卵巢黄体破裂的CT诊断

目的探讨卵巢黄体破裂的CT表现及诊断价值。方法回顾性分析经手术病理证实的11例卵巢黄体破裂患者的临床及CT资料。结果患者均在月经周期后半期发病,其中右侧卵巢9例、左侧卵巢2例。CT表现为附件区有直径3.2～5.6 cm囊样病变(平均4.2 cm),2例圆形、9例椭圆形;2例囊液密度均匀如水(平扫CT值10～15 HU)、9例囊内密度不均匀(平扫CT值17～53 HU);可见局部囊壁连续性中断,病变周围和盆腔见密度较高的腹腔积液(CT值30～65 HU)。结论 CT可显示卵巢黄体破裂的特征,结合临床能及时作出诊断。     

Ovulation and corpus luteum formation observed by ultrasonography

Ultrasonic observation of the ovary at 8–12 hr intervals reveals typical appearances when ovulation has take place. Shortly after ovulation there is an increase in solid echoes as the cystic follicle decreases in size until a small, less intense echogenic area (“cystic or structural loosening”) stays visible within the ovary. This either stays unchanged during the luteal phase or increases up to a cystic corpus luteum. Premensturally, the ovary regains its more homogenous solid structure. When cystic alteration has taken place, solid echoes invade the cystic corpus luteum which continuously decreases in size once menstruation has started. A cystic structure, similar to a cystic corpus luteum, in the second part of the menstrual cycle possibly signifies luteinisation of the unruptured follicle when no collapse of the follicle is observed before. After multifollicular development, the collapse of the predominant follicle may be difficult to outline when, simultaneous to ovulation, other follicles enlarge as in patients treated with gonadotrophins.     

彩超在黄体破裂中的诊断价值

目的评价彩色多普勒超声对黄体破裂的诊断价值.方法分析32例彩超诊断黄体破裂的声像图特点及临床特点.结果 26例经手术证实为黄体破裂.陈旧性宫外孕2例,宫外孕2例,卵巢浆液性囊腺瘤破裂2例.结论彩色多普勒对黄体破裂诊断符合率81%,有着十分重要的作用.     

MRI诊断卵巢黄体囊肿破裂

目的 探讨卵巢黄体囊肿破裂（OCLCR）的MRI表现。方法 回顾性分析经手术病理证实的28例OCLCR的临床、MR影像资料。结果 28例附件区可见单囊、多囊或多房囊性包块,长径3.0～12.0 cm。根据肿块形态不同在MRI上分为3型：Ⅰ型为单囊型,17例,根据单囊与血肿位置不同又分为2种亚型,Ⅰa型（囊内血块型）8例,Ⅰb型（囊肿旁血肿型）9例;Ⅱ型为多囊型,5例;Ⅲ型为多房型,6例。增强扫描25例,囊壁及分隔厚约2.5～5.0 mm,呈环形、分隔状明显强化,20例囊壁见破裂口表现环形强化连续性中断、塌陷或缺损。与手术病理结果对照,MRI对OCLCR破裂口的诊断敏感度为90.91%（20/22）、特异度为100% （6/6）,准确率为92.86%（26/28）。MRI与手术病理诊断的一致性高（Kappa=0.81,P<0.001）。结论 OCLCR MRI表现附件区单囊、多囊或多房厚壁囊肿,MRI能准确识别囊壁破裂口,与手术病理具有高度一致性。     

Various sonographic appearances of the hemorrhagic corpus luteum cyst

Although hemorrhagic corpus luteum cysts are frequently seen during sonography of the female pelvis, their diagnosis is often challenging as a result of variations in size, thickness of the cyst wall, and internal echo pattern depending on the formation and lysis of the clot. There are cases in which hemoperitoneum is the most obvious finding. The differential diagnosis is extensive and includes ectopic pregnancy, adnexal torsion, neoplasm, and pelvic inflammatory disease. This review describes and illustrates the diverse appearances of the hemorrhagic corpus luteum, as well as other etiologies of adnexal pathology that can mimic the appearance of a hemorrhagic corpus luteum sonographically.     

中西医结合治疗卵巢黄体破裂66例

目的 探讨卵巢黄体破裂的诊断与处理.方法 对66例卵巢黄体破裂患者的临床症状、体征、诊断及治疗进行回顾性分析.结果 66例患者中保守治疗成功共59例,占89.39%;手术6例,占9.09%;放弃治疗出院1例,占1.51%.结论 卵巢黄体破裂,尤其内出血较多的患者,传统的治疗方法多采用手术治疗,为减轻患者痛苦,对其早期进行干预治疗,保守治疗成功的几率仍较大.     

