三维与二维超声对睾丸体积测量准确性的对比研究

目的评价三维超声、二维超声对睾丸体积测量的准确性。方法对20位拟行去势手术的晚期前列腺癌患者共40枚睾丸,术前使用二维超声对睾丸的长、宽、高（前后径）进行测量,使用椭球体公式计算睾丸体积;然后再使用三维超声自动测量程序测出睾丸容积。睾丸切除术后应用排水法测量睾丸的实际体积,并以此作为标准,评价三维超声和二维超声测量睾丸体积与睾丸实际体积的相关性及两种方法测量结果的准确性。结果两种超声测量方法所测睾丸体积与实际体积均高度相关;但二维超声测量的值较睾丸实际体积偏小,P〈0．05,而三维超声容积探头所测体积与实际体积比较差异无统计学意义,P〉0．05。结论三维超声对睾丸体积测量的准确性优于二维超声,所测数值能更好地代表实际睾丸体积;使用椭球体公式所计算的睾丸体积小于实际体积。     

Serial fetal lung volume measurement using three-dimensional ultrasound.

OBJECTIVE: To establish reference intervals for fetal lung growth. DESIGN: Longitudinal observational study. SUBJECTS: Fifty-eight women with initially uncomplicated singleton pregnancies were recruited from the antenatal population of a teaching hospital. Four women were excluded from the final analysis because of complications arising in their pregnancy. METHODS: Each subject was serially scanned at monthly intervals. At each visit lung volume was measured using an ultrasound-based computerized three-dimensional imaging system. Multilevel models were used to determine conditional and unconditional reference intervals. RESULTS: Reference intervals for fetal lung growth were derived. Fetal lung volume increases in a non-linear way with gestation. CONCLUSIONS: Our computerized system has the capacity to be used in conjunction with any standard two-dimensional ultrasound scanner in order to measure volume. Lung volume measurement may be useful in predicting pulmonary hypoplasia.     

Assessment of postoperative postvoid residual bladder volume using three-dimensional ultrasound volumetry

The aim of our prospective study was to assess the concordance between postvoid residual volumes (PVR) of the urinary bladder obtained by two different three-dimensional (3-D) ultrasound (US) volumetric methods (VOCAL and XI VOCAL) and with measurement by the catheter in postoperative patients who have undergone radical hysterectomy. The 3-D sonographic volume-determination of PVR with both methods correlated significantly with the actual amount of PVR by the catheter. The accuracy of both 3-D US volumetric methods was significantly higher under 300 mL of PVR. Bland-Altman plots were generated to examine limits of agreement. Both noninvasive 3-D sonographic methods are appropriate for the correct volume-determination of PVR following radical hysterectomy. Thus, we may avoid routine, albeit often unnecessary, catheterization to measure postoperative residual bladder volumes and subsequently the incidence of lower urinary tract infection may be reduced and better postoperative comfort for patients may be permitted. (E-mail: szabolcs.bozsa@aok.pte.hu)     

Reliability and validity of tissue volume measurement by three-dimensional ultrasound: an experimental model.

OBJECTIVE: To determine the validity and the intra- and interobserver reliability of volume measurements of an endometrium-like model using a three-dimensional (3D) ultrasound rotational technique. METHODS: A 3D ultrasound dataset was obtained from a sample of bovine liver containing a portion of chicken chest muscle (CCM). The process was repeated seven times using pieces of CCM of different sizes, resulting in seven datasets. Each portion of CCM was then placed in a water-filled volume-scaled tube and the 'actual' volumes were calculated by water displacement. For each dataset, ten volumes were calculated by each of two observers using a (VOCAL) with a 15 degrees rotational step. Reliability was assessed by calculating intraclass correlation coefficients (ICC) and validity by examining the percentage difference from the actual volume using limits of agreement. RESULTS: The volume measurement of organic tissues using the 3D ultrasound rotational method was highly reliable (intraobserver ICC, 0.998 for Observer 1 and 0.997 for Observer 2; interobserver ICC, 0.997) and valid (the bias and 95% limits of agreement of the percentage difference from the actual volume was only 0.57 (-3.07 to 4.21) % for Observer 1 and - 0.17 (-4.34 to 4.0) % for Observer 2). CONCLUSIONS: The 3D sonographic measurement, using VOCAL with a 15 degrees rotational step, of small and irregular tissues is reliable and valid, suggesting that it is a useful technique for measurement of the endometrial volume and other volumes of similar size.     

