黄体囊肿误诊输卵管妊娠19例分析

目的：探讨卵巢黄体囊肿误诊为未破裂型输卵管妊娠的原因。方法：回顾性分析19例经腹超声疑诊为输卵管妊娠患者,应用经阴道超声结合彩色多普勒血流技术对卵巢黄体囊肿与未破裂型输卵管妊娠进行鉴别诊断。结果：15例患者腹部超声所发现卵巢旁囊实性包块为卵巢黄体囊肿,在对侧附件区发现输卵管妊娠包块。4例为子宫内孕,附件区包块为卵巢黄体囊肿。结论：经阴道超声结合彩色多普勒血流技术诊断未破裂型输卵管妊娠及卵巢黄体囊肿更准确,更有临床价值。     

经阴道彩色多普勒超声诊断宫内双胎合并输卵管妊娠的分析

目的 探讨经阴道超声下宫内早孕双胎合并输卵管妊娠及黄体囊肿的声像图特征及其诊断价值。方法 采用经阴道超声检查13例确诊为宫内早孕双胎合并输卵管妊娠及黄体囊肿患者。结果 宫内早孕双胎合并输卵管妊娠及黄体囊肿主要表现为多种不同声像图特征：1、宫内早孕双胎声像图：宫腔内见两个清晰的妊娠囊，位于子宫腔的不同部位或两个妊娠囊相互紧靠，妊娠囊的囊壁厚度均匀，回声强度一致；2、输卵管妊娠的声像图：附件区可见低回声均质的包块或囊实性混合性肿块，在囊实性肿块内可见部分妊娠囊，其内见胚芽及胎心管搏动。在子宫直肠窝及盆腔等部分可见多少不等的液性暗区；3、部分患者的输卵管侧及对侧见圆形或椭圆形的囊性肿块，边界清楚，边缘规则，见包膜回声，后方回声增强。结论 经阴道超声检查宫内早孕双胎合并输卵管妊娠及黄体囊肿的诊治有重要的价值。     

宫内妊娠合并卵巢黄体破裂误诊为异位妊娠原因分析

目的分析宫内妊娠合并卵巢黄体破裂误诊原因,探讨防范误诊策略。方法对我院2002年1月～2007年12月收治的8例宫内妊娠合并卵巢黄体破裂误诊病例进行回顾性分析。结果8例均以腹痛就诊,6例伴有阴道流血,后穹隆穿刺均抽出不凝固血液,腹部B超检查均未见宫内妊娠囊,误诊为异位妊娠。3例保守治疗后行人工流产术见绒毛组织,术后复查B超示附件包块消失。2例开腹手术,3例腹腔镜手术,术中腹腔内均未发现妊娠物,但见一侧卵巢黄体有破裂口,其中2例有活动性出血,经病理检查确诊为卵巢黄体破裂。5例术后阴道B超见宫内妊娠囊,术后2～7d阴道内排出或人工流产术均见绒毛组织。结论对怀疑早期异位妊娠患者应动态监测血β-人绒毛膜促性腺激素,B超观察官腔内变化,需与宫内妊娠合并卵巢黄体破裂鉴别,以减少误诊误治。     

腹部与经阴道超声检查卵巢囊肿蒂扭转的临床分析

目的:探究腹部与经阴道超声检查卵巢囊肿蒂扭转的临床价值。方法:选取2017年10月-2019年10月于我院接受诊断治疗的76例卵巢囊肿蒂扭转患者。结果:病理检查发现,卵巢囊肿蒂扭转患者76例,其中34例患者为卵巢浆液囊腺瘤蒂扭转,24例患者为卵巢巧克力囊肿蒂扭转,10例患者为卵巢囊性畸胎瘤蒂扭转,8例患者为卵巢黄体囊肿蒂扭转。经腹部超声检查发现卵巢囊肿蒂扭转患者54例。经阴道超声检查发现卵巢囊肿蒂扭转患者69例。经阴道超声检查诊断符合率(90.79%)与经腹部超声检查诊断符合率(71.05%)对比存在明显差异。腹部超声检查中,6例被误诊为输卵管积水扭转,5例被误诊为黄体囊肿破裂,4例被误诊为异位妊娠破裂,7例被误诊为阑尾周围囊肿。经阴道超声检查中,2例被误诊为输卵管积水扭转,1例被误诊为黄体囊肿破裂,1例被误诊为异位妊娠破裂,3例被误诊为阑尾周围囊肿。腹部超声检查误诊率(28.95%)与经阴道超声检查误诊率(9.21%)对比明显较高。讨论:对于卵巢囊肿蒂扭转的经阴道超声检查与腹部超声检查相比,经阴道超声检查效果更佳理想,误诊率更低,值得广泛推广。     

