经阴道彩超诊断子宫腔内病变的临床价值分析

目的探讨经阴道彩超诊断子宫腔内病变的临床价值。方法选取2018年1月至2019年9月我院收治的疑似子宫腔内病变患者162例为研究对象,对患者进行经阴道彩超检查以及病理学检查,以病理学检查结果作为诊断金标准,分析经阴道彩超检查诊断子宫腔内病变的临床价值。结果疑似子宫腔内病变162例患者中,病理学检查诊断结果显示,子宫内膜增生48例、子宫内膜息肉66例、子宫黏膜下肌瘤29例、子宫内膜癌19例;阴道超声检查结果显示,子宫内膜增生52例、子宫内膜息肉62例、子宫黏膜下肌瘤28例、子宫内膜癌19例、萎缩性内膜炎1例;阴道超声检查与病理学检查诊断结果一致者共145例(89.51%),诊断结果不一致者共17例(10.49%)。以病理学检查结果为诊断金标准,阴道超声检查诊断子宫腔内病变的灵敏度、特异度、准确率、阳性预测值、阴性预测值均较高;与病理学检查诊断结果的一致性Kappa值也较高。结论经阴道彩超检查与经病理学检查诊断子宫腔内病变的结果具有较高地一致性,诊断的灵敏度、特异度、准确率均较高,具有较高的临床应用价值。     

经阴道彩色多普勒超声检测子宫内膜良性病变的临床分析

目的评价经阴道彩色多普勒超声诊断子宫内膜良性病变的临床意义。方法回顾性分析92例经阴道彩色多普勒超声诊断子宫内膜良性病变患者子宫内膜的声像图及血流动力学特征,并与子宫内膜诊刮病理及宫腔镜检查进行对照。结果超声诊断符合率89.1%（82/92）,其中子宫内膜息肉16例;子宫黏膜下肌瘤25例;子宫内膜增生过长41例;正常子宫内膜分泌期改变10例。结论经阴道彩色多普勒超声是一种有效的诊断及鉴别诊断子宫内膜病变的检查方法。     

老年女性子宫腔积液临床分析

目的 研究老年女性子宫腔积液的超声声像特征、临床特点和病理结果,探讨临床处理对策.方法 应用阴道超声测量老年女性子宫腔积液患者子宫腔内积液深度,结合其子宫内膜厚度、子宫腔积液透声强度及有无内膜癌发病的高危因素,选择子宫腔镜内膜活检、分段诊断刮宫术及子宫腔细胞刷取术.将超声声像资料及子宫腔细胞学和内膜组织学检查的结果进行分析.结果 72例患者中,子宫腔镜检查9例(12.5％);分段诊断刮宫51例(70.8％);子宫腔细胞学检查(子宫腔刷)加诊断性刮宫12例(16.7％).病理诊断:子宫内膜癌7例(9.7％);子宫内膜不典型增生2例(2.8％);内膜良性病变6例(8.3％);子宫腔积脓14例(19.4％);正常内膜单纯积液43例(59.7％).7例子宫内膜癌,2例子宫内膜不典型增生的9例患者中,有1种及1种以上内膜癌高危因素者8例(88.9％),明显高于正常内膜及内膜良性病变组(29/63,46.1％),两者比较差异有统计学意义(x2=4.20,P＜0.05).结论 老年女性是子宫内膜癌的高发人群,密切监测子宫内膜状态有利于尽早发现子宫内膜病变.老年女性对药物、手术的耐受性降低,治疗风险增大.阴道超声及子宫腔细胞学联合检查是一种较好的筛查子宫内膜病变和引流子宫腔积液的方法,可使有创性检查技术的使用率降低,减少诊断性刮宫.     

