早期成人型卵巢颗粒细胞瘤复发相关因素分析北大核心CSCD

目的探讨国际妇产科联盟(FIGO)(2014版)Ⅰ期成人型卵巢颗粒细胞瘤复发的相关高危因素。方法回顾性分析首都医科大学附属北京朝阳医院及中国医学科学院北京协和医院1995年1月至2010年1月收治的FIGOⅠ期成人型卵巢颗粒细胞瘤。分析患者临床及病理相关因素与肿瘤复发的关系。结果研究共纳入18例FIGOⅠ期成人型卵巢颗粒细胞瘤患者,患者中位年龄为43岁(31~69岁)。初始治疗中7例行单纯肿瘤剥除/单侧附件切除术,8例行子宫双附件切除术,3例行卵巢肿瘤全面分期术。患者术后5年和10年总生存率分别为94.4%和83.3%。共6例患者复发,中位复发时间为76个月。肿瘤直径>10cm、术中瘤体破裂是患者近期复发(<5年)的高危因素。低分化、术中瘤体破裂、高核分裂象(≥4/10HPF)是患者远期复发(≥5年)的高危因素。结论早期成人型卵巢颗粒细胞瘤整体预后好,高核分裂象、术中瘤体破裂可能是早期卵巢颗粒细胞瘤复发的潜在高危因素。     

阴道超声诊断卵巢正常大小的原发性卵巢上皮性癌综合征的临床价值

目的探讨经阴道超声术前诊断卵巢正常大小的原发性卵巢上皮性癌综合征的应用价值.方法总结分析经阴道超声对32例卵巢正常大小的卵巢癌患者的诊断结果,观察其声像图特征,术后经病理组织学验证.结果经阴道超声检测卵巢正常大小的卵巢癌的准确率为91%.结论经阴道超声检查能较准确地早期诊断卵巢正常大小的原发性卵巢上皮癌综合征,可作为该病患者术前的首选影像学检查方法.以二维阴道超声为基础,结合彩色多普勒血流显像,可以提高对该病的诊断准确率.     

卵巢颗粒细胞瘤及卵泡膜细胞瘤53例临床分析

卵巢颗粒细胞瘤及卵泡膜细胞瘤５３例临床分析陈亚枫卵巢颗粒细胞瘤及卵泡膜细胞瘤属于卵巢性索间质肿瘤，亦称卵巢功能性肿瘤。常伴有不规则阴道出血及闭经。本研究对我院收治的５３例进行回顾性分析，现将结果报告如下。一、临床资料１．一般情况：我院自１９６４年１月...     

彩色多普勒超声诊断卵巢扭转的临床意义

目的:探讨彩色多普勒超声(CDFI)对卵巢扭转的诊断临床意义。方法:应用CDFI对经手术后病理证实的12例卵巢扭转的声像图进行综合分析。结果:3例为单纯性卵巢扭转,7例为卵巢肿物伴扭转,超声准确提示扭转10例。结论:彩色多普勒超声诊断卵巢扭转有十分重要的临床意义。     

卵巢颗粒细胞瘤伴发血睾酮升高、继发性闭经1例

卵巢颗粒细胞瘤(granulosa cell tumor,GCT)是最常见的卵巢性索间质肿瘤,占卵巢肿瘤的1%～2%,占卵巢恶性肿瘤的3%～5%.GCT诊断时大多处于临床早期,但却以晚期复发而闻名.GCT可分泌多种激素如:卵泡刺激素(FSH)、促黄体生成素(LH)、雌激素、抑制素(inhibin)、孕酮、雄激素、抗苗勒激素等.成人型GCT常表现为高雌激素体征,而以男性化体征为临床表现者罕见.目前,国外文献报道以雄激素增高进而出现男性化体征的成人型GCT例数较少.在此,我们报道1例以血睾酮增高和继发性闭经为首发表现的成人型GCT.     