未破裂型异位妊娠与妊娠黄体囊肿应用经阴道超声鉴别诊断的价值分析

目的:探讨未破裂型异位妊娠与妊娠黄体囊肿应用经阴道超声鉴别诊断的价值分析.方法:选取2017年9月至2018年10月本院产科收治的未破裂型异位妊娠患者34例,以及妊娠黄体囊肿患者共34例两组患者均通过阴道超声检查.对比指标包括肿块大小、环壁厚度、血流阻力指数以及血流频谱形态情况.结果:未破裂异位妊娠组与妊娠黄体囊肿组在...     

探讨超声诊断非辅助生殖技术所致的宫内外同时妊娠的临床价值

目的：探讨超声诊断非辅助生殖技术所致的宫内外同时妊娠的临床价值。方法：对16例非辅助生殖技术所致的宫内外同时妊娠患者经腹及经阴道超声检查结果以及临床资料进行回顾性分析,并随访宫内妊娠结局以及手术病理检查结果。结果：通过经腹壁及经阴道超声联合应用,结合病史及临床症状,14例首诊高度怀疑并提示宫内宫外同时妊娠,超声仅发现宫内孕囊及附件区包块,但无法确认包块是宫外孕或黄体破裂者1例,经后穹窿穿刺出不凝血而高度怀疑;附件包块漏诊1例,1周后腹痛复查时证实。上述16例患者均由手术病理证实,经腹壁及经引道超声检查两者联合应用,宫内外同时妊娠诊断符合率达87.50%。其中仅4例宫内继续妊娠,2例得以足月生产,另外2例分别于16周4天和18周1天流产。结论：经腹和经阴道超声联合应用是提高宫内外同时妊娠诊断率的有效方法,同时结合病史及临床症状、仔细全面的超声检查、超声图像的认真分析,可有效减少宫内外同时妊娠的误、漏诊。早期的诊断对选择合适的治疗方案具有十分重大的临床意义。     

超声诊断异位妊娠68例分析

目的：探讨超声检查在异位妊娠中的应用价值。方法：经腹部和经阴道超声检查,对68例诊断异位妊娠与手术结果对比分析。结果：68例中,子宫角妊娠4例,黄体囊肿破裂2例,巧克力囊肿破裂1例,陈旧型异位妊娠2例,宫颈妊娠1例;余58例均为输卵管妊娠。检出率为95．6％（65／68）。结论：超声检查能准确检出异位妊娠,且能提高诊断符合率,早孕者均应做超声检查,早期诊断以排除异位妊娠。     

超声在妊娠合并卵巢肿瘤患者的诊断价值

目的探讨超声检查在妊娠合并卵巢肿瘤患者的诊断价值。方法回顾性分析2016年1月~2018年12月就诊的48例妊娠患者临床及超声检查资料,年龄20~41岁（30.5±4.7岁）,所有患者均在妊娠期超声检查发现并经手术病理证实卵巢肿瘤,总结超声检查在妊娠期卵巢肿瘤诊治的价值。结果48例妊娠合并卵巢肿瘤患者,经超声发现病灶共51例,其中成熟性畸胎瘤28例,粘液性、浆液性囊腺瘤分别为8例、10例,黄体囊肿并出血2例,浆-粘液性肿瘤并内膜样囊肿、单纯性囊肿、甲状腺肿各1例,超声检查可显示各类型病灶特征。肿瘤直径2.2~12.1 cm（5.5±2.1 cm）,超声上提示恶性病变3例,提示妊娠合并卵巢肿瘤并发肿瘤蒂扭转或黄体囊肿出血7例。因患者意愿终止妊娠并肿瘤切除3例,因妊娠急腹症、可疑恶变、肿瘤体积较大等采用腹腔镜手术切除卵巢肿瘤共12例,采用期待疗法33例,在剖宫产分娩时进行卵巢肿瘤切除,大部分患者取得良好的妊娠结局。结论超声检查可测量妊娠合并卵巢肿瘤的病灶大小、判断良恶性、鉴别组织学来源、有无合并症、并对妊娠过程中卵巢肿瘤进行动态监测,为临床决策提供关键证据。     