肝硬化脾功能亢进行部分性脾栓塞术后并发症原因分析及对策

目的探讨肝硬化脾功能亢进患者行部分性脾栓塞术后并发症发生的原因及对策。方法对24例肝硬化脾功能亢进患者采用Seldinger技术行部分性脾栓塞术,术后予以严密观察及对症处理。结果 24例患者脾功能亢进均有不同程度的改善,未发生严重并发症。所有患者均于术后病情好转出院。结论重视术后并发症的观察及对症处理可以减少并发症的发生,提高栓塞术效果。     

部分脾动脉栓塞术后早期活动对病人的影响

[目的]探讨早期活动对部分脾动脉栓塞术后病人的影响。[方法]将接受部分脾动脉栓塞术的100例病人随机分为对照组和实验组,实验组采取术后早期活动,对照组实施常规护理,比较两组病人术后舒适度及并发症等。[结果]实验组病人术后腰酸背痛、排尿困难、失眠、烦躁等并发症比对照组明显减少,舒适度提高。[结论]早期活动可以减少部分脾动脉栓塞术后病人不良反应和并发症,提高舒适度。     

Effectiveness of the portable ultrasound bladder scanner in the measurement of residual urine volume after total mesorectal extirpation

The measurement of residual urine volume by bladder catheterization causes quite some suffering to the patient and sometimes causes urinary tract infections. To evaluate the postoperative measurement of residual urine volume with a portable ultrasound bladder scanner (Bladder Scan BVI 3000) and the cost-benefit analysis as compared with postoperative catheterization we carried out a study on 30 patients with primary rectal cancer. The data were then compared with actual urine volumes. This was a prospective study dealing with the economical benefit of ultrasound scanning over catheterization during the hospital stay. The ultrasound bladder scanner was found to be a reliable method of estimating residual urine volume since its data correlated with actual volumes with a coefficient of 0.9. The results satisfied both physicians and patients. Ultrasound scanning of the bladder to measure residual urine volume reduced the frequency of catheterization by 38% as compared with the patients on intermittent catheterization, with 17.4 catheters saved for each patient. In conclusion, the ultrasound bladder scanner could protect patients from the discomfort and urethral injury which might have been caused by bladder catheters, thus decreasing medical expenses. This technique will play an important role in determining whether to conduct invasive urethral catheterization for postoperative urinary disturbance in rectal cancer.     

实时三维超声测量膀胱容积的初步探讨

目的:评价实时三维超声技术测量膀胱容积的准确性与可行性,并探讨测量的最佳旋转角度。方法:使用实时三维超声采集10个模拟膀胱的橡胶水囊及33例正常成人的膀胱“锥形”三维数据库,应用其容积分析软件,用不同旋转角度:6°,9°,15°,30°测量水囊及膀胱容积;同时用二维计算公式测量水囊及膀胱容积,将三维及二维测值与实际值比较。结果:在水囊及成人膀胱容积测量,实时三维超声不同平面间角度与实际值均呈正相关(r2>0.90),两者无显著性差异(P>0.05);二维超声测值与实际值虽呈正相关(r2>0.85),但两者间有显著性差异(P<0.05)。各旋转角度之间相比较,水囊及膀胱容积测量时不同旋转角度之间无显著性差异(P>0.05);实时三维超声测量误差较二维超声明显为小(P<0.05)。结论:实时三维超声技术测量膀胱容积准确可靠,重复性高。临床应用实时三维超声测量膀胱容积时,选择平面间角度30°即可提供足够信息,为兼顾准确与简便的最佳选择。     

