三维超声对大体积前列腺TURP术中出血的预测价值

目的探讨三维能量多普勒超声(3D-PDU)预测大体积前列腺增生(BPH)经尿道前列腺切除术(TURP)术中出血的可行性。方法对34例大体积BPH病人术前进行3D-PDU检查,获得:血管形成指数(VI),血流指数(FI),血管形成-血流指数(VFI);TURP术中记录出血参数;切除标本计数微血管密度(MVD)。比较各参数的相关性。结果 VI、VFI与切除1g前列腺组织出血量、MVD呈正相关(P0.01);VFI作为预测TURP术中输血的指标,敏感性、特异性分别为0.625、0.962。结论 3D-PDU对评估大体积BPH的血流具有临床意义。     

彩色多普勒血流定量技术评价系统性红斑狼疮患者肾皮质血流

目的探讨多普勒超声血流定量技术评价系统性红斑狼疮（SLE）患者肾脏皮质血流灌注的临床价值。方法选取SLE患者21例（SLE组）,22名健康人作为正常对照组。采用Philips IU22超声诊断仪测量肾叶间动脉、小叶间动脉阻力指数（RI）;以定量分析软件计算反映。肾脏皮质血流灌注的各项指数：血管指数（VI）、血流指数（FI）和血管一血流指数（VFI）。并对SLE组与正常对照组各指标进行比较分析。结果SLE患者肾皮质彩色血流信号较对照组稀疏,血流束纤细,到达皮质边缘的彩色血流信号较正常组减少;SLE患者叶间动脉、小叶间动脉R1值与正常对照组差异无统计学意义（P〉0．05）,VI、FI、VFI值均低于正常对照组,差异有统计学意义（VI、VFI,P〈0．01;FI,P=0．01）。结论SLE患者的肾血流灌注显著低于正常对照组;彩色多普勒超声血流定量技术为诊断SLE肾损害提供了一种便捷、实时、无创的新方法。     

经阴道三维能量多普勒超声评价卵巢储备功能

目的探讨经阴道三维能量多普勒超声评价卵巢储备功能的价值。方法回顾性分析36例卵巢早衰(POF)患者(POF组)与40名无POF者(对照组)的临床资料,应用三维能量多普勒超声和QLab量化软件对两组的卵巢功能进行定量测量,包括窦卵泡数(AFC)、卵巢体积(OV)、卵巢基质血管化指数(VI)、血流指数(FI)、彩色强度总和(VFI)参数,并检测患者同期血清雌二醇(E2)、基础卵泡刺激素(FSH)的水平。结果对照组AFC、OV、VI、FI、VFI均高于POF组(t=3.95、6.31、6.03、17.26、4.18,P均<0.05)。POF组AFC、OV、VI、FI、VFI与FSH水平呈负相关(r=―0.41、―0.42、―0.55、―0.38、―0.45,P均<0.05),而与E2水平无相关性(r=0.12、0.12、0.24、0.19、0.30,P均>0.05)。结论卵巢早衰患者AFC、OV、VI、FI、VFI均与FSH水平密切相关。经阴道三维能量多普勒超声评价卵巢储备功能有重要临床价值。     

短期应用度他雄胺对前列腺内血流及TURP术中出血的影响

目的探讨经尿道前列腺电切术(TURP)术前短期应用度他雄胺减少术中出血的可行性。方法将115名良性前列腺增生(BPH)患者随机分为对照组和实验组。对照组病人术前无药物治疗史,实验组病人服用度他雄胺(0.5mg/d,共8周)。术前进行三维能量多普勒超声成像技术(3D-PDU)检查,获得:血管形成指数(VI),血流指数(FI),血管形成-血流指数(VFI);TURP术中记录出血参数;切除标本计数MVD。结果在大体积BPH(≥80mL)中,实验组与对照组比较,MVD、VI、VFI、总出血量(TBL)和切除1g前列腺组织出血量(BL/g)差异均具有统计学意义(P0.01)。结论术前短期应用度他雄胺可以明显减少大体积BPH(≥80mL)TURP术中出血。     

