输卵管异位妊娠的彩色多普勒超声诊断

目的:探讨输卵管异位妊娠的声像图特点,以降低误诊率,提高诊断正确性。方法:对经超声提示的60例输卵管异位妊娠与临床诊断(包括临床症状、手术及病理结果)进行对照分析。结果:本组病例中超声检查15例探及孕囊样无回声;13例探及稍强回声环,其中11例见血流环绕;32例见混合回声包块。有35例探及腹、盆腔积液。手术及病理证实60例均系输卵管异位妊娠,包括未破裂型输卵管妊娠、流产型输卵管妊娠及破裂型输卵管妊娠。结论:输卵管异位妊娠超声图像分为孕囊型、彩环型及包块型,诊断中除应熟悉输卵管异位妊娠的超声图像特点外,还应密切结合临床(包括月经史、尿妊娠试验及腹痛特点),才能对输卵管妊娠作出正确的诊断。     

经阴道超声在未破裂异位妊娠诊断中的价值

目的：探讨未破裂异位妊娠超声图像诊断依据。方法：对经手术病理证实的35例未破，裂异位妊娠的临床症状、超声表现及手术病理对照分析。结果：经阴道超声诊断36例异位妊娠中，手术病理证实35例为输卵管妊娠，1例妊娠黄体误诊为宫外孕。声像图表现分为二型，胎囊型9例，卵巢旁探及完整胎囊，并可探及卵黄囊结构及胎心搏动。包块型26例，其中16例一侧卵巢旁见稍强回声团块，周边有血流信号环绕，并探及低阻血流频谱；10例在一侧卵巢旁见混合性团块，团块内见不规则暗区，团块内见少许血流信号；子宫直肠陷窝积液28例；另外27例异位妊娠同侧卵巢内探及妊娠黄体。结论：采用经阴道超声检查异位妊娠可弥补经腹超声检查中干扰因素，对包块进行分型，并观察其血流情况，对异位妊娠早期诊断及治疗的选择提供了可靠诊断依据。     

超声对未破裂输卵管妊娠的诊断价值

目的 探讨未破裂输卵管妊娠的超声图像特征及超声对未破裂输卵管妊娠的诊断价值.方法 应用腹部超声及阴道超声对68例未破裂输卵管妊娠进行超声检查并诊断.结果 未破裂输卵管妊娠共68例全部经手术与病理证实,阴道超声诊断49例,符合率72%;腹部超声诊断8例,符合率12%;漏诊11例,漏诊率16%.结论 阴道超声对未破裂输卵管妊娠的图像显示率明显高于腹部超声,其对未破裂输卵管妊娠的直观显示可为临床提供客观的诊断依据.     

输卵管妊娠的超声分析

目的 探讨输卵管妊娠的声像图特征,以早期发现和诊断.方法 回顾性分析73例经手术和病理证实的输卵管妊娠患者的经腹及经阴道超声资料,从包块分型、血流分级分析输卵管妊娠的声像图特点.结果 本组73例输卵管妊娠患者宫旁、附件区探及不均质包块者52例,占71.2%;CDFI显示包块内血流信号:0级11例,Ⅰ级32例;Ⅱ级7例,Ⅲ级2例."双环状"征13例,囊周边探及血流信号:Ⅱ级8例,Ⅲ级5例.宫内外同时妊娠2例.手术证实输卵管妊娠流产型、破裂型的声像图多以包块形式出现;输卵管妊娠未破裂型的声像图呈"双环状"征.经腹结合经阴道超声对输卵管妊娠的诊断准确率为 91.8 %.结论 超声及早检测出"双环状"征声像图,界限不清的附件区包块,盆腔积液,对输卵管妊娠的诊断及附件区包块的鉴别诊断有重要的临床价值.     