Assessment of normal fetal upper arm volume by three-dimensional ultrasound

Fetal upper arm volume (UAV) is closely related to fetal growth and nutrition status. In the past, 2-D ultrasound (US) has shown limitations in assessing fetal UAV. With the recent advancement of 3-D US, the limitation in assessing fetal UAV by 2-D US can be overcome. To establish a reference chart of fetal UAV for clinical use, a prospective and cross-sectional study using 3-D US was undertaken to assess the fetal UAV in normal pregnancy. In total, 206 singleton fetuses ranging between 20 and 40 weeks of gestation that fit the criteria of normal pregnancies were enrolled in this study. Our results showed that fetal UAV is highly correlated with the gestational age. Furthermore, using gestational age (GA) as the independent variable and UAV as the dependent variable, the best-fit regression equation was UAV (mL) = 43.546 - 4.530 x GA + 0.133 x GA(2) (r = 0.913, n = 206, p < 0.0001). For further clinical use, a chart of normal growth centiles of fetal UAV in utero was then calculated based on this equation. In conclusion, we believe our data of fetal UAV assessed by 3-D US can serve as a useful reference in evaluating fetal growth and nutrition status during gestation.     

Prenatal assessment of normal fetal humerus volume by three-dimensional ultrasound

Because fetal humerus dysplasia is associated with a variety of congenital syndromes, prenatal assessment of the fetal humerus growth is very important. The fetal humerus volume is one of the indexes in evaluating the humerus growth, but it has never been studied by 3-D ultrasound (US) in utero. To establish a normal reference chart of the fetal humerus volume for clinical use, we undertook a prospective and cross-sectional study using 3-D US to assess the fetal humerus volume in normal pregnancy. A total of 216 singleton fetuses that ranged between 20 and 40 weeks of gestation and fit the criteria of normal pregnancies were included in this study. Our results showed that the fetal humerus volume is highly correlated with the gestational age (GA). Using GA as the independent variable and the humerus volume as the dependent variable, the best-fit regression equation was humerus volume (mL) = 0.0044GA² − 0.0841GA + 0.6874 (r = 0.97, n = 216, p < 0.0001). For clinical use, a chart of normal growth centiles of the fetal humerus volume was then established based on this equation. In addition, the common indexes of fetal biometry, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight, were all highly correlated with the humerus volume (all p < 0.0001). In conclusion, our data of the fetal humerus volume assessed by 3-D US can serve as a useful reference in evaluating the fetal humerus growth during normal gestation. (E-mail: fchang@mail.ncku.edu.tw)     

The assessment of normal fetal liver volume by three-dimensional ultrasound

Liver volume (LIVV) is very important in determining the status of fetal growth. However, to measure human fetal LIVV in utero precisely and noninvasively is not an easy task. With the recent advancement of three-dimensional (3-D) ultrasound (US), the limitation in assessing fetal LIVV by 2-D US can be overcome. The purpose of this study was to establish a normal reference chart of fetal LIVV for clinical use. A prospective and cross-sectional study using 3-D US was undertaken to assess the fetal LIVV in normal pregnancy. In total, 226 singleton fetuses ranging between 20 and 40 weeks of gestation and fitting the criteria of normal pregnancies were enrolled in this study. Our results showed that fetal LIVV is highly correlated with the gestational age (GA). Furthermore, using GA as the independent variable and fetal LIVV as the dependent variable, the best-fit regression equation was LIVV (mL) = -398.26 + 46.199 xGA - 1.7567 x GA(2) + 0.0236 x GA(3) (r = 0.97, n = 226, p < 0.0001), with SD of LIVV (mL) = 1.2533 x (0.77956 + 0.17267 x GA). These common indexes of fetal biometry, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HCi), abdominal circumference (ACi), femur length (FL), and estimated fetal weight (EFW), were all highly correlated with fetal LIVV (all p < 0.0001). In conclusion, our data of fetal LIVV assessed by 3-D US can serve as a useful reference in evaluating fetal growth status during normal gestation.     

Distance and volume measurement using three-dimensional ultrasonography.