三维超声造影在诊断宫腔粘连中的应用价值

目的探讨三维超声造影(3D-CEUS)在诊断宫腔粘中的应用价值。方法对71例经阴道三维超声(3DTVS)检查提示怀疑宫腔粘连的患者行宫腔镜检查,以宫腔镜检查为金标准,比较两者诊断宫腔粘连的准确率;在月经20~23d对3D-TVS诊断疑似宫腔粘连的患者行声诺维(sonovue)3D-CEUS检查,获得内膜厚度、容积(V)、回声强度(MG)、血管指数(VI)、血流指数(FI)、血管血流综合指数(VFI)等相关指标;对经sonovue 3D-CEUS疑似宫腔粘连的的患者,于月经第3~7天行宫腔镜检查,回顾性分析不同程度宫腔粘连的患者与3D-CEUS获得的V、MG、VI、FI、VFI值的关系。结果 3DTVS与宫腔镜比较,3D-TVS诊断宫腔粘连的符合率是90.14%;宫腔镜检查轻、中、重度3组,各组间子宫内膜厚度和容积比较均有显著性差异(P0.05);轻度和重度组子宫内膜MG分别(39.75±7.46)、(45.64±6.10),其差异具有统计学意义(P0.05);轻度和重度组组间子宫内膜VI、FI、VFI相比较,差异均具有统计学意义(P0.05),而中度组与其它两组比较均无显著性差异(P0.05)。经静脉推注30mg sonovue造影剂后,3D-CEUS检查结果显示:3组内膜血流VI值分别较造影前显著增加(P0.001),轻度和重度、中度和重度组的内膜VI、FI、VFI相比较,差异均具有统计学意义(P0.05)。结论 3DCEUS检查不仅可以较准确的诊断宫腔粘连,而且通过计算机辅助分析技术对宫腔粘连患者子宫内膜V、MG、VI、FI、VFI进行定量测量,对宫腔粘连的程度有更客观的评价。     

三维超声预测TURP术中出血的临床研究

目的:探讨三维能量多普勒超声预测经尿道前列腺电切术(TURP)术中出血的价值。方法:本实验对115例BPH患者术前进行超声检查,获得血管形成指数(VI)、血流指数(FI)、血管形成血流指数(VFI)、阻力指数(RI)及收缩期峰值血流速度(PSV)。TURP术中记录出血相关参数;术后切除标本计数MVD。比较超声定量参数、术中出血参数及微血管密度(MVD)的相关性。结果:VI、VFI与切除单位重量前列腺组织出血量正相关,相关系数为0.882、0.885(P0.01);与MVD正相关,相关系数为0.870、0.830(P0.01)。VI、VFI作为预测TURP术中出血量超过300ml的指标时,敏感性为0.692和0.641,特异性为0.697及0.737。结论:三维能量多普勒超声对评估前列腺内的血流具有临床意义。     

不育女性心理压力对子宫内膜及内膜下血流的影响

目的探讨不育女性的心理压力对子宫内膜及内膜下血流的影响。方法选取2015年4~9月在我院生殖中心门诊就诊的初诊不育女性155例,采用三维能量多普勒超声测量子宫内膜及内膜下容积、血管化指数(VI)、血流指数(FI)及血管化血流指数(VFI);采用中文版FPI量表对其进行心理压力的测评,分析心理压力大小对子宫内膜及内膜下血流的影响。结果有无子女生活方式的取舍与子宫内膜下FI(r=-0.163)、性关注与子宫内膜FI(r=-0.171)、FPI总分与子宫内膜FI(r=-0.163)、FPI总分与子宫内膜下FI(r=-0.178)具有相关性(P均0.05)。结论心理压力与子宫内膜及内膜下血流相关指数存在相关性,心理干预能否改善子宫内膜血流有待进一步研究。     

