宫腹腔镜下子宫输卵管通液检查及子宫输卵管碘水造影在不孕症诊断中的应用

目的探讨宫腹腔镜下子宫输卵管通液检查与子宫输卵管碘水造影对不孕症的诊断价值。方法随机将输卵管病变致不孕症的84例患者分为2组,每组42例。对照组采用子宫输卵管碘水造影,观察组采用宫腹腔镜下子宫输卵管通液检查。比较2组的诊断效果。结果观察组诊断结果与术后结果的符合率明显高于对照组;输卵管病变导致的不孕症误诊率及漏诊率明显低于对照组。结论应用宫腹腔镜下子宫输卵管通液检查对不孕症诊断具有较高的临床价值。     

腔内超声节段分析法诊断先天性子宫及阴道畸形

目的探讨应用腔内(经阴道或经直肠)三维超声节段分析法诊断先天性子宫及阴道畸形的价值。方法将226例先天性子宫及阴道畸形患者分为A、B两组。A组154例,采用回顾性分析,对比分析其经腹或腔内二维超声检查的结果及临床结局;B组72例,采用前瞻性研究,对比分析应用节段分析法经腔内三维超声检查的结果及临床结局。结果 A组154例中,二维超声检查诊断符合率为64.29%(99/154),漏、误诊55例,未进行详细分类;B组72例中,腔内三维超声节段分析法的诊断符合率达95.83%(69/72),漏、误诊3例。结论应用腔内三维超声节段分析法可明显提高对于先天性子宫及阴道畸形的定性及分类诊断的准确性。     

子宫输卵管造影在不育患者中诊断输卵管通畅程度的临床价值

目的探讨子宫输卵管造影(HSG)诊断输卵管病理的准确性及临床应用价值。方法选择我院2009年7～12月不育患者119例,采用HSG和腹腔镜两种方法检查输卵管237支,交叉分析二者检查输卵管病理改变的结果,评价HSG的临床应用价值。结果 HSG的总符合率为73.0%,灵敏度为93.4%,特异度为45.0%,阳性似然比1.7,阴性似然比0.1;其中造影检查提示输卵管通畅的灵敏度和特异度分别为45.0%和93.0%,阳性似然比6.4,阴性似然比0.6;输卵管积水的灵敏度和特异度分别为85.4%和76.3%,阳性似然比3.6,阴性似然比0.2;输卵管不通的灵敏度和特异度分别为43.5%和65.2%,阳性似然比1.3,阴性似然比0.9;通而不畅的灵敏度和特异度分别为56.0%和42.0%,阳性似然比1.0,阴性似然比0.9。结论 HSG检查输卵管积水的准确性良好,输卵管通畅的特异性较高;对输卵管不通畅或者通而不畅的患者需进一步腹腔镜检查。     

经阴道三维超声成像在先天性子宫畸形中的诊断价值研究

目的探讨经阴道三维超声成像应用于先天性子宫畸形中的诊断价值。方法选取2017年12月至2019年12月82例疑似先天性子宫畸形者进行研究,均采用经阴道三维超声(观察组)、二维超声(对照组)检查,并以宫腹腔镜和临床手术等作为最终诊断结果。比较两者诊断效果。结果观察组在完全纵隔子宫、不完全纵隔子宫、弓形子宫的诊断准确率及总诊断准确率明显高于对照组,P0.05。结论经阴道三维超声成像在先天性子宫畸形中具有较高诊断价值,其可较好地显示患者宫底部外观形态等状况,从而提高诊断准确率。     

宫腔镜联合B超诊断24例子宫畸形

目的探讨子宫畸形,尤其少女子宫畸形的宫腔镜诊断可行性. 方法选择24例子宫畸形采用宫腔镜联合B超检查确定子宫畸形的类型. 结果确诊双角子宫8例,单宫颈纵隔子宫10例,双宫颈单宫体纵隔子宫2例,青春期残角子宫4例. 结论宫腔镜联合B超诊断子宫畸形明确,且适用于少女.     

228例不孕症子宫-输卵管碘油造影与宫-腹腔镜联合通畅试验检查诊断符合率分析

目的探讨不孕症患者子宫-输卵管造影（hysterosalpingography,HSG）诊断与宫-腹腔镜诊断的符合率。方法对228例不孕症HSG检查为输卵管梗阻、输卵管积水、盆腔粘连者再进行宫-腹腔镜联合通畅试验检查。结果HSG诊断输卵管梗阻与宫-腹腔镜检查的符合率为58.7%（64/109）,诊断伞端积水的符合率为90.8%（109/120）,诊断盆腔粘连的符合率为78.5%（153/195）。结论宫-腹腔镜联合通畅试验检查准确率高于HSG检查。     

子宫输卵管造影诊断输卵管因素不孕的价值分析

目的 探讨子宫输卵管造影(HSG)在输卵管因素不孕患者中的诊断价值. 方法 回顾性分析24位医生对64例不孕患者术前HSG图像的判读与宫腹腔镜手术所见资料. 结果 共124条输卵管纳入分析,HSG诊断与宫腹腔镜检查结果的总符合率为70.8％,其诊断输卵管通畅性的总敏感度为65.5％,特异度为76.2％.HSG诊断输卵管通畅、积水及阻塞的符合率有统计学差异(P＜0.05),原发或继发不孕、有无手术史、输卵管周围有无粘连对HSG诊断符合率均有显著影响(P＜0.05). 结论 HSG是输卵管性不孕有价值的筛查手段,尤其适合原发不孕、无手术史及输卵管周围无粘连者.     