B型超声诊断宫外孕——附30例分析

本文报告了B型超声检查并经手术证实的宫外孕30例。超声诊断正确28例,诊断符合率93.3％,误诊2例,误诊率6.7％。30例宫外孕,破裂型多见占56.7％,其次为流产型占23.3％,未破裂型和陈旧型少见。其中1例未破裂型手术取出小活胎儿,1例宫外孕同时宫内孕、手术切除破裂的输卵管,宫内孕至足月分娩。输卵管间质部妊娠3例,破裂1例。右卵巢妊娠破裂同时宜内孕1例,手术后3天阴道流出血性物,病理证实为绒毛组织。依据闭经史,突发腹痛,B超见异位妊娠囊、附件包块或盆腹腔液性暗区可协助     

经阴道三维超声联合断层超声显像技术在早期异位妊娠诊断中的应用

目的探讨经阴道三维超声联合断层超声显像技术(TUI)在早期异位妊娠诊断中的应用价值。方法对停经4~6周临床疑似异位妊娠的120例患者行经阴道二维及三维超声联合TUI技术检查,做出超声分型诊断;与手术病理及临床随访结果对照,对经阴道二维及三维超声联合TUI技术诊断早期异位妊娠患者的超声声像图特征及漏误诊病例图像特征进行总结分析。结果 120例患者手术病理及临床随访结果证实异位妊娠102例,宫内妊娠18例。与手术病理诊断结果及临床随诊结果对照显示:(1)输卵管妊娠92例,经阴道二维超声正确诊断80例(86.9%,80/92),漏诊8例,误诊4例;经阴道三维超声联合TUI成像正确诊断84例(91.3%,84/92),漏诊8例,无误诊病例。超声声像图示附件区类妊娠囊回声包块,呈"Donut"征或边界不清的不规则包块,多数包块边界和内部结构清晰或较清晰,包块与输卵管位置关系清晰或较清晰。超声诊断未破裂型输卵管妊娠36例,流产型43例,破裂型5例。(2)子宫角妊娠10例,经阴道二维超声正确诊断6例(60.0%,6/10),误诊4例;经阴道三维超声联合TUI成像正确诊断9例(90.0%,9/10),误诊1例。超声声像图示妊娠囊位于一侧子宫角处向外突出,经阴道二维超声显示10例中6例妊娠囊与子宫内膜不相连,4例妊娠囊周边蜕膜包绕显示不清,4例见间质线征;经阴道三维超声联合TUI成像,通过多平面断层图像,尤其冠状面清晰显示9例妊娠囊与子宫内膜不相连,妊娠囊周边蜕膜包绕不完整,6例见间质线征。(3)102例早期异位妊娠因包块小、超声显示不清,经阴道二维及三维超声联合TUI成像均漏诊输卵管妊娠8例;因宫腔内出现"假妊娠囊"结构、妊娠囊偏向一侧与宫内妊娠难以分辨等原因,经阴道二维超声误诊输卵管妊娠4例及子宫角妊娠4例,经阴道三维超声联合TUI成像后清晰显示异位妊娠包块及妊娠囊位置而明确诊断7例,仅误诊1例子宫角妊娠。结论经阴道三维超声联合TUI成像能提供更详尽的早期异位妊娠超声声像图诊断信息,减少早期异位妊娠漏误诊,经阴道三维超声联合TUI成像对早期异位妊娠超声诊断有较好的临床应用价值。     

经阴道超声诊断卵巢妊娠价值的初步探讨

目的评价经阴道超声对卵巢妊娠的诊断价值。方法回顾性分析21例卵巢妊娠的超声图像特征，并与手术及病理结果进行对照分析。结果所有病例经阴道超声检查均诊断为宫外孕，9例未破裂型卵巢妊娠中，经阴道超声检查进一步提示部位在卵巢者3例，在卵巢表面者3例，部位不清者1例，误诊为输卵管妊娠2例，定位符合率66．7％；12例破裂型卵巢妊娠中，经阴道超声检查均未进一步提示病灶部位。其声像图特征为：子宫正常或略大，宫腔内未见胚囊；卵巢内部或表面见完整的胚囊结构或不均质强回声；或附件区见杂乱不均质回声，其内可测及或未测及完整的胚囊结构，盆腹腔常见多量游离液体。结论经阴道超声对未破裂型卵巢妊娠的术前诊断有一定价值。     