三维能量多普勒超声联合MR弥散加权成像鉴别FIGO ⅠA、ⅠB及ⅡA期宫颈癌

目的 分析三维能量多普勒超声(3D-PDU)联合MR弥散加权成像(DWI)术前鉴别国际妇产联盟(FIGO)ⅠA、ⅠB及ⅡA期宫颈癌的价值。方法 回顾性分析60例经术后病理确诊宫颈癌患者的术前宫颈3D-PDU及DWI,其中FIGO分期ⅠA期19例(ⅠA期组),ⅠB期26例(ⅠB期组),ⅡA期15例(ⅡA期组)。比较各组病灶相关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)及DWI参数表观弥散系数(ADC)和指数ADC (eADC)的差异;以logistic回归及受试者工作特征(ROC)曲线评价3D-PDU、DWI及二者联合鉴别FIGO ⅠA、ⅠB及ⅡA期宫颈癌的效能。结果 FIGO ⅠA、ⅠB及ⅡA期宫颈癌中,随分期级别提高,VI、FI及VFI均逐渐升高,ADC逐渐降低而eADC逐渐升高(P均＜0.05)。3D-PDU、DWI及二者联合鉴别宫颈癌FIGO ⅠA、ⅠB及ⅡA期宫颈癌模型,即logit (PRE)_3D-PDU、logit (PRE)_DWI及logit (PRE)_联合中,logit (PRE)_联合模型判断宫颈癌FIGO分期的曲线下面积(AUC)为0.89,大于logit (PRE)_3D-PDU及logit (PRE)_DWI(0.78、0.75,Z＝4.73、3.55,P均＜0.05),其诊断敏感度及特异度亦均高于logit (PRE)_3D-PDU及logit (PRE)_DWI(P均＜0.05)。结论 三维能量多普勒超声联合DWI可于术前有效鉴别FIGO ⅠA、ⅠB及ⅡA期宫颈癌。     

三维超声联合三维能量多普勒超声评估子宫腺肌病不孕患者子宫内膜-肌层交界区预测体外受精-胚胎移植妊娠结局

目的 观察三维超声联合三维能量多普勒超声(3D-PDUS)评估子宫腺肌病(AD)不孕患者子宫内膜-肌层交界区(EMI)形态及血流用于预测体外受精-胚胎移植(IVF-ET)妊娠结局的价值。方法 回顾性分析160例接受IVF-ET的不孕妇女,其中60例合并AD(AD组)、100例为单纯不孕(对照组),均于移植日接受三维超声联合3D-PDUS检查;比较组间及AD组内妊娠(23例)与未妊娠亚组(37例)移植日EMI超声参数,采用二元logistic回归分析筛选AD患者妊娠结局的独立影响因素,以受试者工作特征(ROC)曲线评估其预测IVF-ET妊娠结局的效能。结果 AD组移植日EMI形态异常比例高于、血流指数(FI)低于对照组(P均＜0.05)。AD组内妊娠亚组EMI平均厚度、容积、血管化指数(VI)、血流指数FI、血管化血流指数(VFI)均高于,而形态异常比例低于未妊娠亚组(P均＜0.05)。多因素logistic回归分析结果显示,EMI容积[OR=0.240,95%CI(0.105,0.551),P＜0.05]及VFI[OR=0.051,95%CI(0.008,0.334),P＜0.05]均与AD患者IVF-ET妊娠结局独立相关。ROC曲线显示,以EMI容积及VFI预测AD患者妊娠结局的曲线下面积(AUC)分别为0.776及0.761。结论 三维超声联合3D-PDUS观察AD不孕患者EMI形态及血流可有效预测其IVF-ET妊娠结局。     

