彩色多普勒超声诊断卵巢囊肿蒂扭转的临床价值

目的探究彩色多普勒超声(CDFI)诊断卵巢囊肿蒂扭转的临床价值,以期为临床治疗提供参考依据。方法以2017年2月至2020年2月46例收治的疑似卵巢囊肿蒂扭转患者作为研究对象,患者均接受CDFI以及病理检查,并对检查结果进行分析。结果46例疑似卵巢囊肿蒂扭转患者的麻花状绳状、血管蒂类型检出率为47.83%,盆腔游离液性暗区检出率为52.17%,囊肿直径≤8 cm的检出率为78.26%,囊壁厚度>0.85 cm检出率为50.00%,囊性肿块检出率为80.43%。疑似卵巢囊肿蒂扭转患者经CDFI检查的卵巢黏液性腺囊瘤、卵巢浆液囊腺瘤、卵巢囊性畸胎瘤、卵巢黄体囊肿、卵巢巧克力囊肿、单纯卵巢囊肿检出率与病理诊断结果比较,差异无统计学意义(P>0.05)。CDFI诊断卵巢囊肿蒂扭转的灵敏度为90.91%,特异度为100.00%,准确度为91.30%。结论CDFI应用在卵巢囊肿蒂扭转患者的诊断中,有着较高的灵敏度、特异度、准确度,可较好地检出疾病,且可鉴别诊断疾病的具体类型,为患者疾病的确诊以及治疗方案的制定提供参考依据。     

超声诊断在子宫附件囊性占位方面的临床价值

目的分析超声诊断在子宫附件囊性占位方面的临床价值。方法将2011年1月至2014年1月就诊的经超声诊断提示为子宫附件囊性占位的患者341例,通过病理检验、临床穿刺检验、超声随访、临床治疗检测等方法进行确诊,比较超声诊断的符合率。结果经手术病理确诊205例中,45例子宫内膜异位囊肿患者超声诊断39例,30例囊腺瘤经超声诊断25例,12例输卵管异位妊娠未破裂型患者经超声诊断12例,50例输卵管积液患者经超声诊断45例,20例附件炎症包块经超声诊断16例,8例囊腺癌患者经超声诊断7例,40例畸胎瘤患者经超声诊断37例,超声诊断与病理检测符合率为88.3%。18例患者经超声诊断为包裹性积液,经临床穿刺生化检验后,16例确诊为包裹性积液,超声诊断与临床穿刺检验符合率为88.9%。110例患者诊断为卵巢非赘生性囊肿,8例患者连续观察10个月经周期后,囊性占位大小无明显变化,超声诊断符合率为92.7%。8例经超声诊断为输卵管积液,1例输液后无明显变化,超声诊断的符合率为87.5%。结论超声检查对子宫附件囊性占位的诊断和指导治疗有很高的价值,值得进一步研究和推广。     

超声诊断输卵管系膜囊肿并输卵管扭转1例

患者女,20岁.已婚.下腹痛1 d入院,外院B超示:左附件区囊性包块.妇产科检查:左附件增厚.拟诊:左卵巢囊肿.超声检查示:子宫及右侧附件区未见明显异常回声,左附件区见一大小约6.6 cm×4.0cm的无回声区,边界清,壁薄(图1、2),与左卵巢关系紧密,但按压可见两者呈逆向运动,并且按压囊肿边缘时患者疼痛加剧.CDFI:左卵巢内部血流正常,囊肿壁未见明显彩色血流信号.盆腔可见厚约2.0cm的液性暗区.超声诊断:(1)左附件区囊性包块(考虑来源输卵管);合并蒂扭转不能排除;(2)盆腔积液.术中见左输卵管近伞端区系膜上可见1个约7 cm的囊肿并输卵管扭转3圈.术后诊断:左输卵管系膜囊肿并左输卵管扭转.     