复合妊娠并卵巢黄体破裂漏诊输卵管妊娠

目的探讨复合妊娠并卵巢黄体破裂的临床特点及诊治要点。方法对1例复合妊娠并卵巢黄体破裂漏诊输卵管妊娠的临床资料进行回顾性分析。结果本例因停经80 d,下腹痛4 d,加重6+h入院。于停经50 d、60 d、74 d在我院行3次彩色多普勒超声(彩超)检查均提示宫内早孕活胎,予黄体酮保胎治疗仍反复出现下腹部绞痛;查孕酮40 nmol/L。以宫内早孕、卵巢黄体破裂?收入院。入院后复查血人绒毛膜促性腺激素(HCG)94 482.99 U/L,孕酮40 nmol/L,血红蛋白75 g/L;彩超检查示:腹腔内出血(卵巢黄体破裂?异位妊娠?),宫内早孕先兆流产。为明确腹腔出血原因行腹腔镜探查术,术后病理诊断为左侧输卵管壶腹部妊娠流产型,右侧卵巢黄体破裂,宫内早孕。结论临床接诊停经后反复发作的腹痛及阴道流血,伴附件肿块不能明确性质者,应想到复合妊娠的可能,及时行腹腔镜探查,可减少误漏诊。     

经阴道超声在诊断异位妊娠中的应用

目的：探讨阴道超声诊断异位妊娠在临床治疗中的价值。方法：对疑为早期异位妊娠的病人经阴道超声检查和随访。结果：48例经阴道超声诊断出的异位妊娠，破裂型9例，未破裂型38例，宫内宫外同时妊娠1例，而未破裂型异位妊娠的诊断尤为重要，占总数79％，其声像图为附件区可见妊娠囊、空妊娠囊、Dount征和混合性回声四种。结论：经阴道超声检查，特别对未破裂型异位妊娠的检查，使异位妊娠的诊断时间大大提高，从而减少失血性休克，降低死亡率，指导临床治疗有着极其重要的意义。     

Heterotopic pregnancy following intrauterine insemination: successful management with salpingectomy and continuation of intrauterine pregnancy

We report the first case of a heterotopic pregnancy (HP) following ovulation induction and intrauterine insemination (IUI) with resultant normal intrauterine pregnancy after salpingectomy. A 41-year-old para 0 +0 that presented with primary infertility due to azoospermia and polycystic ovaries after laparoscopic evaluation. She had induction of ovulation with Clomiphene citrate, gonadotropin stimulation (hCG), and intrauterine insemination using donor sperm. The resulting pregnancy was later diagnosed as heterotopic pregnancy following rupture of the tubal component at 8 weeks' gestation after an initial misdiagnosis as corpus luteum cyst of pregnancy. She had an emergency laparotomy and left salpingectomy, and the intrauterine pregnancy has continued subsequently to 25 weeks of gestation as at 01/04/2011.This report demonstrates that HP may occur after ovulation induction and IUI. The ectopic component could be misdiagnosed as corpus luteum cyst. It is recommended that pregnancies following this procedure be followed up with serial trans-vaginal ultrasound in the first trimester. Presence of corpus luteum cyst of pregnancy in early ultrasound should be an index of suspicious of a possible heterotopic pregnancy. Early diagnosis and prompt intervention is essential to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.     

Persistant corpus luteum cyst of pregnancy: sonographic evaluation of cause of third trimester bleeding.

Corpus luteum cysts are frequently observed in pregnant patients evaluated with diagnostic ultrasound. They are usually regarded as incidental findings because of their limited size and usual pattern of regression by ten weeks. The presence and persistence of larger corpus luteum cysts or other extrauterine masses may complicate pregnancy. A case of a large persistent corpus luteum cyst associated with third trimester bleeding is presented.     