The purpose of this study was to assess the accuracy of distance and volume measurements obtained by three-dimensional ultrasonography. A tissue-mimicking phantom was scanned using a prototype three-dimensional sonographic imaging system to verify distance measurements. Measurements were taken from the reconstructed three-dimensional sonographic data and compared to the real distances. Volume measurements were obtained by scanning 30 balloons of various shapes, sized 23 ml to 2400 ml. Each balloon was scanned twice in two orientations; three different masks were accomplished for each volume. Each volume measurement of 180 three-dimensional sonographic measurements was compared to conventional two-dimensional ultrasonographic volume estimates and to the actual, measured balloon size. Distance measurements had a mean error of 0.02 +/- 3.65% (range, -4.27 to 7.18%). Two-dimensional sonographic volume estimates using traditional scanner based methods had a mean error of 13.7 +/- 10.1%. Three-dimensional sonographic volume measurements had a mean error of 2.2 +/- 2.9% for regular and irregular objects over the entire range of volumes. The masking required 10 to 30 min. The field of view varied from 10 to 24 cm with a mean object depth of 9.8 cm. Three-dimensional ultrasonographic methods can provide accurate volume measurements of regular and irregular objects and offer improved accuracy compared to traditional two-dimensional methods.     

内镜静脉套扎与部分性脾栓塞联合治疗肝硬化门脉高压

目的:探讨内镜静脉套扎(EVL)和部分性脾栓塞(PSE)联合治疗肝硬化门脉高压症的效果。材料和方法:13例肝硬化门脉高压症的患者行EVL与PSE联合治疗,记录EVL及PSE实施情况,比较治疗前后临床症状、肝脏功能、外周血细胞计数及脾脏大小的变化,观察术后不良反应及严重并发症。结果:EVL平均次数1.5次,除1例(首次联合术后9个月因脾亢复发行第二次PSE)外,所有患者均行1次PSE治疗。联合治疗后消化道出血、腹胀症状明显改善,腹水减少或消失,肝功能部分恢复,外周血血小板和白细胞计数明显升高(P<0.05),脾脏体积缩小。除1例患者术后消化道出血死亡,余无严重并发症出现。结论:EVL联合PSE方法简单、安全,对肝硬化所致的门脉高压症近期疗效确切。     

部分脾动脉栓塞术在脾功能亢进治疗中的应用及并发症的防治

目的：探讨部分性脾动脉栓塞术（PSE）在脾功能亢进治疗中的应用，并重点探讨脾动脉栓塞术后并发症的防治。方法：使用明胶海绵颗粒对53例脾功能亢进患者实施了PSE，应用配对t检验对治疗前后的数据进行了统计学分析。结果：本组53例患者于栓塞后2-3d，白细胞和血小板即开始回升，其中以白细胞回升最快，一般10．15d后恢复到正常范围。其中有3例患者出院时白细胞和血小板仍略低于正常范围，但较术前明显提高；有1例患者发生异位栓塞而紧急行外科手术：1例患者术后9月因脾亢复发而行第二次栓塞。未有脾脓肿等并发症发生。结论：PSE因其创伤小，恢复快，效果满意，且保留部分脾功能等优点，已成为脾功能亢进的首选治疗方法。但如何防范和处置并发症的发生，则是我们在工作中应特别注意的。     

彩色多普勒超声观测肝硬化门静脉高压症部分脾动脉栓塞术后肝脾血流动力学改变

目的　探讨彩色多普勒超声观测肝硬化门静脉高压症患者行部分脾动脉栓塞术的临床应用价值。方法　在28例肝炎后肝硬化门静脉高压症患者,于部分脾动脉栓塞术前后对肝脾血流动力学变化做定量分析和对比研究。结果　与术前相比,手术后2周的门、脾静脉血流量参数降低(P<0.05),血管内径缩小(P<0.01)。术后半年,三条血管血流量参数和平均血流速度又进一步降低(P<0.01),门、脾静脉血流量参数的减少与脾动脉血流量参数的减少呈正相关关系(分别为r=0.89,P<0.01和r=0.96,P<0.01)。结论　部分脾动脉栓塞可减少门静脉血流量参数,术前彩色多普勒超声检查可为栓塞剂用量提供较准确的数据     

部分脾栓塞术后肝硬化患者的护理干预效果观察

目的 探讨护理干预对部分脾栓塞术后肝硬化患者的护理效果.方法 60例实施部分脾栓塞术后肝硬化患者分成对照组和实验组,对照组患者实施常规护理,实验组进行护理干预,手术后4周采用自我护理能力测定量表与慢性肝病问卷对两组患者进行自理能力和生命质量的问卷调查.结果 实验组患者自我护理能力和生存质量均高于对照组(P<0.05...     