经阴道彩色多普勒超声对宫外孕破裂与卵巢黄体破裂的鉴别诊断价值

目的 分析宫外孕破裂与卵巢黄体破裂的鉴别诊断中经阴道彩色多普勒超声的应用价值。方法 选取40例宫外孕破裂患者（设为宫外孕破裂组）与40例卵巢黄体破裂患者（设为卵巢黄体破裂组）,患者均接受经阴道彩色多普勒超声诊断,对比两组超声检查结果及影像学表现。结果 经阴道彩色多普勒超声检查宫外孕破裂、卵巢黄体破裂准确率分别为85.00%、87.50%,误诊率分别为15.00%、12.50%。两组患者血流信号形态、血流频谱及血流参数比较,差异具有统计学意义（P<0.05）。宫外孕破裂超声声像特征：未见宫内孕囊声像,附件区多为高回声,包块多呈不规则状且边界不清。对血流频谱进行分析,发现以高阻力型最多,信号以点状分布;妊娠囊结构分辨困难。卵巢黄体破裂超声声像：附件区可见囊实性包块,呈不规则状且边界不清。对血流信号进行分析,发现以环状、半环状为主,血流信号充盈且未见过多血流信号;血流频谱以低阻力型最多,超声信号以低回声为主,包块内部偶见强回声。结论 经阴道彩色多普勒超声诊断宫外孕破裂与卵巢黄体破裂的影像学表现差异明显,能够作为鉴别诊断的主要方法。     

20例成人型卵巢颗粒细胞瘤的临床病理特点与分析

目的 分析归纳成人型卵巢颗粒细胞瘤（AGCT）的临床病理特点,为疾病诊治提供参考。方法 回顾性分析20例经手术与病理证实为AGCT患者的临床病理资料,分析该病临床病理特点和治疗方案。结果 20例患者中,腹胀、腹痛7例,盆腔包块8例,阴道异常出血5例,雌激素升高者11例,疾病分期多为早期（Ⅰ期19例）,均行手术治疗,4例行术后化疗。术后回访无复发。结论 卵巢颗粒细胞瘤临床症状不明显,对于阴道异常出血、腹部包块、腹胀腹痛、雌激素水平升高者考虑AGCT的可能。诊断需参考影像学资料及病理组织学形态及免疫表型,注意与其他卵巢肿瘤的区别。以手术治疗为主,早期诊治复发率低,该疾病有远期复发特点,需长期随访。     

小儿急性阑尾炎的声像图分析

目的：探讨小儿急性阑尾炎的声像图特征及分型。方法：对106例经超声诊断为急性阑尾炎的患儿,分析阑尾炎声像图特征并进行分型,最后与手术及病理结果对照。结果：全部病例均经手术及病理证实。声像图中可显示阑尾内径均增粗〉6mm,黏膜毛糙、回声中断或缺失,106例中单纯性阑尾炎67例,占63%,化脓性阑尾炎16例,占15%,坏疽性阑尾炎21例,占20%,阑尾周围脓肿2例,占2%。结论：超声检查对小儿阑尾炎的诊断及其分型具有重要价值。     

经阴道彩色多普勒超声诊断异位妊娠的临床价值

目的 探讨经阴道彩色多普勒超声诊断异位妊娠的价值。方法 选取72例疑似异位妊娠患者为研究对象,术前均接受经阴道彩色多普勒超声与经腹部彩色多普勒超声检查,以手术病理结果为诊断标准,比较两种检查方式的诊断效能及异位妊娠典型声像图特征检出情况。结果 72例疑似异位妊娠患者经手术病理确诊61例,余下9例为其余腹部急症。经阴道彩色多普勒超声检查的诊断准确率、灵敏度、特异度、阳性预测值与阴性预测值为95.83%、96.72%、90.91%、98.33%、83.33%,高于经腹部彩色多普勒超声检查的73.61%、83.61%、18.18%、85.00%、16.67%(P<0.05)。经阴道彩色多普勒超声检查对混合型团块、疑似孕囊影、胚芽胎心、盆腔积液征象检出率分别为80.56%、61.11%、52.78%、88.89%,均明显高于经腹部彩色多普勒超声检查的58.33%、22.22%、30.56%、62.50%(P<0.05)。结论 经阴道彩色多普勒超声检查诊断异位妊娠的诊断效能较经腹部彩色多普勒超声检查更高,且异位妊娠典型声像图特征检出率更高,值得推广。     

卵巢囊性颗粒细胞瘤临床病理观察

目的探讨卵巢囊性颗粒细胞瘤的临床病理学特征、诊断以及相关的鉴别诊断。方法复习2例卵巢囊性颗粒细胞瘤临床资料,观察组织病理学表现、进行免疫组化染色,同时复习相关文献。结果2例女性分别为28岁和60岁,肿瘤为囊性,大小分别为12 cm×11.5 cm和6.5 cm×4 cm,囊内壁由单层和/或多层颗粒细胞构成,囊壁中可见实性片状排列的颗粒细胞。免疫组化标记inhibin,CD99,Vimentin阳性。结论卵巢囊性颗粒细胞瘤较少见,在囊内壁中的成片颗粒细胞中找到Call-exner小体或微滤泡结构是诊断的关键,免疫组化染色对诊断具有帮助。     