绝经后阴道出血患者子宫内膜变化及临床意义

绝经后阴道出血临床常见 ,常见原因为子宫肌瘤、宫腔内良恶性病变及炎症等。为提高宫腔内病变的确诊率 ,我们采用经阴道超声及宫腔镜或诊断性刮宫对 6 3例绝经后阴道出血患者的子宫内膜进行了观察 ,现将结果报告如下。资料与方法 :本组年龄 5 2～ 72岁 ,平均 6 1岁 ,门诊检查已     

绝经后阴道流血患者的子宫内膜病理学分类及相关因素分析

目的 分析绝经后阴道流血(PMB)患者子宫内膜的病理学分类及相关因素,探讨诊断子宫内膜癌的实用检测方法.方法 查阅274例PMB患者的病历资料,统计其年龄、绝经年龄、流血前绝经时限、产次、高血压、糖尿病、超声检查结果,诊断性刮宫(诊刮)的病理结果及子宫切除术后病理结果,分析超声检测子宫内膜厚度与子宫内膜病理诊断的关系、诊刮病理诊断与子宫切除术后病理诊断的关系.结果 患者年龄、绝经年龄、产次、高血压、糖尿病及流血前绝经时限与子宫内膜癌的发病未显示良好的相关性(P均＞0.05),超声测得子宫内膜厚度与子宫内膜癌的发病有良好的相关性(P＜0.01).子宫内膜癌患者的子宫内膜明显增厚,与子宫内膜不典型增生、正常子宫内膜、子宫内膜单纯性增生及复杂性增生患者均有统计学差异(P均＜0.01).诊刮病理诊断为子宫内膜不典型增生患者的子宫切除术后病理诊断为子宫内膜癌13例(61.90％).结论 超声测量子宫内膜厚度可作为PMB患者筛查子宫内膜癌的首选方法,辅以诊刮可减少漏诊率,必要时需依据子宫切除术后病理诊断.     

子宫息肉的超声临床与病理分析

目的分析子宫息肉的超声图像特征、临床表现与病理关系,提高超声检出率。方法对资料齐全的66例经手术及病理证实的子宫息肉彩色多普勒超声检查结果及临床资料进行专项回顾性分析。结果子宫息肉分内膜与宫颈息肉两种。内膜息肉超声提示准确率87.6%,表现为4种类型(1)内膜增厚型;(2)宫腔占位型;(3)囊性变型;(4)内膜回声不均型。宫颈息肉超声表现为占位、宫腔积液、宫颈肥大,检出率低。两者临床常见症状为阴道不规则出血或月经紊乱或经期延长。结论经腹超声子宫内膜息肉声像图具有一定特征,结合临床表现经腹超声和妇检对子宫息肉及宫颈管息肉有重要的诊断价值。     

经阴道彩色多普勒超声在子宫内膜病变诊断中的应用

阴道出血为妇科常见疾病,多由子宫内膜病变引起.2007年12月～2009年7月,我们经子宫内膜诊刮或手术病理检查确诊子宫内膜病变患者104例,现回顾性分析其经阴道彩色多普勒超声（TDS）检查结果,旨在探讨后者的诊断价值.     

阴超检测用三苯氧胺治疗绝经后妇女子宫内膜病变的作用

目的 评估用三苯氧胺（Tamoxifen TAM)作为辅助治疗的绝经后乳腺癌妇女,阴超测量其子宫内膜厚度的价值。方法 研究82例患乳腺癌的绝经后妇女,用TAM辅助治疗6月以上的超声检查结果,子宫内膜厚度以两层厚度计算,将内膜厚度≥5mm作为绝经后妇女异常的标准,作为膜活检。结果 82例中22例（28．1％）有阴道流血症状,所有这些病人阴超子宫膜厚度均超过5mm。子宫内膜厚度超过9mm的妇女,内膜有异常组织学发现的比例显示高于内膜厚度低于9mm的妇女（前63．6％,后6．1％,P＜0．001）。子宫内膜厚度＞9mm,同时有阴道流血,将预示子宫内膜有病变。结论 使用TAM的绝经后妇女,阴超子宫内膜厚度超过9mm,同时存在阴道流血是子宫内膜病变的重要信号,必须作内膜活检。鉴于检测子宫内膜的敏感性达86．9％,可见阴超用于研究用TAM治疗的绝经后妇女子宫内膜的变化是十分有效的。     