三维超声检测胎儿甲状腺体积

胎儿甲状腺功能减低(简称甲减)或甲状腺功能亢进(简称甲亢)与甲状腺体积相关,并严重影响胎儿正常发育[1-3]。目前,三维超声体积自动测量系统(3DUS-VOCAL)可较准确地测量胎儿肺、肾脏、胸腺等器官体积[4]。本研究采用3DUS-VOCAL技术检测胎儿甲状腺体积,并与二维超声测量值和实际体积对比,探讨3DUS-VOCAL技术在检测胎儿甲状腺体积     

Assessment of fetal cerebellar volume using three-dimensional ultrasound

The purposes of this study were to assess the fetal cerebellar volume during normal gestation using three-dimensional (3-D) ultrasound (US) and to establish a normal chart of fetal cerebellar volume using Altman's model of statistics. In total, 231 healthy fetuses were studied for assessment of cerebellar volume using a 3-D US volume scanner. The fetuses to be studied were selected to give a cross-sectional series (i.e., each fetus was examined only once). Polynomial regression analysis was calculated to find the best-fit model using gestational age as the independent variable and cerebellar volume as the dependent variable. Altman's model was used to calculate the age-related reference centiles for the variance of cerebellar volume. In addition, common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight, were also measured for the correlation between cerebellar volume and these indices. Our results indicated that the fetal cerebellar volume was highly correlated with gestational age in normal pregnancies with the best-fit polynomial regression equation of a second-order (r = 0.91, p < 0.0001). In addition, fetal cerebellar volume in normal gestation is also highly correlated with common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight (all p < 0.0001). Following the Altman's model, a normal growth chart of fetal cerebellar volume was established for clinical reference. In conclusion, with 3-D US, the assessment of fetal cerebellar volume becomes feasible. We believe that fetal cerebellar volume assessed by 3-D US may be useful in detecting cerebellar hypoplasia and relevant syndromes prenatally.     

三维超声评价胎儿小脑体积

目的应用三维超声建立不同孕周胎儿小脑体积正常范围参考值。方法对16～40周正常单胎胎儿283例进行小脑三维超声容积扫查,采用VOCAL程序30°旋转法测定小脑体积,应用相关回归分析拟合小脑体积随孕周增长的回归模型。结果正常妊娠胎儿小脑体积三维超声测量值与孕周高度相关(r=0.924,P<0.0001)。小脑体积随孕周增长的最适方程为幂曲线方程(R2=0.975,F=10751.86,P<0.0001)。结论三维超声不同孕周胎儿小脑体积正常值的建立将为产前判断小脑发育不良及相关异常,准确推算孕周提供有价值的参考。     

Alterations of coagulation and fibrinolysis in patients with blunt splenic injury after splenic artery embolization

BackgroundThrombotic complications following splenectomy have been documented. However, there has been sparse literature regarding thrombotic complications following splenic artery embolization (SAE).The objective of this study was to determine changes in coagulation and fibrinolysis and assess the thrombotic risk after SAE in patients with blunt splenic injury (BSI).MethodsThis study included 38 BSI patients who were hemodynamically stable on admission. SAE was performed if the splenic injury was classed as grade III or greater and had no requirement of immediate surgery. Platelet (PLT), fibrinogen (FIB), D‐dimers (D‐D), fibrinogen/fibrin degradation products (FDP), antithrombin III (AT III), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), hemoglobin (Hb), and hematocrit (Hct) were measured before SAE procedures and then 1d, 3d, and 7d after SAE.ResultsThe technical success rate of SAE and the splenic salvage rate were 100%. There was no mortality. Compared with pre‐SAE values, the levels of PLT, FIB, D‐D, and FDP increased significantly at 3 days and 7 days after SAE (p < 0.05). However, AT III, PT, APTT, TT, Hb, and Hct showed no statistically significant difference at 1d, 3d, and 7d after SAE (p > 0.05).ConclusionAlterations in PLT and hemostatic parameters might contribute to the increased risk of thrombotic complications in BSI patients undergoing SAE. Thromboembolism following SAE should be considered and thrombotic prophylaxis should be recommended.