彩色多普勒阴道超声对诊断恶性畸胎瘤的价值

目的探讨彩色多普勒阴道超声及血清甲胎蛋白（AFP）测定对诊断恶性畸胎瘤的价值。方法对2000年～2005年我院收治畸胎瘤患者465例，其中未成熟畸胎瘤13例，成熟畸胎瘤恶变3例，进行回顾性分析，着重探讨彩色多普勒阴道超声下肿物声像图特征及血流情况。部分患者进行了血清AFP测定。结果彩色多普勒阴道超声术前诊断恶性畸胎瘤及恶性卵巢肿瘤10例（10／16），符合率62．5％。未成熟畸胎瘤组9例进行了AFP测定，阳性6／9例（66．7％）；在成熟畸胎瘤恶变3例患者中，AFP均为阴性。结论彩色多普勒超声对恶性畸胎瘤诊断符合率较高，结合血清AFP含量测定，有助于对未成熟畸胎瘤，畸胎瘤恶变及卵黄囊瘤的鉴别。     

Usefulness of Doppler sonography in the diagnosis of ovarian torsion

OBJECTIVE: To assess the predictive value of Doppler sonography in the diagnosis of ovarian torsion and to correlate Doppler results with surgical findings and various clinical characteristics. DESIGN: Retrospective study of discharged inpatients. SETTING: An academic community hospital. PATIENT(s): Twenty-one patients with surgically confirmed ovarian torsion over an 8-year period.Intervention(s): Data were collected on Doppler flow results, ultrasound and surgical findings, patient characteristics, and associated morbidity. MAIN OUTCOME MEASURE(s): Accuracy of Doppler diagnosis as to presence of ovarian torsion. RESULT(s): Twenty-one patients had surgically confirmed ovarian torsion. Doppler sonography was performed in 10 of the 21 patients. Doppler sonographic findings were normal in 60% (6 of 10), and abnormal (decreased or absent) in 40% suggestive of torsion. In cases involving ovulation induction, Doppler sonography findings were normal in 25% (1 of 4). Furthermore, the time to diagnosis of ovarian torsion (mean = 5.3 hours) and the time to hospital discharge (mean = 2 days) were both decreased when compared with instances when normal flow was detected by Doppler sonography (59 hours and 2.7 days, respectively). CONCLUSION(s): Abnormal flow detected by Doppler sonography is highly predictive of adnexal torsion and is therefore useful in the diagnosis of ovarian torsion. However, when normal flow is detected by Doppler sonography, it does not necessarily exclude an ovarian torsion; in fact, torsion is missed in 60% of cases, and time to diagnosis in these cases is delayed. In cases of ovulation induction, sensitivity is increased to 75%.     

The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler

OBJECTIVE: The objective was to determine the diagnostic accuracy of three-dimensional (3D) sonography and 3D power Doppler imaging, used together with standard 2D transvaginal grayscale and color/power Doppler modalities, for preoperative sonographic assessment of suspected ovarian lesions. METHODS: Five-year retrospective analysis was performed by our experts on ultrasonography and surgery on the reports from 43 referred patients with suspected stage I ovarian cancer. All patients were evaluated during the week prior to surgery at our department. Preoperative sonographic assessment included careful examination of ovarian volume, morphology, and vascularity by four complementary sonographic methods. Scoring systems combining morphological and Doppler parameters were adopted for 2D and 3D sonographic examinations. Final diagnosis was confirmed by a histopathologist. RESULTS: Out of the 43 stage I ovarian cancers, 42 cases were successfully detected preoperatively by four complementary sonographic methods. Only 30 (69.8%) and 37 (86.1%) cases of stage I ovarian cancer were detected by 2D grayscale and combined 2D grayscale and color Doppler sonography, respectively. Morphological analysis obtained by 3D sonography alone detected 32 of 43 ovarian malignancies, reaching a diagnostic rate of 74.4%. Qualitative analysis of tumor vascularity architecture by 3D power Doppler significantly improved the sonographic management process and successfully detected 41 cases of stage I ovarian cancer (95.4%). When morphological features obtained by 3D sonography were added to 3D power Doppler findings, we achieved an even higher diagnostic accuracy of 97.7%. We found a statistically significant difference (P 相似文献   

The effectiveness of spectral and color Doppler in predicting ovarian torsion. A prospective study

We evaluated the effectiveness of color and spectral Doppler examination of the ovarian vasculature flow, using transvaginal sonography (TVS) in 65 women prior to laparoscopy due to suspected ovarian torsion. There were 15 cases of ovarian torsion. In all of them, a pathology was detected by the color and spectral Doppler examination. Of the 50 patients without torsion at laparoscopy, one had abnormal Doppler studies. Color and spectral Doppler can demonstrate the presence or absence of arterial and venous flow in cases of suspected torsion of the ovary.     