芬吗通联合用药改善多囊卵巢综合征患者冻融胚胎移植周期子宫内膜血流及妊娠结局的研究

目的探讨芬吗通不同给药方案对多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期子宫内膜血流及妊娠结局的影响。方法选择2015年6月至2016年6月于山东中医药大学附属医院生殖与遗传中心接受冻融胚胎移植的PCOS患者为研究对象,随机分为补佳乐组(A组81个周期)、芬吗通口服组(B组78个周期)、芬吗通口服联合阴道给药组(C组86个周期),共245个周期,应用经阴道三维能量多普勒超声于黄体酮诱导内膜向分泌期转化日检测子宫内膜厚度及子宫内膜容积(V)、子宫内膜内血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI),分析不同方案下内膜转化日雌激素水平、超声参数及临床妊娠率。结果 (1)3组患者诱导内膜向分泌期转化日子宫内膜厚度、容积,各组间比较差异无统计学意义(P0.05);诱导内膜向分泌期转化日血流参数:VI、FI、VFI值C组较A组和B组高,差异有统计学意义(P0.05);A组和B组组间比较,差异无统计学意义(P0.05)。(2)A组81个周期,移植79个周期;B组78个周期,移植77个周期;C组86个周期,移植85个周期。3组患者周期取消率、雌激素用药时间(至转化日)、诱导内膜向分泌期转化日P、LH水平、流产率各组间比较,差异无统计学意义(P0.05);诱导内膜向分泌期转化日雌激素水平、着床率、临床妊娠率:C组高于A组和B组,差异有统计学意义(P0.05),A组与B组组间比较,差异无统计学意义(P0.05)。结论芬吗通口服联合阴道给药可明显增加体内雌激素水平,生物利用度高,能够促进子宫内膜内螺旋动脉的增生,增加子宫内膜血流,明显提高PCOS患者FET周期的着床率及临床妊娠率,是一种较理想的子宫内膜准备方案。     

宫腔灌注粒细胞集落刺激因子在不明原因反复种植失败患者中的应用评价

目的 研究宫腔灌注粒细胞集落刺激因子(G-CSF)对不明原因反复种植失败(URIF)患者的子宫内膜容受性及妊娠结局的影响.方法 采用前瞻性随机对照的研究方法,选择2019年1月至2020年9月期间于大连市妇女儿童医疗中心就诊的,拟行人工周期-冻融胚胎移植的U RIF患者120例,将患者随机分为试验组和对照组(每组各60...     

Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta

BackgroundAccurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs.MethodsAntenatal cases of suspected placenta accreta were collected prospectively in a single-site tertiary delivery center. Women with clinical signs of placenta accreta (placenta previa, number of previous cesarean deliveries and/or ultrasound suspicion of placenta accreta) were included. The diagnosis of accreta was confirmed surgically. The primary endpoint was the proportion of surgically-diagnosed placenta accreta among all suspected cases. Logistic regression modeling was performed to assess preoperative risk factors for placenta accreta. The risk score was tested on a receiver operator characteristic curve to identify subjects with placenta accreta and the optimum cut-point was chosen.ResultsOver nine years, 92 suspected accreta cases were identified from 46 623 deliveries (0.2%). The diagnosis was confirmed at surgery in 52/92 cases (56%) and there were no maternal deaths. Blood transfusion requirements were greater in patients with placenta accreta versus patients without placenta accreta (median 7 [range 0–25, interquartile range 3–10] versus 0 [0–6, 0–2] units of blood, P <0.0001). Area under the curve of the receiver operator characteristic curve was 0.846, with contribution from three variables (placenta previa, number of previous cesarean deliveries and ultrasound suspicion), each with a P value <0.05. From the ROC curve a cut-point with 100% sensitivity and specificity 25% (95% CI 12.69%–41.20%) was achieved, compared with 86.6% sensitivity (95% CI 74.21%–94.41%) and 60.0% specificity (95% CI 43.33%–75.14%) using ultrasound alone.ConclusionsCombining diagnostic features associated with placenta accreta through mathematical modeling has better positive predictive value than ultrasound alone.     