中西医结合治疗卵巢黄体破裂66例

目的探讨卵巢黄体破裂的诊断与处理。方法对66例卵巢黄体破裂患者的临床症状、体征、诊断及治疗进行回顾性分析。结果66例患者中保守治疗成功共59例,占89．39％;手术6例,占9．09％;放弃治疗出院1例,占1．51％。结论卵巢黄体破裂,尤其内出血较多的患者,传统的治疗方法多采用手术治疗,为减轻患者痛苦,对其早期进行干预治疗,保守治疗成功的几率仍较大。     

黄体囊肿出血的超声图像分析

目的探讨黄体出血(HCLC)的声像图特点,提高超声诊断率.方法结合病理生理和临床特点,回顾性分析经手术病理确诊的43例(45个病灶)HCLC患者的声像图特征.结果HCLC的超声图像可分为囊实性、实性和囊性3种类型.结论了解HCLC的病理生理特点,有助于其各型超声图像的识别,短期动态超声检测是提高超声诊断率的关键措施之一.     

Macrophages regulate corpus luteum development during embryo implantation in mice

Macrophages are prominent in the uterus and ovary at conception. Here we utilize the Cd11b-Dtr mouse model of acute macrophage depletion to define the essential role of macrophages in early pregnancy. Macrophage depletion after conception caused embryo implantation arrest associated with diminished plasma progesterone and poor uterine receptivity. Implantation failure was alleviated by administration of bone marrow–derived CD11b⁺F4/80⁺ monocytes/macrophages. In the ovaries of macrophage-depleted mice, corpora lutea were profoundly abnormal, with elevated Ptgs2, Hif1a, and other inflammation and apoptosis genes and with diminished expression of steroidogenesis genes Star, Cyp11a1, and Hsd3b1. Infertility was rescued by exogenous progesterone, which confirmed that uterine refractoriness was fully attributable to the underlying luteal defect. In normally developing corpora lutea, macrophages were intimately juxtaposed with endothelial cells and expressed the proangiogenic marker TIE2. After macrophage depletion, substantial disruption of the luteal microvascular network occurred and was associated with altered ovarian expression of genes that encode vascular endothelial growth factors. These data indicate a critical role for macrophages in supporting the extensive vascular network required for corpus luteum integrity and production of progesterone essential for establishing pregnancy. Our findings raise the prospect that disruption of macrophage-endothelial cell interactions underpinning corpus luteum development contributes to infertility in women in whom luteal insufficiency is implicated.     

B超动态监测黄体破裂的临床价值

目的探讨B超检查在对卵巢黄体破裂诊断及治疗方法选择中的临床价值。方法回顾性分析68例经临床手术和病理证实的黄体破裂的超声表现及腹腔积液量的动态变化。结果本组经手术治疗的黄体破裂患者术前超声诊断50例,误诊18例,诊断符合率73．5％。超声声像图表现二种类型：（1）单纯囊性包块14例;（2）囊实性包块36例。B超监测腹腔积液量分：大量（500ml以上）、中等量（100ml-500ml）、少量（100ml以下）三类：结论黄体破裂声像图颇具特征,B超是诊断卵巢黄体破裂和监测腹腔积液量的一个简便可靠的方法,可为临床诊断和选择治疗方案提供依据。     

Imaging of the ovine corpus luteum microcirculation with contrast ultrasound

Ultrasound contrast agents have been the subject of microvascular imaging research. The sheep corpus luteum (CL) is a microvascular tissue that provides a natural angiogenic and antiangiogenic process, which changes during the luteal phase of the estrous cycle of the ewe. It can also be controlled and monitored endocrinologically, providing a very attractive in vivo model for the study and development of microvascular measurement. The perfusion of the fully developed CL between days 8 and 12 of the estrous cycle was studied in six ewes. A Philips iU22 ultrasound scanner (Bothell, WA, USA) with the linear array probe L9-3 was used to capture contrast-enhanced images after an intravenous bolus injection of 2.4 mL SonoVue (Bracco S.P.A., Milan, Italy). Time-intensity curves of a region of interest inside the CL were formed from linearized image data. A lagged-normal model to simulate the compartmental kinetics of the microvascular flow was used to fit the data, and the wash-in time was measured. Good contrast enhancement was observed in the CLs of all animals and the wash-in time averaged at 5.5 s with 9% uncertainty. The regression coefficient was highly significant for all fits. These data correlated with stained endothelial area in the histology performed postmortem. Two ewes were injected with prostaglandin F2alpha to induce CL regression, which resulted in an increase of wash-in time after a few hours. The CL of the ewe is thus proposed as an ideal model for the study and development of microvascular measurements using contrast ultrasound. Our initial results demonstrate a highly reproducible model for the study of the microvascular hemodynamics in a range of tissues and organs. (E-mail: Vassilis.Sboros@ed.ac.uk)     

超声诊断双侧黄体破裂1例

患者女,37岁。2006年7月11日，自感腹痛，未行特殊处理。体息后无明显好转。晨6：00点起床后出现晕厥1次，持续约2min，醒后如常。7：50再次出现晕厥1次，伴头晕、乏力、恶心。晕厥时致左前臂外伤．来我院就诊。