绝经后妇女胃肠道间质肿瘤误诊为卵巢肿瘤3例报道

目的:探讨绝经后妇女胃肠道间质肿瘤容易误诊为卵巢肿物的原因,以及它们之间的鉴别点。方法:回顾性分析3例术前诊断为卵巢肿物,术后证实为胃肠道间质肿瘤患者的临床资料。结果:3例患者均为绝经后妇女,2例以急腹症表现入院。她们伴或不伴有肿瘤标记物轻度升高,彩色多普勒超声显示:有急腹症表现者的肿物血流丰富。行盆腔CT检查者2例,1例检查结果提示为小肠肿瘤。术前均诊断为卵巢肿物行开腹手术。术中发现结合术后病理诊断为胃肠道间质肿瘤。有急腹症表现的患者,术中出血量多。结论:绝经后妇女出现盆腔肿物应考虑到有胃肠道间质肿瘤的可能。可能有急腹症表现,术中出血凶险。术前盆腔CT检查有助于术前诊断。     

Color Doppler sonography of ovarian arteries as a tool in the differential diagnosis of pelvic inflammatory disease and appendicitis

The purpose of this study was to show whether color Doppler ultrasonography of the ovarian arteries is a useful tool for the differential diagnosis of pelvic inflammatory disease (PID) and appendicitis. The study included 50 female patients with clinical symptoms of acute pelvic inflammation and 50 healthy women of the same age as a control group. All were examined with color Doppler ultrasonography to visualize the internal genitalia and estimate the blood flow through the ovarian arteries. Peak systolic velocity (PSV), end diastolic velocity, pulsatility index (DPI), and resistance index were measured. In the healthy women, ovaries were normal in size, and the parameters of ovarian arterial flow were PSV 0.30–0.50, systolic/diastolic ratio <0.7, DPI 1.23–1.50. In 45 of the patients, there was infection and enlargement of the ovaries and/or salpinx, and flow parameters were PSV 0.40–0.70, systolic/diastolic ratio 0.5–0.8, and DPI 1.40–1.96. In five cases the ultrasound image was obscure, and flow parameters were similar to those of healthy women. These patients underwent surgery for a diagnosis of appendicitis. Our study showed that in cases of diagnostic differentiation between PID and appendicitis, examination with color Doppler ultrasound is very easy and useful. The relatively increased flow parameters in ovarian arteries direct the diagnosis to PID.     

Comparison of Transvaginal Color Doppler Imaging and Color Doppler Energy for Assessment of Intraovarian Blood Flow

Objective: To investigate any systematic differences in the analysis of blood flow velocity waveforms derived by color Doppler imaging and color Doppler energy examination of corpora lutea and adnexal tumors, to test whether the accuracy for diagnosing ovarian malignancy differs between end points derived by color Doppler imaging and color Doppler energy, and to compare the reproducibility of flow velocity waveform analysis obtained by both methods.Methods: Fifty-six asymptomatic women with presumed corpora lutea and 67 women with known adnexal masses were included in the study. They all were examined using transvaginal sonography with color Doppler imaging and color Doppler energy. Pulsed Doppler sonography was used to obtain flow velocity waveforms to determine the pulsatility index (PI), resistance index (RI), peak systolic velocity, and time-averaged maximum velocity. The tumors were classified retrospectively according to histologic criteria.Results: There were 52 women with benign, three with borderline, and 12 with malignant ovarian tumors. Repeated-measures analysis of variance revealed no systematic differences in the values of all four measurements performed under color Doppler imaging and color Doppler energy for all cases of corpora lutea and adnexal tumors (PI: P = .153, RI: P = .197, peak systolic velocity: P = .355, time-averaged maximum velocity: P = .159). All cases of borderline and malignant tumors had detectable pulsatile blood flow with color Doppler imaging and color Doppler energy. Forty-two (80.8%) of the benign tumors had flow detectable with color Doppler imaging, compared with 40 (76.9%) with color Doppler energy (P = .480). Analysis of receiver operating characteristic curves showed a marginal but nonsignificant improvement in diagnostic performance with color Doppler energy compared with color Doppler imaging for all four measurements (PI: P = .182, RI: P = .178, peak systolic velocity: P = .254, time-averaged maximum velocity: P = .238). The intraclass correlation coefficients for all four measurements were superior with color Doppler imaging compared with color Doppler energy.Conclusion: Flow velocity waveform analysis and diagnostic accuracy for ovarian malignancy are not significantly different between color Doppler imaging and color Doppler energy. Examinations with color Doppler imaging appear to be more reproducible than those with color Doppler energy.     