乳腺癌术后服用三苯氧胺的绝经后子宫内膜息肉的宫腔镜诊治

目的 探讨宫腔镜检（HS）对乳腺癌术后服用三苯氧胺（TAM）的绝经后妇女子宫内膜息内诊治的临床价值。方法 选取乳腺癌术后服用TAM患者72例，分为绝经前组（32例）及绝经后组（40例），比较子宫内膜息肉阴道超声检查（TVS）及HS诊断与病理诊断，并随访子宫内膜息肉＋内膜切除术（TCRP＋E）手术后息肉的复发情况；比较未服用TAM患者（20例）与服用TAM患者（72例）内膜息肉的大小及病理改变。结果 服用TAM组TVS与HS诊断子宫内膜息肉符合率比较，差异有显著性（P〈0.05）；服用TAM组与未服用TAM组、服州TAM绝经前与绝经后组息肉长径比较，差异有显著性（P〈0．05）；服用TAM绝经前与绝经后组、绝经后服用TAM组与未服用TAM组息肉病理类型比较差异有显著性（P〈0．05）；术后6个月。服用TAM组经宫腔镜手术后均术见息肉复发，术后1年，TCRP组复发6例，TCRP＋E组未见复发。结论 对乳腺癌术后服用TAM患者子宫内膜息肉的诊断，HS明显优于TVS；绝经后服用TAM所致内膜息肉体积较大，纤维型较多；TCRP＋E是治疗乳腺癌术后服用TAM的绝经后妇女内膜息肉的金标准。     

经阴道彩色多普勒超声显像对药物流产不全的诊断价值

目的 探讨经阴道彩色多普勒超声显像(CDFI)诊断药物流产不全的价值.方法 应用经阴道彩色多普勒超声显像(CDFI)诊断药流术后组织残留36例,均经清宫证实.结果 36例应用CDFI检查宫腔内残留,可清晰显示宫腔内残留胚胎组织血流,显示近宫腔内膜子宫肌壁处出现局灶性血流丰富区,并可测到低阻型动脉血流频谱,阻力指数(RI)0.45±0.08.结论 CDFI于近宫腔内膜子宫肌壁处显示局灶性血流信号丰富区是诊断药物流产不全的主要声像图表现,可指导临床治疗,有重要的临床应用价值.     

选择性雌激素受体调节剂对绝经后乳腺癌患者子宫内膜的影响

目的 探讨应用选择性雌激素受体调节剂(SERM)的绝经后乳腺癌患者子宫内膜病变相关因素及筛查方法.方法 分析上海市长宁区妇幼保健院2013年1月至2020年6月间84例口服SERM的绝经后乳腺癌患者因经阴道超声(TVS)发现子宫内膜增厚行宫腔镜下子宫内膜活检术患者的临床资料.结果 宫腔镜术前有13例(15.5％)患者有...     

Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery

BACKGROUND: Endoscopic ultrasound is increasingly used for evaluation of pancreatic cancer. The potential of sonographic morphology to differentiate histology type and biological behaviour of pancreatic lesions is doubtful. METHODS: We prospectively studied 115 patients with focal pancreatic lesions on endoscopic ultrasound. Morphology was assessed using Olympus UM3/20/200 echoendoscopes. Histologic confirmation of diagnosis was obtained in all patients. RESULTS: Endoscopic ultrasound correctly diagnosed 18/34 benign and 77/81 malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV for diagnosing malignancy were 95%, 53%, 83%, 83% and 82%, respectively. Endosonographic diagnosis of the lesions (% correct) were: pancreatic cancer, 84 (63.3%); chronic pancreatitis, 14 (71.4%); ampullary cancer, 9 (77.8%); cystadenoma, 5 (80%); ampullary adenoma, 2 (50%); acute pancreatitis, 1 (0). In 13 patients of chronic pancreatitis, diagnosed as cancer, diagnosis was based on absence of sonographic features of chronic pancreatitis (7) or suspected involvement of adjacent structures (6). In 3 patients malignancy was missed owing to features of chronic pancreatitis. Non-suspected neuroendocrine tumours were misjudged in all 10 cases using morphologic criteria as pancreatic cancer (8), cystadenoma and chronic pancreatitis. Accuracy for prediction of metastatic lymph nodes and an advanced pancreatic cancer stage (TxN1 or T3Nx) was 61% and 75%, respectively. On retrospective analysis, a lesion >2 cm, vessel ingrowth, absence of cystic spaces and absence of diffuse pancreatitis were associated with pancreatic cancer. CONCLUSIONS: While overall sensitivity was high, specificity of endoscopic ultrasound for diagnosis of malignancy was low, especially in presence of chronic pancreatitis. In addition, endosonography had only a limited potential to predict the histological type of lesions.     