彩色多普勒超声评估不同结局早孕妊娠黄体功能的价值

目的探讨经阴道彩色多普勒超声评估不同结局早孕妊娠黄体功能的临床价值。方法分析正常宫内早孕(A组,75例)及宫内早孕流产(B组,66例)的血清孕酮水平及妊娠黄体的经阴道彩色多普勒超声表现,包括妊娠黄体最大径线及血流动力学参数:收缩期峰值流速(PSV)、舒张末期流速(EDV)及阻力指数(RI)。结果A组血清孕酮水平高于B组(P<0.05)。两组妊娠黄体最大径线无显著差异(P>0.05);A组PSV、EDV均高于B组,RI低于B组(P<0.05)。结论正常宫内早孕者孕酮水平较宫内流产者高;经阴道彩色多普勒超声提示正常宫内早孕患者的妊娠黄体血供较宫内流产者好。     

Echogenic adnexal masses associated with first-trimester pregnancy: sonographic appearance and clinical significance

In a retrospective survey of a large obstetrical ultrasound experience, 10 echogenic adnexal masses in nine patients with a coexistent intrauterine pregnancy were detected and analyzed. Definitive follow-up data available for seven of the nine patients disclosed three ovarian teratomas, two hemorrhagic corpus luteum cysts, one endometrioma, one inflammatory mass, and one colonic pseudomass. In one additional patient, an echogenic ectopic pregnancy with an intrauterine pseudogestational sac simulated the above entities. Conservative management with follow-up sonography is generally indicated for echogenic masses coexistent with first-trimester intrauterine pregnancies.     

经阴道超声在妇科急腹症中的应用

目的 探讨经阴道超声在妇科急腹症中的诊断价值。方法 经阴道超声检查妇科急腹症患者87例,并与手术者病理结果对照。结果 87例妇科急腹症病例均经手术病理证实,超声诊断宫外孕65例（其中误诊5例）,黄体破裂15例（误诊2例）,卵巢囊肿蒂扭转7例（误诊1例）。结论 经阴道超声对妇科急腹症探查具有准确、快捷、方便等优点,可以避免经腹探查肠气干扰的影响。     

阴道三维能量多普勒超声检测妊娠黄体血流对异位妊娠的诊断价值

目的 应用阴道三维能量多普勒超声对异位妊娠黄体和宫内妊娠黄体进行对比分析.方法 临床拟诊宫外孕患者30例,手术前行阴道超声检查.使用三维能量多普勒超声观察异位妊娠黄体血流分布,并对同期31例宫内妊娠黄体进行观察.采集三维能量多普勒血流图并测量相应的血管参数:血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI).比较异位妊娠黄体与宫内妊娠黄体血流分布及血管参数差异,评价其在异位妊娠鉴别诊断中的意义.结果 异位妊娠黄体血流信号低于宫内妊娠黄体,异位妊娠黄体血管参数VI、VFI值低于宫内妊娠黄体,差异均有统计学意义(P<0.05),异位妊娠黄体FI值低于宫内妊娠黄体,但无统计学差异.结论 阴道三维能量多普勒超声检测妊娠黄体血流信息,可为异位妊娠的诊断提供有价值信息.     

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.     

Corpus luteum blood flow in normal and abnormal early pregnancy: evaluation with transvaginal color and pulsed Doppler sonography.

One hundred and thirteen (66.5%) women in this study had a normal intrauterine pregnancy with ages ranging 6 to 12 weeks of gestation. Fifty-seven (33.5%) patients were admitted to the hospital owing to clinically suspected abnormal early pregnancy. Dilatation and curettage were done on all women and tissue sample sent to the pathologist for a final diagnostic. Diagnosis of ectopic pregnancy was made on laparoscopy. Both ovaries were examined carefully by color Doppler in sonography in all patients. Color flow was used as a guide for pulsed Doppler exploration. Corpus luteum blood flow was defined as random, usually semilunar in appearance, dispersed vessels with very low impedance to blood flow. The resistive index and pulsatility index were calculated. Overall detection rate of corpus luteum blood flow in normal pregnancies was higher for the left ovary (62.6%) than for the right ovary (37.4%) (P < 0.01). The mean resistive and pulsatility indices from corpus luteum blood flow were not influenced by gestational age in normal pregnancy. The overall mean value for for resistive index was 0.452 +/- 0.04 and for pulsatility index 0.636 +/- 0.09. The overall detection rate of corpus luteum in abnormal pregnancies also was higher for the left ovary (56.7%) than for the right ovary (43.4%) (P < 0.01). The mean resistive indices from corpus luteum blood flow in patients with missed abortion was higher than in women with normal pregnancy (P < 0.01). Both resistive and pulsatility indices were higher in patients with incomplete or threatened abortion in comparison with normal pregnancy (P < 0.01). No statistically significant difference was seen in the case of anembryonic, molar, or ectopic pregnancy.