for evaluating tubal patency; it is suitable as an outpatient diagnostic procedure to be used before more invasive procedures.      

阴道超声与宫腔镜在诊断围绝经期子宫异常出血中的应用

目的探讨阴道超声和宫腔镜检查诊断围绝经期子宫异常出血的临床应用价值。方法收集患者180例,以病理检查结果作为＂金标准＂,比较阴道超声和宫腔镜检查的灵敏度及阳性预测的价值。结果在子宫内膜过度增生、子宫内膜癌、未见明显占位性病变（正常子宫内膜、子宫内膜炎、萎缩性子宫内膜）的诊断中,阴道超声检查的灵敏度分别为77.3%、57.1%、82.2%,宫腔镜检查的灵敏度分别为97.7%、92.9%、95.6%,两组之间的差异有统计学意义（P〈0.05）。在子宫内膜息肉、子宫内膜过度增生的诊断中,阴道超声检查的阳性预测价值为79.7%和75.6%,宫腔镜检查的阳性预测价值为96.2%和93.5%,两组之间的差异有统计学意义（P〈0.05）。结论阴道超声可以作为围绝经期妇女临床筛检的常规方法 ,宫腔镜检查可以作为在阴道超声发现宫腔异常情况或不能明确时进一步检查的重要手段。     

The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan

BACKGROUND Septate uterus seems to be strongly associated with an adverse pregnancy outcome. However, the possible relationship between septate uterus and miscarriage has only been retrospectively ascertained. The aim of our study was to describe the reproductive outcome in women with incidental diagnosis of malformed uterus at first trimester scan. METHODS Women at their first pregnancy attending our centre for a routine viability scan with an incidental suspicion of uterine anomaly at standard sonography were submitted to transvaginal volume ultrasound. All the cases with a 3D diagnosis of septate uterus were prospectively recruited and followed up. RESULTS Overall 24 patients with a single intrauterine pregnancy were included at a median gestational age of 8.2 weeks. The cumulative pregnancy progression rate, as quoted by Kaplan-Meier algorithm, was 33.3% due to the occurrence of early (≤13 weeks) or late miscarriages (14-22 weeks) in 13 and 3 cases, respectively. CONCLUSION The pregnancy outcome is poor if a septate uterus is incidentally diagnosed in the early stage of a viable intrauterine pregnancy.     

822例不孕症宫腔镜诊治的临床意义

目的探讨宫腔镜手术在不孕症患者诊治中的应用价值。方法回顾性分析应用宫腔镜诊治不孕症822例的临床资料。结果 822例不孕症患者行宫腔镜检查,宫腔及输卵管近端异常检出率为83.5%(686/822)。其中:宫腔大致正常者136例(16.6%);子宫内膜病变45l例(54.9%);宫腔粘连125例(15.2%);输卵管近端阻塞69例(8.4%);子宫畸形34例(4.1%);子宫粘膜下肌瘤5例(0.6%);宫内异物2例(0.2%)。822例不孕患者经宫腔镜治疗后随访,有204例正常宫内妊娠,术后妊娠率为24.8%(204/822)。其中:宫腔大致正常者25/136(18.4%,);子宫内膜病变103/451(22.8%,);宫腔粘连39/125(31.2%,);输卵管近端阻塞20/69(29%,);子宫畸形15/34(44.1%,);子宫粘膜下肌瘤2/5(40.0%,);宫内异物0/2(0%,)。结论宫腔镜诊治不孕症准确、有效、简单、微创、并发症少,是目前诊治女性不孕症最有效的手段之一,值得临床应用、推广。     

Cost considerations with infertility therapy: outcome and cost comparison between health maintenance organization and preferred provider organization care based on physician and facility cost

Of 98 retrospectively selected patient couples insured under one scheme (group I) who, based on performance of a hysterosalpingogram (HSG), were assumed to be under active infertility care, 96 were confirmed as infertile. These were matched by date, patient age and time of HSG to 96 patients under infertility care (group II). Both patient populations were then prospectively evaluated for outcome and cost of treatment. Total physician charges for groups I and II were similar. However, charges per achieved clinical pregnancy were higher in group I than group II since group I patients demonstrated a lower pregnancy rate (28/96, 29%) than group II patients (41/96, 43%) (P=0.05). Within group I, pregnancy rates were identical, whether treatment was provided by generalists or subspecialists. In group II, all care was provided by specialists. The number of days of treatment did not vary between groups I and H, though generalists in group I provided significantly fewer treatment days than specialists in either group I (P=0.003) or in group II (P=0.021). This was primarily due to a significantly higher patient drop-out rate in group I patients, and especially amongst those who received care from generalists (P < 0.0019). Group I patients also encountered significantly more surgical procedures than group H patients (P=0.0016). If physician charges are discounted and customary surgical facility costs are added, the actual cost structure for fertility care in group I patients was dramatically higher than in group II patients. The most cost-effective format to provide infertility care of high quality appears to be a managed care setting in which subspecialists provide a majority of care and in which patient choice is restricted to those subspecialists.      