经阴道实时三维超声成像诊断先天性子宫畸形的临床价值

目的探讨经阴道实时三维超声诊断先天性子宫畸形的临床价值。方法应用经阴道实时三维超声容积探头,对2007年11月至2011年5月间因已婚不孕、反复习惯性流产的子宫发育情况进行检查。结果发现纵隔子宫124例,双子宫16例,双角子宫11例,单角子宫15例,残角子宫9例,弓形子宫2例。结论经阴道实时三维超声诊断子宫畸形快速、简便、明确、重复性好、无射线。尤其是纵隔子宫更具有特征性的三维声像特点,是诊断子宫畸形并且区分畸形种类的最佳检查方法,可替代子宫输卵管碘油造影及宫腔镜检查等有创手段,值得在子宫畸形者中应用,有利于优生优育,减少流产儿的发生。     

子宫输卵管造影及腹腔镜检查在输卵管性不孕的诊断价值研究

目的:探讨子宫输卵管造影(HSG)与腹腔镜检查在诊断输卵管性不孕症中的临床价值。方法:回顾性分析不孕症患者100例,先后接受HSG和腹腔镜检查,分析比较其检查结果。结果:HSG宫腔异常检测率为11.0%(11/100),腹腔镜检出率35.0%(35/100),两者比较差异有高度统计学意义(P<0.01)。HSG通畅符合率为60.0%,诊断特异性为38.5%(5/13),灵敏度为65.0%(52/80);腹腔镜检查通畅符合率为80.0%,诊断特异性为16.1%(5/31),灵敏度为86.7%(52/60),两者比较差异均有统计学意义(P<0.05)。HSG盆腔病变检出率为24.0%,腹腔镜检出率81.0%,两者比较差异有高度统计学意义(P<0.01)。结论:腹腔镜检查可直视下直接寻找导致不孕的原因,准确性高,有利于宫腹腔内病变的治疗,术后妊娠率高,是目前不孕症诊治的最佳方法之一,值得临床上推广。     

胆囊癌误诊2例分析

目的分析胆囊癌的临床特点及误诊原因，提高对胆囊癌的诊断正确率。方法回顾我院2004～2005年收治2例胆囊癌病例资料，分析误诊原因并查阅相关文献。结果2例胆囊癌分别误诊为胆囊息肉及胆囊结石，误诊率高。结论对胆囊癌的认识不足，辅助检查的正确率较低是造成误诊率较高的主要原因。     

Prevention of spontaneous abortion by cervical suture of the malformed uterus

In a group of 82 women with congenital or acquired uterine malformation (such as intrauterine adhesions or uterus myomatosus), cerclage was successfully performed according to the McDonald method. The percentage of term deliveries increased from 29.8% to 69.2% and the percentage of spontaneous abortions decreased from 67.9% to 6.6%. Cerclage should be performed in all cases of uterine malformation, even if the patient previously suffered only one spontaneous abortion, as this is the best way to end the pregnancy with a viable fetus.     

不同子宫输卵管造影结果对选择宫腔镜-注水腹腔镜的意义

目的探讨不同子宫输卵管造影（hysterosalpingography,HSG）结果后行官腔镜联合经阴道注水腹腔镜（hysteroscopy and transvaginal hydrolaparoscopy,Hys-THL）检查的意义。方法回顾性研究2009年4月～2011年12月HSG提示不同程度输卵管和子宫异常而接受Hys—THL检查的364例不孕患者（共693条输卵管）的临床资料,比较2种检查方法的符合情况。结果以Hys—THL为金标准,HSG对子宫形态诊断的敏感性和特异性分别为100．0％（13／13）,99．4％（349／351）。对输卵管通畅、间质部阻塞和积水诊断的敏感性分别为67．0％（390／582）、68．1％（49／72）和53．8％（21／39）;特异性分别为72．0％（80／111）、69．4％（431／621）和98．2％（642／654）。结论对于HSG提示输卵管间质部阻塞的患者,IVF并非首选的助孕方式,Hys—THL可能为更好的选择。但对HSG提示有输卵管积水的患者,并不推荐进一步采取Hys—THL检查。     

A tumor of an ectopic ureter mimicking uterine cervix adenocarcinoma: case report and brief review

Single system ectopic ureter is a rare congenital malformation of the urinary tract, frequently associated with genital tract malformations. We report the first case of an adenocarcinoma arising in an ectopic ureter in a woman and mimicking uterine cervical adenocarcinoma. A 34-year-old woman, previously diagnosed as having bicornuate uterus, presented with post-coital bleeding. On gynecological exam, there were two cervixes with a small nodule on the left cervix. After nodule biopsy, the initial diagnosis was adenocarcinoma of the uterine cervix. Pelvic ultrasound and magnetic resonance imaging demonstrated an ectopic tumoral ureter draining a dysplastic pelvic kidney and inserted in the cervix of a bicornuate uterus. The patient was treated by radical hysterectomy and left nephroureterectomy. Pathological exam demonstrated an adenocarcinoma arising in the ectopic ureter. We suggest that this case could be an argument for recommending regular follow-up for women with ectopic ureter for detecting malignant transformation.     

