经阴道超声与经腹部超声诊断异位妊娠的比较

目的比较经阴道超声(TVS)与经腹超声(TAS)在异位妊娠诊断中的价值。方法对109例异位妊娠患者以双盲法分别进行经腹部和经阴道超声检查。结果子宫清晰显示率、子宫内膜测定率、盆腔肿块显示率、盆腔肿块清晰显示率、肿块内检出孕囊样结构及原始心管搏动率,以及肿块内彩色血流信号检出率,TVS均明显高于TAS。结论TVS比TAS诊断异位妊娠更准确。临床诊断疑为异位妊娠的患者,应首选进行TAS或TVS检查,有条件的医院应常规进行TVS检查。     

经阴道彩色多谱勒血流显像对早期异位妊娠的诊断价值

目的:通过经阴道黑白超声与经阴道彩色多谱勒超声诊断早期异位妊娠的对比研究,探讨经阴道彩色多谱勒超声诊断异位妊娠的价值.方法:90例临床拟诊为异位妊娠的患者,均同时进行经阴道黑白超声检查(TVS)和经阴道彩色多谱勒血流显像(TVS-CDFI),以手术结果为诊断的金标准,将TVS及TVS-CDFI诊断结果分别与手术结果比较,评价TVS-CDFI诊断异位妊娠的价值.结果:经阴道彩色超声(TVS-CDFI)诊断异位妊娠的敏感性100%,特异性85.7%,准确性97.7%,阳性预测值97.4%,阴性预测值100%;经阴道黑白超声(TVS)诊断异位妊娠的敏感性97.3%,准确性92.2%,特异性64.3%,阳性预测值93.6%,阴性预测值81.8%.结论:经阴道彩色超声检查在诊断异位妊娠时较黑白超声检查能为临床提供更准确的超声诊断.     

异位妊娠的超声诊断及鉴别诊断

探讨了不同类型异位妊娠(EP)的超声表现和鉴别诊断,其中着重讨论了卵巢黄体囊肿与异位妊娠孕囊的鉴别诊断;宫腔及内膜超声表现预测异位妊娠的价值。探讨了各种超声新技术的比较优势,结果经阴道超声(TVS)结合彩色多普勒能量图(CDPI)被认为是诊断异位妊娠特异且敏感的方法,三维、四维超声及超声造影技术则更多应用于罕见部位的妊娠诊断,被认为较传统的二维超声更具优势。     

经阴道彩色多普勒诊断早期异位妊娠86例临床体会

通过对86例异位妊娠的早期诊断，发现经阴道彩色多普勒常规探查的基础上，同时监测异位妊娠包块和子宫内膜的血流频谱，可增加诊断早期异位妊娠的准确性。     

经阴道彩色多普勒能量图诊断异位妊娠的价值

目的　早期诊断异位妊娠 ,提高异位妊娠的诊断率。方法　经阴道彩色多普勒能量图检查。结果　①妊娠囊周围见滋养层血流 ,妊囊内见胚芽及闪烁的心管搏动 ;②复杂型包块见滋养层周围性血流或血流丰富 ;③飘浮型包块内血流丰富。滋养层周围性血流或附件包块血流丰富区脉冲多普勒频谱形态各异或呈低阻力型动脉频谱 ,阻力指数 (RI) 0 43± 0 0 5。结论　经阴道彩色多普勒能量图检查是早期诊断异位妊娠的有效方法 ,诊断率10 0 %。     

经阴经腹彩色多普勒超声结合血HCG检测对宫外孕诊断的临床意义

目的探讨经阴经腹彩色多普勒超声结合血人绒毛膜促性腺激素(HCG)监测对宫外孕(EP)的临床诊断价值。方法选择2010年6月—2013年10月在我院就诊的疑似早期EP孕妇108例,检测孕妇血HCG水平,进行彩色多普勒超声、断层超声成像(TUI)及容积对比成像-C(VCI-C)平面检查,同时检测孕妇子宫内膜厚度、血流分布情况,子宫动脉和滋养动脉所呈现的血流频谱,并进行对比分析。结果 108例可疑患者经病理诊断输卵管妊娠102例、卵巢妊娠3例,经阴经腹彩色多普勒超声结合血HCG检测准确率为97.22%。其中3例患者属于宫内孕合并卵巢黄体破裂被误诊为EP,误诊率为2.78%。结论经阴经腹彩色多普勒超声结合血HCG检测能够快速、准确地判定EP,是EP早期诊断的首选方法。     