介入性超声对盆腔囊性包块诊治的价值

目的 探讨介入性超声对盆腔囊性包块诊治的价值。方法 在超声引导下通过阴道或腹壁穿刺盆腔囊肿,抽出囊液注入药物。结果 对68例盆腔囊性包块进行介入性超声诊疗后,诊断附件非赘生性包块63例,介入治疗后囊肿消失44例,缩小12例,复发7例,其中1例输卵管妊娠穿刺失败改开腹手术,总有效率90.3％。诊断卵巢恶性肿瘤2例,卵巢囊腺瘤3例,均行开腹手术。结论 介入性超声对诊治附件非赘生性肿瘤具有很好的应用价值。     

婴儿卵巢囊性包块30例彩超诊断分析及临床价值

目的 观察婴儿卵巢囊性包块彩超声像图特点。方法 回顾性分析我院2013年1月至2016年10月收治的30例婴儿卵巢囊性包块的彩超典型特点,将彩超声像图与手术、病理结果进行对照分析。结果 卵巢囊肿伴蒂扭转、坏死12例,单纯囊肿、滤泡囊肿分别8例,1例黄体囊肿,1例成熟性囊性畸胎瘤。2例术前彩超误诊为囊性畸胎瘤,1例误诊为肠重复畸形,1例误诊为胎粪性腹膜炎。超声总诊断符合率为86.6%。结论 婴儿卵巢囊性占位疾病的表现部分具有独特性,尤其卵巢囊肿伴蒂扭转坏死罕见的彩超表现值得总结、分析、分享。彩超诊断符合率较高,同时应注意相关疾病的鉴别。     

超声造影对卵巢囊实混合性包块的诊断价值

目的 :探讨超声造影在卵巢囊实混合性包块鉴别诊断中的应用价值。方法 :对60例卵巢囊实混合性包块进行超声造影检查,所有病灶均经病理或增强MRI证实。结果:60例中恶性9例,良性51例。彩色多普勒鉴别包块囊实性敏感度79%,特异度82%,超声造影鉴别包块囊实性敏感度100%,特异度100%,两组间差异有统计学意义(P<0.05)。结论:超声造影可以有效鉴别包块内实性成分,对卵巢囊实混合性包块鉴别诊断具有应用价值。     

腹部及经阴道超声联合检查在卵巢囊肿蒂扭转患者诊断中的应用探讨

目的:对卵巢囊肿蒂扭转患者采用腹部和经阴道超声联合检查的效果。方法:于本院疑似卵巢囊肿蒂扭转患者中随机抽取81例,均进行腹部超声联合经阴道超声检查,由3位资深影像科医师评估检查结果,卵巢囊肿蒂扭转判定为阳性,其余症状为阴性,对比腹部、阴道以及联合检查的准确度。结果:对比病理检查结果,腹部超声阳性检出率32例(71.1%),经阴道超声阳性检出率36例(80.0%),联合超声阳性检出率44例(97.8%)。与单独检查对比,差异显著(P0.05)。联合超声阴性检出率34例(94.4%),三组无统计学意义(P0.05)。腹部超声组灵敏度(71.1%),准确度(75.3%)。经阴道超声组灵敏度(80.0%),准确度(87.7%)。联合超声组灵敏度(97.8%),准确度(96.3%)。与单独检查对比,差异显著(P0.05)。三组特异度无统计学意义(P0.05)。结论:在卵巢囊肿蒂扭转诊断中,联合使用腹部超声和经阴道超声可显著提高灵敏度和准确度,辅助医生准确诊断,具有推广应用价值。     

女性卵巢肿瘤蒂扭转的超声诊断

目的探讨女性卵巢肿瘤蒂扭转的超声声像图特征及诊断价值。方法对9例经超声检查诊断为卵巢肿瘤蒂扭转的病例进行回顾性分析,并与手术病理检查对照。结果超声检查该组患者均显示盆腔探及异常包块,为囊性或混合性包块,张力较大,其中4例包块周围或盆腔探及积液回声。结论超声检查简便、无创,对女性卵巢肿瘤蒂扭转的及时诊断具有较高的价值。     

超声漩涡征诊断附件完全扭转及程度的价值

目的探讨超声漩涡征在附件完全扭转及扭转程度中的评估价值。方法纳入我院收治的急腹症患者190例,选取经手术证实为附件完全扭转的患者41例行回顾性分析,分析超声漩涡征诊断附件完全扭转的效果。结果经手术提示患者附件扭转类型分别为卵巢成熟性畸胎瘤11例,卵巢单纯囊肿11例,输卵管系膜囊肿7例,卵巢浆-黏液性囊腺瘤7例,卵巢过度刺激2例,输卵管积水1例,子宫内膜异位1例,卵巢及输卵管单纯扭转1例。经超声诊断提示,有37例确诊附件完全扭转,均可见"漩涡征",将手术结果作为最终判定标准,提示超声漩涡征诊断附件完全扭转的灵敏度为90.24%(37/41),有4例(9.76%)漏诊。其中21例动静脉血流消失,10例仅存在动脉血流,6例动静脉血流均存在。结论超声是诊断附件完全扭转的首选方法,"漩涡征"是特异度征象,彩色多普勒超声可判断扭转程度及附件存活概率。     