经阴道彩色多普勒超声诊断子宫肌瘤、腺肌症及腺肌瘤的临床价值

目的探讨经阴道彩色多普勒超声诊断子宫肌瘤、腺肌症与腺肌瘤的准确率。方法选取陆军军医大学第一附属医院2017年5月至2019年3月经手术病理诊断为子宫肌瘤(53例)、腺肌症(46例)及腺肌瘤(21例)的120例妇科疾病患者,同时采用经腹部和经阴道彩色多普勒超声检查,比较两种检测方式的准确率。结果经阴道彩色多普勒超声检查子宫肌瘤、子宫腺肌症、子宫腺肌瘤的准确率分别为96.23%、93.48%、85.71%,经腹部彩色多普勒超声检查子宫肌瘤、子宫腺肌症、子宫腺肌瘤的准确率分别为83.02%、78.26%、57.14%,2组比较差异具有统计学意义(P<0.05)。经阴道彩色多普勒超声检查能够有效分辨出子宫肌瘤、腺肌症与腺肌瘤病灶内部与周边的血流状况。结论与腹部彩色多普勒超声检查比较,经阴道超声检查可以清楚地看到子宫的组织结构,检测病灶内部和周边的血流动力学特点,对子宫肌瘤、腺肌症以及腺肌瘤的诊断准确率更高。     

Saline infusion contrast intrauterine sonographic assessment of the endometrium with high-frequency, real-time miniature transducer in normal menstrual cycle: a preliminary report.

Normal endometrial texture was visualized using saline infusion contrast intrauterine sonography with a specially developed 20 MHz flexible catheter-based high-resolution, real-time miniature (2.4 mm outer diameter) ultrasound transducer in primary infertile women (n = 15) with a normal menstrual cycle. All the women had <2 years infertility duration and were studied in proliferative, and early or mid-secretory phases. Before intrauterine sonography, transvaginal sonographic assessment of the endometrium was conducted. The overall image clarity was subjectively compared between intrauterine and transvaginal sonography. Most endometrial textures in both proliferative and secretory phases were viewed more easily with intrauterine rather than transvaginal sonography, and this was especially true with an intrauterine saline infusion technique. Moreover, it was possible to obtain finer image quality of very small endometrial interfacial and internal textures with intrauterine sonography. However, the depth of penetration of the ultrasound beam is only approximately 2 cm, therefore examination of larger pathological endometrial lesions is markedly limited because of the shallow scanning range of the high-frequency transducer. Intrauterine sonography may be a valuable tool in imaging endometrial texture in normal menstrual cycle, and possibly in infertility practice, complementing and not replacing transvaginal sonography.     

超声监测联合宫腔镜诊断不孕患者子宫内膜异常的价值

目的探讨阴道超声和宫腔镜检查对不孕患者子宫内膜病变的诊断价值。方法对在我中心不孕门诊进行阴道超声、宫腔镜检查的152例患者分为两组进行对照分析。自然周期超声监测内膜回声异常的105例为研究组,超声监测内膜正常的47例为对照组。结果研究组宫腔镜检查确诊内膜病变为84例（80.00%）,对照组为4例（8.51%）,两组比较差异有非常显著性意义（P〈0.001）。研究组中,子宫内膜息肉占30.48%（32/105）,内膜增殖36.19%（38/105）,粘膜下肌瘤0.95%（1/105）,输卵管阻塞8.57%（9/105）,内膜炎症3.81%（4/105）;对照组异常内膜为内膜粘连4.25%（2/47）,内膜炎症4.25%（2/47）。以宫腔镜结果为金标准,经阴道超声监测对子宫内膜病变诊断的敏感度95.45%（84/88）,特异度67.19%（43/64）。研究组确诊内膜异常者84例,妊娠率46.43%（39/84）,对照组确诊为内膜正常者43例,妊娠率74.41%（32/43）,两组比较差异有显著意义（P〈0.05）。结论阴道超声是诊断不孕症患者宫腔内病变的一种简便、廉价、无创伤、诊断率高的方法,可以作为不孕患者宫腔镜检查的初筛,而宫腔镜检查则为内膜病变提供准确的诊断。     

超声检测宫颈长度预测双胎早产的价值

目的研究超声检测宫颈长度（CL）对双胎先兆早产孕妇发生早产的预测价值。方法对215例双胎先兆早产初产孕妇,分别经腹部、经阴道、经会阴超声检测CL,以CL〈2.6cm为宫颈缩短,追踪妊娠结局,比较三种方法对早产的预测价值。结果经腹部超声检测CL74例,CL〈2.6cm 38例,早产率68.42%,CL≥2.6cm 36例,早产率52.78%。经阴道超声检测CL 69例,CL〈2.6cm 36例,早产率88.89%,CL≥2.6 cm 33例,早产率33.33%。经会阴超声检测CL 72例,CL〈2.6cm 37例,早产率89.19%;CL≥2.6 cm 35例,早产率34.29%。经腹部、经阴道、经会阴超声测量CL〈2.6cm组早产率均显著高于CL≥2.6cm组的早产率。经腹部、经阴道、经会阴超声测量预测双胎早产的敏感性分别为57.78%、74.42%、73.33%。三组比较,经会阴、经阴道超声测量预测双胎早产的敏感性显著高于经腹部（P〈0.05）。结论超声检测CL对双胎先兆早产孕妇发生早产有一定的预测意义。经会阴、经阴道超声预测双胎早产敏感性优于经腹部超声。经会阴超声检测可以替代经阴道超声检测,从而提高病人依从性。