异位妊娠的彩色多普勒超声特征

目的:早期诊断异位妊娠,提高异位妊娠诊断率。方法:经腹经阴道彩色多普勒超声联合应用。结果:异位妊娠宫外表现:子宫外包块内见局灶性丰富血流区,99％(83/84)探及滋养动脉频谱,但频谱形态各异,89％合并盆腔或盆腹腔积液。与40例早期宫内妊娠进行比较。结论:彩色多普勒超声结合临床资料可早期确诊宫内妊娠或异位妊娠。     

经阴道三维超声对早期输卵管妊娠的观察

目的探讨经阴道三维超声成像和三维能量多普勒在早期诊断输卵管妊娠的检测价值。方法应用经阴道三维超声成像和三维能量多普勒成像对80例异位妊娠患者的附件区包块进行三维超声成像和三维能量多普勒成像,并对其血流频谱进行对照分析。分析经阴道三维超声成像和三维能量多普勒技术对输卵管妊娠定性的可能性。结果经阴道三维超声诊断早期输卵管妊娠80例,经手术病理确诊79例,诊断符合率98.7%,79例早期输卵管妊娠中,75例检测到滋养层周围血流频谱。结论经阴道三维超声成像和三维能量多普勒成像是目前诊断早期输卵管妊娠最有价值的检测方法,其血流频谱特征和立体的“输卵管环”具有特殊诊断和鉴别诊断意义,尤其对异位妊娠的早期诊断具有特异性。     

经阴道彩色多普勒超声对异位妊娠孕囊与黄体囊肿的鉴别诊断

目的:对异位妊娠孕囊与早孕时卵巢黄体囊肿超声特点进行比较,以提高异位妊娠的早期检出率.方法:回顾分析异位妊娠(孕囊型)107例和早孕时卵巢黄体囊肿114例的经阴道超声图像特点,记录异位妊娠孕囊及黄体囊肿大小、灰阶超声图像、彩色血流特点及彩色血流的阻力指数.结果:异位妊娠孕囊平均(1.2±0.5) cm,黄体囊肿平均(2.1±0.7) cm,黄体囊肿有4种类型;有80.37％的异位妊娠孕囊囊壁回声高于卵巢实质回声,而69.30％的黄体囊肿囊壁回声等于或低于卵巢实质回声(P＜0.01);黄体囊肿组囊壁血流阻力指数较异位妊娠孕囊低(P＜0.05).结论:异位妊娠孕囊与卵巢小黄体囊肿可通过比较囊壁回声、血流阻力指数等超声资料及结合临床资料相鉴别.     

宫外孕与妊娠黄体的经阴道彩色多普勒血流显像及频谱形态分析

目的 探讨宫外孕与妊娠黄体的经阴道彩色多普勒血流显像及频谱形态特征,以提高超声对宫外孕的诊断符合率.方法 对126例宫外孕及132例宫内或宫外孕伴黄体囊肿进行经阴道彩色多普勒超声检测,检测结果与其临床病理进行对照分析.结果 (1)宫外孕血流常显示为宫外孕病变处某局部富血流信号,血流均不来源于卵巢,而妊娠黄体血流则常显示黄体周边环状血流信号,血流均来源于卵巢内;(2)宫外孕的多普勒血流频谱可表现为多种形态:包括极低阻力型血流频谱、低阻力型血流频谱、高阻力型频谱、无舒张期血流频谱及舒张期反向血流频谱;而妊娠黄体则常表现为低阻力型及高阻力型血流频谱.结论 经阴道彩色多普勒血流显像及频谱形态特征能为宫外孕与妊娠黄体的鉴别诊断提供有价值的信息.     