经阴道彩超对诊断早期未破裂型输卵管妊娠的体会

目的:探讨经阴道彩超诊断早期未破裂型输卵管妊娠的价值.方法:回顾分析我院2002年12月～2008年5月行阴道超声检查并经术后病理检查证实的68例早期未破裂型输卵管妊娠的超声声像资料.结果:68例中右侧输卵管妊娠36例,左侧输卵管妊娠32例;根据超声声像图特点分为输卵管环型34例(50.0%),非特异性肿块型 27例(39.7%),胎心、胎囊型7例(10.3%).结论:经阴道彩超分辨率高,能较清楚显示子宫、卵巢及宫内假妊娠囊,区分未破裂输卵管妊娠囊与妊娠黄体,且能较准确地提示输卵管妊娠肿块的大小、部位以及胚芽是否存活,是提高输卵管妊娠检出率的最佳方法.     

经阴道超声诊断未破裂型输卵管妊娠50例分析

目的:探讨经阴道超声对未破裂型输卵管妊娠的早期诊断价值及漏误诊情况。方法:应用经阴道超声对50例未破裂型输卵管妊娠患者进行检查,均经腹腔镜或手术病理证实。结果:经阴道超声对未破裂型输卵管妊娠诊断的准确率为90%(45/50)。结论:经阴道超声检查结合彩色血流测定可提高未破裂输卵管妊娠的早期诊断准确率,能发现临床症状不典型、经腹部超声未发现或不能确定的早期异位妊娠包块,但仍有漏误诊病例。需分析原因,进一步提高确诊率。     

输卵管间质部妊娠45例超声诊断体会

目的:探讨超声检查诊断输卵管间质部妊娠的价值.方法:回顾分析我院收治的经手术和病理证实的45例输卵管间质部妊娠的超声表现.结果:45例输卵管间质部妊娠术前超声检查正确诊断为输卵管间质部妊娠36例,诊断为宫角妊娠2例,输卵管妊娠未准确定位7例,超声诊断准确率80%(36/45),未破裂型15例、流产型17例和破裂型13例.其声像图特征为:子宫不对称增大,一侧宫底部见膨出物,其内为孕囊结构或不均质包块,与宫腔不相通,围绕的肌层不完全,彩色多普勒显示妊娠囊或肿块周围血流信号较丰富,三维超声重建宫腔的形态,显示包块位于子宫角外侧.结论:彩色多普勒超声及三维超声对早期诊断与鉴别诊断输卵管间质部妊娠具有重要的临床价值,三维超声重建宫腔形态能准确定位孕囊位置.     

经阴道彩色多普勒超声对未破裂型输卵管妊娠的诊断价值

目的探讨经阴道彩色多普勒超声(TV-CDFI)在未破裂型输卵管妊娠的诊断与鉴别诊断的价值。方法对75例临床确诊的未破裂型输卵管妊娠的二维声像图、血供分布及血流动力学参数进行回顾性分析。结果未破裂型输卵管妊娠的二维声像图可分为三型,以“输卵管环”为特征性表现(占76%),回声多数(82.5%)高于同侧卵巢实质回声,多数(78.9%)位于卵巢内侧。“输卵管环”型和非特异性包块型以星点形血供分布为主,RI值比较无统计学差异(P>0.05)。胎心胎囊型血供最丰富,流速曲线呈高速低阻型。结论TV-CDFI对未破裂型输卵管妊娠的早期诊断价值较高,是一种有效的方法。     

不典型异位妊娠的声像图分析

目的分析和总结不典型输卵管、宫颈、宫角及卵巢妊娠的声像图特点。方法对临床未知妊娠部位的38例患者行二维、彩色多普勒及脉冲多普勒超声观察,并与手术及病理结果对照分析。结果不典型输卵管妊娠表现为输卵管增粗,横切面可见小的厚壁囊性结构,内无卵黄囊及胚芽,彩色血流显像无明显血流信号;卵巢妊娠未破裂时包块周围常可见卵巢组织,卵巢妊娠发生流产或破裂时,超声诊断较为困难;早期宫颈妊娠子宫外形呈葫芦状,宫颈膨大,可见以实性为主的囊实性包块,宫颈内口关闭;早期宫角妊娠时患侧宫角增大,厚壁的囊性结构与宫腔相通,周围有较厚均匀一致的肌层环绕。结论掌握不典型输卵管妊娠、卵巢妊娠及宫颈、宫角妊娠的声像图特点,可提高超声对异位妊娠的诊断能力。     