A rare case of multiple leiomyomas on rudimentary uterus in a woman with Mayer Rokitansky Kuster Hauser (MRKH) syndrome: A challenging diagnosis and laparoscopic approach

Mayer Rokitansky Kuster Hauser (MRKH) syndrome is a congenital disorder involving reproductive, genitourinary, bone, and cardiac malformation. The incidence is 1 in 4000–5000 females livebirths. The phenotype is female 46 XX karyotype, normal secondary sexual characteristics, and normal functional ovaries. The occurrence of leiomyoma in uterine remnant in MRKH syndrome is a very rare case, even though several cases have been reported. The diagnosis and management approach, in this case, is quite challenging. Here, we report a 38 years old female who represents multiple leiomyomas on the rudimentary uterus, then we did laparoscopic removal of the fibroids and adjacent rudimentary uterus.     

A Case of Unique Communication Between Blind-Ending Ectopic Ureter and Ipsilateral Hemi-Hematocolpometra in Uterus Didelphys

Uterus didelphys with double vagina and hemi-vaginal atresia is a rare syndrome of congenital anomalies. A 17-year-old girl had a right blind-ending ectopic ureter, the proximal end of which communicated with the ipsilateral uterine cervix of uterus didelphys. The patient presented with vaginal urinary incontinence after incision of the vaginal wall for right hemi-hematocolpometra. Following various examinations, the ipsilateral kidney was found to be absent. The ectopic ureter and communicating duct were resected, and the fistula was closed. The genesis of malformation of the female genitalia and urinary tract resulting in such a unique communication is discussed. The importance of preoperative meticulous examinations, including cysto-genitography, pelvic magnetic resonance imaging and panendoscopy with the patient under anesthesia, is emphasized.     

耳模型无创矫正新生儿先天性耳廓畸形的疗效评估

目的 评估先天性耳廓畸形耳模型矫正治疗的临床效果，评估其应用价值。方法 选取2020年1月-12月我院收治的68例先天性耳廓畸形的患儿为研究对象，合计119只畸形耳廓，所有患儿均行耳廓畸形耳模型无创矫正治疗，治疗后3个月，统计患儿治疗时间、临床效果、并发症及复发情况。结果 68例患儿治疗时间（6.67±0.89）周，并发症发生率为10.92%，治疗总有效率100.00%，无复发患儿。结论 耳模型无创矫正治疗先天性耳廓畸形疗效显著，并发症发生率低，安全性高，值得临床应用推广。     

Endometrial ablation for the treatment of menorrhagia: a comparison of patients with normal, enlarged, and fibroid uteri.

One hundred sixty-one patients underwent endometrial ablation with the Nd:YAG laser for the treatment of refractory menorrhagia. Patients were divided into one of three groups: those with a normal-sized uterus; those with an enlarged uterus (greater than 10 cm); and those with uterine fibroids, which had been documented clinically, ultrasonographically, or by a combination of hysteroscopy and laparoscopy or by one or the other. All patients were considered candidates for hysterectomy. Both preoperatively and postoperatively, patients monitored their menstrual cycles and evaluated their flow according to predetermined categories of amenorrhea, light flow, normal flow, heavy flow, and severe flow. After treatment, 68% of patients with normal-sized uterus and 91% of patients with an enlarged uterus (greater than 10 cm) and 88% of patients with uterine fibroids became amenorrheic or had light flow. None of the patients in this last group have had to undergo hysterectomy. This study indicates that the patient with an enlarged or fibroid uterus may not have contraindications for endometrial ablation. Endometrial ablation may be effective in at least temporarily controlling bleeding in those patients with enlarged or myomatous uterus.     

女性不育输卵管检查法评估

分析了我院女性不育门诊为了解输卵管情况进行的输卵管通液、子宫输卵管碘油造影及腹腔镜检查法。结果3种检查方法的准确率分别为83％、92％和90％。认为3种方法各有优缺点,输卵管通液只能了解输卵管通畅与否,无助于病因诊断;子宫输卵管碘油造影能看到官腔及输卵管腔内的形态,对生殖道结核有特异的诊断价值;腹腔镜能看到盆腔与输卵管外形,对外在型子宫内膜异位症的诊断准确率高。分析了3种方法与妊娠的关系,其共同特点是操作后半年内妊娠率较高(44.9%～62.0%)。讨论了在不育检查中如何选择输卵管检查法,以提高各种方法的诊断价值与妊娠率。