经阴道超声对未破裂型宫外孕的诊断应用

目的 探讨经阴道超声(TVS)及时准确诊断未破裂型宫外孕的检查方法.方法 回顾性分析我院2004年1月-2005年1月确诊的64例未破裂型宫外孕患者的超声检查资料.具体方法是先行常规超声检查显示子宫及卵巢后注意追踪显示输卵管;后行TVS扫查子宫以上部位,并与肠管回声鉴别;用探头反复轻推,根据可疑病灶与卵巢是否同步运动以辨别其与卵巢的关系. 结果 64例均显示附件区妊娠囊样环状回声.根据声像图显示中妊娠囊样环状回声与输卵管及卵巢的关系分为3型:Ⅰ型:输卵管可显示型(29例):较清楚显示输卵管,管内可见妊娠囊样环状回声;其中5例于初检漏诊后注意追踪显示输卵管而提示宫外孕诊断;Ⅱ型:与卵巢分界清型(27例):6例于初检漏诊后注意扫查子宫底以上部位、并与肠管回声鉴别而提示宫外孕诊断;Ⅲ型:与卵巢分界不清型(8例):7例在反复轻推探头后辨别与卵巢是否同步运动而提示宫外孕诊断.结论 TVS在检查方法上的完善有助于更及时、准确地诊断未破裂型宫外孕.     

经阴道超声诊断异位妊娠:209例分析

目的 评估经阴道超声诊断异位妊娠的价值.方法 回顾性分析临床确诊为异位妊娠的209例患者的经阴道超声声像图特征,并与腹腔镜结果相对照.结果 经阴道超声诊断异位妊娠的准确率为99.04％(207/209).已破裂的异位妊娠包块主要为混合性回声型(36/38,94.73％);孕囊型、卵黄囊或胚芽型仅见于未破裂包块;直径＞5 cm的异位妊娠包块发生破裂的比例为92.00％(23/25);经阴道超声诊断盆腔积液的假阴性率为64.55％(51/79);当超声测量积液深度＞3 cm时,腹腔镜检查显示盆腔出血量＞500ml,96.30％(26/27)发生破裂.结论 经阴道超声能够为临床诊断异位妊娠、拟定治疗方案提供丰富的信息,具有重要临床应用价值.     

经腹彩超和经阴道超声诊断异位妊娠的临床应用价值及有效性

目的比较经腹彩超(TAS)与经阴道超声(TVS)诊断异位妊娠的临床应用价值及有效性。方法选取我院2018年1月至2018年12月收治的120例异位妊娠患者作为研究对象,均行TAS扫查与TVS扫查。以病理诊断结果为检验金标准,比较两种超声扫查方法的诊断准确率。结果TAS扫查诊断准确率为74.17%,显著低于TVS扫查的90.83%(P<0.05)。TVS扫查对宫外混合性团块、宫外孕囊影、孕囊影中胚芽检出率高于TAS扫查,差异具有统计学意义(P<0.05);两种超声扫查方法对胎心检出率比较,差异无统计学意义(P>0.05)。结论相较于TAS扫查,TVS扫查可更有效地诊断早期异位妊娠,同时,TAS扫查仍是异位妊娠诊断中的一个重要的辅助检查方法。     

二维及彩色多普勒超声对早期宫内外孕的鉴别诊断价值

目的 探讨二维超声及彩色多普勒超声（简称彩超）对早期宫内外孕的鉴别诊断价值。方法 采用二维超声检查,筛选,对可疑宫外孕早孕合并盆腔包块者及早孕二次复查不能确诊者加用彩超检查。用彩色能量图显示低速血流,用脉冲多普勒寻找高舒张期低阻力滋养动脉血流频谱。结果 135例中76．3％（71／93）的宫内孕可用二维超声诊断,64例加用彩超者,宫内孕或宫外孕包块可检测出滋养层动脉血流。而宫内“假孕囊”,内良性包块均显示不出滋养层动脉血流频谱。结论 彩超是目前诊断宫内外孕的最有价值的手段,其血流频谱的特征性具有鉴别诊断意义,而二维超声的经济实用性可作为早孕检查的首选。     

Primary twin ovarian pregnancy: case report and review of the literature

Primary twin ovarian pregnancy is extremely rare. We present one such case in a 25-year-old primigravida who complained of lower abdominal pain and mild vaginal bleeding at 8 weeks after her last menstrual period. Transvaginal sonography revealed an empty uterus and presence of a gestational sac containing 2 dead embryos in the right ovary. The patient underwent unilateral oophorectomy, and histologic studies confirmed a uniovular-diamniotic ovarian pregnancy. A brief review of the literature revealed that primary ovarian pregnancy may occur without any classical antecedent risk factors, and endovaginal sonography can be useful to establish early preoperative diagnosis of ectopic ovarian pregnancy.     

Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics.

Despite the widespread use of TVS for diagnosing EP and extensive literature on the subject, there is no consensus regarding the best positivity criterion for adnexal findings or the performance characteristics of TVS. We conducted a literature search to identify original studies presenting suitable data on the use of TVS for the diagnosis of EP. The data were combined to determine the sensitivity and specificity of four sonographic criteria for EP, listed in order from most to least stringent: Criterion A, living extrauterine pregnancy; criterion B, extrauterine gestational sac containing yolk sac or embryo; criterion C, empty "tubal ring" or extrauterine gestational sac containing yolk sac or embryo; and criterion D, any adnexal mass other than a simple cyst. Positive and negative predictive values were computed using Bayes' theorem. Ten studies involving a total of 2216 patients, 565 with EP and 1651 without EP, were included in our analysis. Based on the combined data from these studies, criteria A, B, and C all have high specificities (99.5-100%) and positive predictive values (97.8-100%) but low sensitivities (20.1-64.6%) and mediocre negative predictive values (78.5-89.1%). Criterion D, the most lax criterion, has the most uniformly excellent characteristics, with only slightly lower specificity (98.9%) and positive predictive value (96.3%) but considerably higher sensitivity (84.4%) and negative predictive value (94.8%). The performance characteristics of TVS criteria for EP, computed by pooling data from published studies, indicate that the appropriate TVS criterion to diagnose EP is any noncystic adnexal mass. These performance characteristics can be used as a basis for comparing TVS with other proposed diagnostic modalities for EP.     

彩色多普勒超声诊断剖宫产术后子宫瘢痕妊娠的价值

[目的] 评价彩色多普勒超声在诊断剖宫产术后子宫瘢痕妊娠中的价值.[方法] 11例子宫下段瘢痕妊娠患者,采用经腹经腔内联合彩超检查,观察孕囊位置,妊娠物与子宫切口处肌层的回声、血流分布及两者的分界、宫腔宫颈情况等.[ 结果] 所有患者在宫腔正常部位未见到孕囊.孕囊或包块着床于子宫下段切口肌层处,根据其超声图像表现分为2种类型：①孕囊型2例,②流产包块型9例.[ 结论] 经腹经腔内彩超对剖宫产术后子宫下段瘢痕妊娠的早期诊断有着重要作用.     

Diagnosis of early intramural ectopic pregnancy

Intramural ectopic pregnancy is a very rare diagnosis. Establishing a diagnosis is difficult and is often made intraoperatively. Demonstration of a live extrauterine gestation is the only specific sign of such a pregnancy. A small number of ectopic pregnancies are interstitial or cornual pregnancies. Rupture of an intramural ectopic pregnancy is a serious clinical complication. Diagnosis of this ectopic pregnancy can sometimes be made using 2-dimensional transvaginal ultrasound (TVS), but it may also require 3-dimensional TVS. We present the case of a 25-year-old gravida 0, para 0 woman with amenorrhea lasting 6(+5) weeks. Previous surgery included a right adnexectomy for torsion of a right dermoid cyst. The patient's serum hCG was elevated. TVS provided a detailed view of the endometrial cavity. The results of 2-dimensional TVS suggested the presence of an ectopic pregnancy. The sonogram showed a gestational sac with an embryonic pole and a yolk sac, which was separated from the endometrium. Use of 3-dimensional TVS demonstrated a live embryo in a gestational sac surrounded by myometrium below the right cornu lying outside the endometrium. This finding was confirmed by laparotomy and the conceptus was excised. The patient had an uneventful postoperative course and was discharged 7 days after surgery. In our case, the previous adnexectomy was an identifiable risk factor. Nonetheless, making a diagnosis of an intramural pregnancy was challenging. Suspicion may arise when sonography has revealed an intramural gestational sac.