经腹与经阴道超声对输卵管妊娠诊断价值的比较研究

目的　研究经腹超声 (TAS)与经阴道超声 (TVS)对输卵管妊娠的诊断价值。方法　 44例输卵管妊娠患者行TAS与TVS ,并与手术结果进行对比分析。结果　输卵管妊娠直接声像图表现为环状回声与附件区非特异性包块 ;TAS对附件包块的诊断敏感性与包块大小相关 ;TAS与TVS对破裂型输卵管妊娠诊断的敏感性无差异 ;TVS对早期未破裂型输卵管妊娠的诊断明显优于TAS。结论　TVS对输卵管妊娠的早期诊断具有重要的临床应用价值。     

Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic.

The purpose of this report is to compare the echogenicity of the tubal ring of an ectopic pregnancy and the corpus luteum with that of the ovary for improved detection of early ectopic pregnancy. In patients with ectopic pregnancy diagnosed at sonography on the basis of the presence of an adnexal tubal ring, echogenicity of the ring was compared with the echogenicity of the ovarian parenchyma. Twenty-six patients with tubal rings containing either a yolk sac or cardiac activity were included. Twenty-three (88%) of the 26 tubal rings had echogenicity equal to or greater than that of ovarian parenchyma. In 13 patients with ectopic pregnancy diagnosed on the basis of an empty tubal ring, 10 rings (77%) were more echogenic than the ovary. In 45 control patients with intrauterine pregnancy, the corpus luteum was more echogenic than the ovary in only 3 (7%). The tubal ring of an ectopic pregnancy is usually more echogenic than ovarian parenchyma, and the corpus luteum is usually equal to or less echogenic than the ovary. Echogenicity of an adnexal mass may help distinguish the tubal ring of an ectopic pregnancy from a corpus luteum.     

Classification of tubal gestations by transvaginal sonography.

Transvaginal sonographic images of tubal pregnancies were correlated with the surgical findings in 191 patients having this condition. The sonographic appearance of the ectopic gestations was classified by the absence or presence of structures such as a 'tubal ring' containing the yolk sac, embryonic structures, heart activity, a sonolucent or irregularly echogenic gestational sac, dilated Fallopian tube with amorphous content, fluid in the pelvis and an empty uterus. The following classifications were made: Type Ia (n = 43) A well-defined 'tubal ring' and a beating heart with or without discrete embryonic or extra-embryonic structures.Type Ib (n = 48) A 'tubal ring' containing embryonic and/or extra-embryonic structures without heart beats. Type II (n = 64) An ill-defined or thin tubal wall containing sonolucent or an irregularly echogenic core but not embryonic or extra-embryonic structures. Type III (n = 28) Free pelvic fluid and an empty uterus in patients with positive serum beta-hCG levels. The outline of the tube cannot be visualized. Surgery revealed unruptured tubal pregnancies in 90 patients of the combined groups of Types Ia and Ib. In one additional patient, a tubal rupture was found. In the Type II patients, 26 tubal pregnancies with blood clots in the tube but no evidence of bleeding into the pelvis, and 38 tubal ruptures or abortions were diagnosed. All Type III patients had ruptured tubal pregnancies or bleeding tubal abortions. In eight patients (4.2%), the only sonographic finding was an empty uterus, and these cases were erroneously diagnosed as not having an ectopic pregnancy (false negatives). There were two false-positive cases in which a tubal ring was detected, and this was related to an hemorrhagic corpus luteum. When used for diagnosing tubal pregnancy, the transvaginal scanning technique (together with beta-hCG in Type III cases) carries a sensitivity of 95.8% and specificity of 99.9%. It is an invaluable tool in the diagnostic work-up and management of patients with suspected ectopic gestation.     