妇科急腹症122例临床分析

目的了解妇科常见急腹症的临床特征以减少误诊。方法对2007-12-2009-12武汉市第七医院妇产科收治的122例腹痛患者进行分析。结果盆腔炎48例(39.34%)有多次流产史或生育史伴发热白带异常,B超示盆腔积液附件囊性包块,异位妊娠56例(45.90%)有停经史阴道不规则流血尿HCG阳性,B超示盆腔积液附件混合性包块甚至胎心搏动,黄体破裂7例(5.74%)发生在月经中后期B超示盆腔积液附件包块,卵巢囊肿蒂扭转5例(4.10%)有附件包块病史B超示附件包块回声不均,子宫穿孔2例(1.64%)均有宫腔操作史,浆膜下肌瘤蒂扭转2例(1.64%)B超示盆腔包块,急性阑尾炎2例(1.64%)有转移性右下腹痛病史麦氏点压痛反跳痛伴血象高。结论诊断时应重视病史的采集,尤其是月经史是否有不洁性生活史或宫腔手术史,注重临床体征,影像学检查是一种重要的辅助诊断方法。     

儿童肠系膜囊肿及继发病变超声表现

目的总结儿童肠系膜囊肿及继发病变超声表现,评价超声诊断儿童肠系膜囊肿及继发病变的价值。方法对2005年1月至2010年12月我院收治的经手术及病理证实的41例肠系膜囊肿患儿超声表现和手术所见进行对比分析。结果本组41例肠系膜囊肿患儿共42个病灶,其中单发40例,多发1例。42个肠系膜囊肿病灶中,超声呈单房囊性(4个)或多房囊性(37个)包块;肠系膜囊肿超声声像图表现为形态规则的单房囊性团块或边缘不规则、囊腔大小不一、形态不一的多房囊性团块,囊内回声因成分不同而不同。本组8例肠系膜囊肿患儿继发出血,超声检查示出血囊腔张力增高、透声减低;6例患儿肠系膜囊肿及肠扭转并肠梗阻,超声检查可见肠管积液扩张及扭转肠系膜的"集束征"或"漩涡征";4例患儿继发感染,超声检查示囊肿壁增厚、周围见低回声索条。本组41例肠系膜囊肿患儿42个病灶术前超声诊断正确39个,超声诊断符合率92.9%(39/42),术前超声误诊3个,分别误诊为大网膜囊肿1个、肠重复畸形1个、肠系膜淋巴血管瘤1个;本组肠系膜囊肿合并症诊断符合率为66.7%(12/18),术前超声漏诊6例,分别为出血3例、肠梗阻1例、感染2例。结论超声检查对儿童肠系膜囊肿可作出定性诊断,对其并发症诊断也有很高的价值。超声检查应作为儿童肠系膜囊肿首选影像学检查方法 。     

Diagnosis of adnexal torsion in the third trimester of pregnancy: a case report

The diagnosis of adnexal torsion is difficult to establish on the basis of symptoms, physical findings, or radiologic techniques. If possible, in pregnancy the diagnostic workup should avoid any risk of drug administration, and the indication for a surgical intervention needs to be severe. Between 10% and 20% of ovarian torsions are associated with pregnancy, but adnexal torsion in the third trimester is rare. We present the case of a 22-year-old female presenting with a sudden onset of severe right lower quadrant abdominal pain associated with nausea and vomiting. The presumptive diagnosis was appendicitis. Transvaginal sonography showed some free fluid in the pouch of Douglas, but could not define the accurate diagnosis. In transabdominal ultrasound, a predominantly hyperechogenic mass containing small cysts was found in the right lower abdomen. No blood flow within the mass was detected with color and power Doppler sonography. With ultrasound, the anatomic relation of the mass could not be precisely identified. Magnetic resonance imaging clearly delineated the mass, which was due to enlargement of the right ovary, with predominately hyperintense signal containing small areas with hypointense lesions in T2-weighted images, a potential sign of hemorrhagic infarction. The mesovarium was hyperintense in T2-weighted images and also enlarged. The left ovary seemed to be normal. Due to the displacement of the ovaries in the second and third trimesters, the diagnostic workup is very largely restricted when using transvaginal ultrasound. Especially in pregnancy, it is mandatory to obtain a reliable diagnosis to reduce any risk to the fetus. Our case report indicates that the combination of magnetic resonance imaging and Doppler sonography fulfills these requirements and allows for accurate and fast diagnosis of adnexal torsion.     