Endoscopic Ultrasound for Differential Diagnosis of Focal Pancreatic Lesions,Confirmed by Surgery

Background: Endoscopic ultrasound is increasingly used for evaluation of pancreatic cancer. The potential of sonographic morphology to differentiate histology type and biological behaviour of pancreatic lesions is doubtful. Methods: We prospectively studied 115 patients with focal pancreatic lesions on endoscopic ultrasound. Morphology was assessed using Olympus UM3/20/200 echoendoscopes. Histologic confirmation of diagnosis was obtained in all patients. Results: Endoscopic ultrasound correctly diagnosed 18/34 benign and 77/81 malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV for diagnosing malignancy were 95%, 53%, 83%, 83% and 82%, respectively. Endosonographic diagnosis of the lesions (% correct) were: pancreatic cancer, 84 (63.3%); chronic pancreatitis, 14 (71.4%); ampullary cancer, 9 (77.8%); cystadenoma, 5 (80%); ampullary adenoma, 2 (50%); acute pancreatitis, 1 (0). In 13 patients of chronic pancreatitis, diagnosed as cancer, diagnosis was based on absence of sonographic features of chronic pancreatitis (7) or suspected involvement of adjacent structures (6). In 3 patients malignancy was missed owing to features of chronic pancreatitis. Non-suspected neuroendocrine tumours were misjudged in all 10 cases using morphologic criteria as pancreatic cancer (8), cystadenoma and chronic pancreatitis. Accuracy for prediction of metastatic lymph nodes and an advanced pancreatic cancer stage (TxN1 or T3Nx) was 61% and 75%, respectively. On retrospective analysis, a lesion >2 cm, vessel ingrowth, absence of cystic spaces and absence of diffuse pancreatitis were associated with pancreatic cancer. Conclusions: While overall sensitivity was high, specificity of endoscopic ultrasound for diagnosis of malignancy was low, especially in presence of chronic pancreatitis. In addition, endosonography had only a limited potential to predict the histological type of lesions.     

卵巢扭转的超声特征表现及检查技巧分析

目的探讨卵巢扭转的声像图特征性表现及检查技巧。方法应用彩色多普勒超声仪对15例卵巢扭转患者进行检查,分析其二维超声征象,并应用彩色多普勒超声评估卵巢内血流情况,以判断卵巢成活与否。检查结果与手术对比。结果 15例患者患侧卵巢均表现不同程度增大,卵巢基质回声增高,回声分布不均质,其中11例卵巢外带可见"串珠状"卵泡结构,12例合并卵巢良性肿瘤病变,6例可显示血管蒂结构;12例彩色多普勒超声显示卵巢内及血管蒂无血流信号,3例卵巢内有中央静脉血流信号显示。结论超声检查是诊断卵巢扭转的首要影像技术,并能根据卵巢扭转血管蒂及卵巢内血流情况预测卵巢功能情况,为临床诊治提供可靠依据。     

value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion

AIM To describe contrast-enhanced ultrasound(CEUS) features and evaluate differential diagnosis value of CEUS and conventional ultrasound for patients with benign and malignant gallbladder lesions. METHODS This study included 105 gallbladder lesions. Before surgical resection and pathological examination, conventional ultrasound and CEUS were performed to examine for lesions. Then, all the lesions were diagnosed as(1) benign,(2) probably benign,(3) probably malignant or(4) malignant using both conventional ultrasound and CEUS. The CEUS features of these gallbladder lesions were analyzed and diagnostic efficiency between conventional ultrasound and CEUS was compared.RESULTS There were total 17 cases of gallbladder cancer and 88 cases of benign lesion. Some gallbladder lesions had typical characteristics on CEUS(e.g., gallbladder adenomyomatosis had typical characteristics of small nonenhanced areas on CEUS). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were 94.1%, 95.5%, 80.0%, 98.8%and 95.2%, respectively. These were significantly higher than conventional ultrasound(82.4%, 89.8%, 60.9%, 96.3% and 88.6%, respectively). CEUS had an accuracy of 100% for gallbladder sludge and CEUS helped in differential diagnosis among gallbladder polyps, gallbladder adenoma and gallbladder cancer.CONCLUSION CEUS may provide more useful information and improve the diagnosis efficiency for the diagnosis of gallbladder lesions than conventional ultrasound.     