卵巢妊娠的超声分型及术前超声诊断价值

目的探讨卵巢妊娠的超声分型,评估术前超声在卵巢妊娠的诊断和鉴别诊断中的价值。方法对手术及病理证实的14例卵巢妊娠患者进行回顾性研究,根据其超声表现进行分型,并综合分析每一型的鉴别诊断要点。结果根据声像图特征,14例卵巢妊娠可分为两型:破裂型(8例)与未破裂型(6例),后者又可再分为胚囊型(2例)和非均质包块型(4例)。所有未破裂型卵巢妊娠的声像图都有特征性的实性高回声环或包块,其中66.7%(4/6)得以术前经阴道超声诊断。8例破裂型卵巢妊娠的声像图没有特征性的结构和回声,术前超声均诊断为宫外孕破裂或黄体破裂。结论经阴道超声检查对卵巢妊娠的早期诊断十分重要,认识其特征性的超声结构,可以提高术前诊断的准确率。     

经阴道彩色多普勒对未破裂型输卵管妊娠的临床应用价值

目的　探讨经阴道彩色多普勒超声 (TVCD)对未破裂型输卵管妊娠的临床应用价值。方法　应用TVCD诊断未破裂型输卵管妊娠 72例 ,根据超声所见分为未破损型或早期流产型及流产型 ,并对手术所见及保守治疗中监测的结果进行分析。结果　手术组 2 3例 (包括保守治疗中转手术的 9例 ) ,超声诊断符合率 95 .7% (2 2 /2 3 ) ,术中见两型间局部活动性出血情况显著不同 ;保守组 5 8例 ,治疗成功率 84.5 % (4 9/5 8) ,其中未破损型或早期流产型及流产型治疗成功率分别为92 .9%及 62 .5 % ,两型间疗效亦显著不同。结论　TVCD能及早对未破裂型输卵管妊娠做出可靠准确的诊断 ,并可根据超声分型协助临床对保守治疗病例的选择及疗效的监测评价     

子宫腺肌病合并妊娠的超声诊断价值

目的探讨子宫腺肌病合并妊娠时妊娠囊着床位置对妊娠的发展与转归的影响。方法分析42例经病理证实为子宫腺肌病患者的声像图特征,其中12例合并妊娠的患者在超声显示妊娠囊后确定妊娠囊着床位置,追踪观察妊娠的发展与转归。结果42例子宫腺肌病患者,弥漫型10例,局限型32例。合并妊娠12例,其中弥漫型2例,声像图示子宫内膜较薄,早期即出现过期流产;局限型10例,着床于病变宫壁8例,声像图示子宫内膜不对称性增厚,病变宫壁侧子宫内膜厚度较正常侧薄,均出现流产,着床于正常宫壁1例,能发育至足月妊娠分娩,异位妊娠1例。结论超声诊断子宫腺肌病合并妊娠时,孕囊着床位置对囊胚的发育和发展转归有关。     

Ultrasonographic Endometrial Features in Tubal Pregnancy: Are They Predictive Factors of Successful Medical Treatment?

The aim of this study was to explain possible relationships in cases of ectopic pregnancy between sonographic endometrial features and treatment outcome following methotrexate (MTX) injection. A total of 157 cases of unruptured tubal pregnancy were diagnosed and treated systemically with MTX. The sonographic endometrial pattern, endometrial thickness and treatment outcome were retrospectively analyzed. There were four types of endometrial patterns: these were trilaminar, homogeneous, heterogeneous and pseudosac. Success rates following MTX treatment were different for each group: these were 64.7%, 78.4%, 50.0% and 46.2%, respectively (p = 0.0129). And the risk of treatment failure was increased 3.64 times (95% CI 1.56 to 8.49) in heterogeneous thick pattern and 4.24 times (95% CI 1.18 to 15.23) in pseudosac pattern. In conclusion, when tubal pregnancy was seen in a pseudogestational sac pattern or a heterogeneous pattern, the failure rate of medical treatment was increased. This can serve as a reference for considering the decision about medical treatment in women with unruptured tubal pregnancy.