Contrast-enhanced, three-dimensional power Doppler sonography for differentiation of adnexal masses

OBJECTIVE: To investigate the potential usefulness of contrast-enhanced, three-dimensional power Doppler sonography in the differentiation of benign and malignant adnexal lesions. METHODS: A total of 45 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy. All the results were compared with histopathology. RESULTS: There were 12 cases of ovarian malignancy and 33 benign adnexal lesions. Of the 12 ovarian cancers, seven (58. 3%) showed vascular distribution suggestive of malignancy at nonenhanced three-dimensional power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy. One cystadenofibroma demonstrated penetrating vessels at initial scan, whereas two benign lesions (fibroma and cystadenofibroma) were misdiagnosed as malignant at contrast-enhanced, three-dimensional power Doppler sonography. The use of a contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency (95.6%) that was superior to that of nonenhanced three-dimensional power Doppler sonography (86. 7%). CONCLUSION: Contrast-enhanced, three-dimensional power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with three-dimensional morphologic ultrasound assessment, enhanced three-dimensional power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.     

绝经后卵巢肿瘤136例临床病理分析

目的　探讨 5 0岁以上绝经妇女发生卵巢肿瘤的临床病理学原因。方法　对 1998年 1月至 2 0 0 2年 7月发生的 136例 5 0岁以上绝经妇女卵巢肿瘤患者的临床资料及病理结果进行回顾性分析。结果　 136例中恶性卵巢肿瘤 5 9例 (43 4 % ) ,交界性肿瘤 6例 (4 4 % ) ,良性卵巢肿瘤 71例 (5 2 2 % )。恶性卵巢肿瘤以 6 0～ <6 5岁发生率最高 (48 5 % ) ,70岁以上发生率较低 (2 0 0 %～ 2 6 7% ) (P <0 0 5 )。在病理组织切片上 ,良性卵巢肿瘤以黏液性囊腺瘤为多 ,恶性卵巢肿瘤以浆液性囊腺癌为多。对 10 8例患者用彩色超声检查测量的肿瘤直径进行分析 ,其中以肿瘤直径 >10cm组恶性卵巢肿瘤发生率最高 ,与直径 <5cm组比较差异有显著性意义 (P <0 0 5 )。结论　绝经后应定期进行常规妇科检查和宫颈刮片细胞学检查 ,如有异常宜及时进行影像检查及肿瘤标志物和病理检查 ,积极地进行治疗。     

妊娠合并卵巢幼年型颗粒细胞瘤一例报告及文献复习

目的：分析妊娠合并卵巢幼年型颗粒细胞瘤（juvenile granulosa cell tumor,JGCT）的临床特点、诊断要点、治疗及预后,提高鉴别诊断水平。方法：回顾性分析 1 例妊娠合并JGCT病例资料,复习相关文献。结果：患者27岁,因停经39+3周,间断右下腹疼痛3 d入院。彩色超声提示右下腹部一8.5 cm×6.1 cm囊实混合回声。查糖类癌抗原125（CA125） 32.3 U/mL, CA19-9为19.1 U/mL,诊断为先兆临产,盆腔包块（性质待排）,行剖宫产术+剖腹探查术,探查见右侧卵巢一囊性肿物,已破溃,行右侧卵巢肿物切除术,术后病理诊断为卵巢JGCT。行二次手术,给予右侧卵巢输卵管切除术+左侧卵巢活检术+盆腔淋巴结取样术+部分大网膜切除术+阑尾切除术+盆腔粘连松解术。术后予顺铂+长春新碱+博莱霉素（PVB方案）化疗3个疗程,随访8个月,肿瘤无复发。结论：JGCT是一种罕见的恶性肿瘤,发生于妊娠期者更为罕见,确诊需依赖病理及免疫组化检查。