Imaging of hydrosalpinx with torsion following tubal sterilization

Hydrosalpinx following tubal sterilization has been observed with increasing frequency. Women who have had PID or who have used IUDs might be at risk of developing this condition because they may already have occluded tubes from prior salpingitis. If a previously occluded tube is ligated or cauterized so that a second occlusion is created, hydrosalpinx may be anticipated. Often bilateral, hydrosalpinx may be present for years. Recurrent pelvic pain may signify intermittent noninfarctive torsion, but severe acute pain is a sign of torsion with impending infarction and gangrene in some patients. This condition has been detected by ultrasound and CT, enabling preoperative diagnosis. Presumably it will also be imaged by MR. Nontorsive hydrosalpinx is usually imaged as a thin-walled adnexal cyst. Torsion with infarction is seen as a larger cystic structure with thicker walls and internal debris from venous congestion and internal hemorrhage. Since 25 of 30 patients with post-tubal sterilization hydrosalpinx have presented with acute torsion, the significance of a nontorsive hydrosalpinx detected by any imaging modality should not be disregarded. Surgical removal or percutaneous puncture and drainage should be considered. Awareness of the patient's medical history is the key to diagnosis.     

评价血清CA125在附件包块中的鉴别诊断价值

目的评价血清CA125在附件包块中的鉴别诊断价值。方法对2006年1月至2008年12月中山大学附属第三医院妇科收治的375例附件包块进行回顾性分析。结果375例附件包块中,血清CA125〉35U／ml的有198例,其中卵巢恶性肿瘤92例,附件良性包块106例,分别占46．5％和53．5％,但卵巢恶性肿瘤的血清CA125值高于附件良性包块（P〈0．05）,而且CA125取值不断升高时,附件包块的患者中诊断为卵巢恶性肿瘤的比例就越来越高。当血清CA125〉65U／ml时,检出卵巢恶性肿瘤的敏感性、特异性和诊断准确性都较高,分别为84．5％、80．1％和81．3％。当血清CA125〉150U／ml时,提示晚期卵巢恶性肿瘤的敏感性、特异性和诊断准确性都较好,分别为84．4％、76．3％和78．4％。结论血清CA125取65U／ml是临床鉴别诊断附件良恶性肿瘤的较佳临界值;当血清CA125〉150U／ml时,提示晚期卵巢恶性肿瘤的意义较大。     

二维及彩色多普勒超声在颌面部囊肿中的诊断价值（附118例分析）

目的 探讨二维及彩色多普勒血流显像在领面部囊肿诊断上的实用价值。方法 收集应用二维超声及彩色多普勒血流显像诊断颌面部肿块118例。其中114例经手术及病理证实。结果 二维超声及彩色多普勒血流显像对颌面部囊肿诊断的敏感性、特异性及准确性分另97.96％、60.00％及91.53％。还分析误属诊的原因。结论 二维超声对颌面部囊肿的诊断有较大价值。彩色多普勒血流显像能提供更多的信息。二维超声与彩色多普勒血流显像的结合能提高颌面部囊肿的诊断准确率。     