Diagnosis of Testicular Adrenal Rest Tumors on Ultrasound: A Retrospective Study of 15 Cases Report

The aim of this study was to evaluate the imaging features of testicular adrenal rest tumors (TARTs) on baseline ultrasound (BUS).The imaging features of 30 TART lesions pathologically or clinically confirmed in 15 patients who had undergone BUS were evaluated, and the sonographic characteristics of the lesions were analyzed.All 15 cases were bilateral and located near the testicular mediastinum. Approximately 56.7% (17/30) of the TART lesions exhibited homogeneous hypoechogenicity, 36.7% (11/30) of the lesions exhibited heterogeneous hypoechogenicity, and 6.6% (2/30) of the lesions exhibited heterogeneous isoechogenicity. In addition, 76.7% (23/30) of the lesions exhibited a rich blood supply, whereas 23.3% (7/30) of the lesions exhibited a scarce blood supply.The sonographic characteristics of the TARTs were bilateral growth, location adjacent to the testicular mediastinum, hypoechogenicity, and rich blood supply, which may play important roles in early clinical diagnosis.     

行激素补充疗法的绝经后妇女子宫内膜安全性监测

目的　探讨应用激素补充疗法(HRT)的绝经后妇女子宫内膜安全性的监测方法。　方法　对60例绝经后行HRT妇女进行血清雌二醇(E2)测定;阴道B超(TVS)监测子宫体积和子宫内膜厚度;对部分患者行子宫内膜的病理学检查和雌激素受体(ER)、孕激素受体(PR)半定量检测。　结果　应用HRT后,子宫内膜明显增厚,均值从2.8mm升至3.9mm(P＜0.05);E2显著上升,由(20.6±6.9)ng/L升至(33.8±11.7)ng/L（P＜0.01）;子宫内膜厚度与E2呈正相关关系(r=0.94,P＜0.01);20例送检内膜中,2例简单型增生过长,1例复杂型增生过长,余为萎缩型;ER(+)19例,ER(++)1例;PR均为(+)。　结论　根据临床表现,并结合血清E2和TVS检测子宫内膜厚度,可对子宫内膜安全性进行初步评估;当E2＞45ng/L,子宫内膜厚度≥5mm时,则需进一步行子宫内膜病理学检查和ER测定。     

经阴道超声、宫腔镜检查在绝经后阴道流血病因诊断中的价值

目的探讨经阴道超声（TVS）、宫腔镜检查在绝经后阴道流血（PMB）病因诊断中的价值。方法分析210例PMB患者的TVS和宫腔镜检查结果,并与病理检查结果作对比分析。结果TVS和宫腔镜检查并经病理检查确认,PMB的病因中子宫内膜良性病变占86．67％、子宫恶性肿瘤占13．33％。TVS诊断子宫内膜异常的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为99．16％、51．65％、72．84％、97．92％及78．57％,宫腔镜分别为100％、91．21％、93．70％、100％及96．19％。结论TVS及宫腔镜对PMB病因诊断的敏感性都很高,宫腔镜的特异性高于TVS。     

超声内镜引导下细针穿刺在消化系占位性病变诊断中的价值

目的 探讨超声内镜引导下的细针穿刺检查(EUS-FNA)在消化系占位性病变诊断中的价值.方法 2007年5月-2008年12月对68例患者行超声内镜检查及超声内镜引导下的细针穿刺检查,对比细胞学和(或)病理学检查结果与术后病理结果及随访结果.结果 EUS-FNA细胞取材成功率91.18%(62/68).其中病灶位于食管4例(6.45%,4/62),胃19例(30.65%,19/62),直肠19例(30.65%,19/62),肝脏3例(4.84%,3/62),纵隔4例(6.45%,4/62),淋巴结13例(20.97%,13/62).40例患者细胞学检查结果阳性,阳性率为64.52%(40/62).22例患者获得组织碎片或细条行病理学检查,组织获得率为35.48%(22/62),其中10例病理学检查结果阳性,阳性率为45.45%(10/22).与术后病理结果及长期随访结果对照,EUS-FNA对消化系占位性病变诊断的准确率为85.48%.敏感度为90.91%,特异度为100.00%,阴性预测值为57.14%,阳性预测值为100.00%.结论 在消化系占位性病变诊断中,EUS-FNA是一项安全、有效、准确的诊断及鉴别诊断方法,在细胞学诊断中具有重要临床价值.