超声在胎儿腹部囊性包块的产前诊断及预后评估的价值

目的回顾性分析胎儿腹部囊性包块,探讨超声在胎儿腹部囊性包块的产前诊断及预后评估的价值。方法对我院超声诊断胎儿腹部囊性包块病例190例进行总结、比较和讨论其超声特征,分析产后及引产后结果。结果在190例病例中,11~14周,巨膀胱占比93.3%,单纯腹部囊性包块、脾囊肿和卵巢囊肿占比均为2.2%;14~28周,在肠重复、单纯腹部囊性包块、胆总管囊肿和巨膀胱占比较大,分别为20.4%、11.1%、25.9%、29.6%;>28周,卵巢囊肿占比最大,为60.4%,其次为肠重复患者,为18.7%。结合产后情况分析,肠重复、单纯腹部囊性包块、肾上腺区囊性包块和卵巢囊肿产后消失的占比较高,而胆总管囊肿、肝囊肿、巨膀胱、胃重复产后消失占比低。结论产前超声检查能较准确判断胎儿腹部囊性包块的性质,对胎儿产前咨询评估及预后提供重要的临床指导意义。     

A case of uterine torsion concurrent with a ruptured ovarian endometrial cyst

The patient was a 54-year-old female presented with severe abdominal swelling and intermittent pain. On emergent CT, massive ascites with thickened peritoneum and intra-pelvic cystic mass approximately 20 cm in diameter were observed. The cyst wall showed redundant irregular shape. The uterus was enlarged with intramural mass located at its right anterior fundus. MRI showed this pelvic cyst as high intensity on T1-weighted images, so that it was suspected as an endometrial cyst. The operation revealed the rupture of endometrial cyst and the uterine torsion of 180° around the long axis. Retrospectively, the X-shaped configuration of the upper vagina was observed on MRI and both the adnexa, including right ovarian cyst, were connected to the opposite side ovarian vein. Torsion of a non-gravid uterus is rare. In this case, the uterine torsion seemed to be caused by enlarged uterine body and ruptured endometrial cyst. Radiologists should be aware of this potential complication of huge ovarian mass and enlarged uterus and its appearance.     

Value of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgery.

OBJECTIVES: To assess the value of preoperative ultrasound examination in predicting the feasibility of intermediate-level laparoscopic surgery for benign adnexal masses. METHODS: Symptomatic women with a clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy/oophorectomy. In all cases an attempt was made to establish a likely histological diagnosis using the pattern recognition method. The selection criteria for laparoscopic surgery were: no ultrasound features suggestive of ovarian cancer, predominantly cystic lesion with no solid foci > 5 cm in mean diameter, no evidence of severe pelvic endometriosis or severe pelvic adhesions and dermoid cyst < 10 cm in mean diameter. Laparoscopic surgery was classified as successful if the mass was removed completely without resorting to a laparotomy. RESULTS: One hundred and forty-three women were diagnosed with a total of 162 adnexal cysts. The final dataset consisted of 137 women (with 153 lesions), 113 (82.5%) of whom were selected for laparoscopy and 24 (17.5%) for laparotomy. On histological examination 152 (99.3%) cysts were benign and the remaining one (0.7%) was borderline. The operation was successfully completed laparoscopically in 107/113 (94.7%) cases. The preoperative ultrasound assessment predicted the successful outcome of laparoscopic surgery with a sensitivity of 98% (95% CI, 94-99%), specificity of 79% (95% CI, 60-90%), positive predictive value of 95% (95% CI, 89-98%), positive likelihood ratio of 4.58 (95% CI, 2.25-9.32) and negative likelihood ratio of 0.02 (95% CI, 0.01-0.09). CONCLUSIONS: A detailed preoperative transvaginal ultrasound examination is a helpful tool for assessing the feasibility of intermediate-level laparoscopic surgery in women with benign adnexal lesions.     

胎儿卵巢囊肿蒂扭转产前超声诊断及临床预后分析

目的 探讨产前超声诊断胎儿卵巢囊肿蒂扭转的临床价值。方法　回顾性分析超声诊断为胎儿卵巢囊肿蒂扭转7例胎儿期超声图像,随访新生儿出生后情况,分析胎儿卵巢囊肿蒂扭转超声特征及早期诊断意义。结果 7例中6例产后证实为卵巢囊肿蒂扭转,1例术后证实为阴道闭锁,为误诊病例,余6例囊肿分娩前均表现为复杂性囊肿,6例直径大于4cm,1例直径小于4cm,超声诊断胎儿卵巢囊肿蒂扭转的准确性为85.7%。结论 产前超声能够明确胎儿卵巢囊肿蒂扭转,具有重要的临床价值,复杂囊肿并囊肿直径大于4cm是产前超声诊断胎儿蒂扭转的关键指标。