Effect of decreased fetal perfusion on placental clearance of volatile anesthetics in a dual perfused human placental cotyledon model

Placental transfer of volatile anesthetics is a critical issue in managing fetal distress during cesarean section under general anesthesia. Using dual perfused human placental cotyledons obtained from parturients undergoing elective cesarean section (n = 5), we investigated the effect of decreased fetal perfusion on placental clearance of sevoflurane and isoflurane. Keeping the maternal flow rate fixed, fetal flow rate was consecutively decreased from 3 ml/min (control perfusion) to 2 ml/min (intermediate perfusion) and to 1 ml/min (hypoperfusion). Placental transfer was assessed by the clearance of anesthetics by the placenta, defined by the ratio of anesthetic concentration in fetal vein and maternal artery, multiplied by fetal flow rate. Placental clearance was compared between different fetal perfusion states and anesthetics. Hypoperfusion resulted in a lower clearance of sevoflurane and isoflurane compared with control (P = 0.002, P < 0.001) and intermediate (P = 0.04, P = 0.018) perfusion. Clearances of sevoflurane and isoflurane were comparable during control perfusion (P = 0.93), intermediate perfusion (P = 1.00), and hypoperfusion (P = 0.88). Thus, maintenance of volatile anesthetics at a marginally low concentration may not be necessary when fetal distress is observed during emergency cesarean delivery because placental transfer of volatile anesthetics decreases with decreasing fetal perfusion.     

彩色多普勒血流显像联合声触诊组织量化技术评价经颈静脉肝内门体静脉分流术术后疗效

目的探讨CDFI与声触诊组织量化(VTQ)技术评价经颈静脉肝内门体静脉分流术(TIPS)疗效的可行性。方法对24例接受TIPS的肝硬化门静脉高压患者行常规超声及CDFI检查,测量手术前后脾脏指数和门静脉及脾静脉的血流动力学参数,同时采用VTQ技术测量手术前后脾脏剪切波速度(SWV),评价TIPS疗效。结果 TIPS术后门静脉压力较术前明显降低(P<0.01);门静脉和脾静脉主干流速及流量显著增加(P均<0.01),充血指数明显减小(P均<0.01);脾脏SWV值明显减小(P<0.01);脾脏体积亦明显缩小,手术前、后脾脏指数差异有统计学意义(P<0.01)。结论 CDFI可检测TIPS前后门静脉系统及支架内血流情况,VTQ技术可无创定量检测脾脏硬度,间接反映门静脉压力;两者结合对评价TIPS疗效具有重要临床价值。     

凶险性前置胎盘合并胎盘植入剖宫产术中腹主动脉远端球囊阻断的临床疗效

目的分析剖宫产术中腹主动脉远端球囊阻断对于治疗凶险性前置胎盘合并胎盘植入的临床疗效。方法回顾性分析72例凶险性前置胎盘合并胎盘植入产妇的资料。其中53例(阻断组)于剖宫产术前预留腹主动脉球囊导管,术中暂时阻断腹主动脉血流;19例(未阻断组)未留置腹主动脉球囊导管,直接行剖宫产手术。比较2组术中、术后情况及新生儿情况。结果球囊阻断组术中出血量、术中输血量、子宫切除率均低于未阻断组(P均0.05),2组间术后转入重症监护室(ICU)的比例及ICU住院时间差异均有统计学意义(P均0.05),手术时间、术后感染发生率及术后住院总时间差异均无统计学意义(P均0.05)。2组间新生儿体质量及出生后5min、10min的Apgar评分差异均无统计学意义(P均0.05)。结论凶险性前置胎盘合并胎盘植入剖宫产术中行腹主动脉远端球囊阻断安全可行,可有效减少术中出血及输血量,降低子宫切除率。     

Neuraxial anesthesia and postoperative opioid administration for cesarean delivery in patients with placenta accreta spectrum disorder: a retrospective cohort study

BackgroundThere is no consensus on optimal anesthetic and analgesic management of patients presenting for cesarean delivery with suspected placenta accreta spectrum disorder. Neuraxial anesthesia is preferred for uncomplicated procedures, but general anesthesia may be indicated for those at risk of hemorrhage and hysterectomy. We compared the effect of anesthesia techniques on postoperative maternal opioid administration and neonatal respiratory distress.MethodsA single-center retrospective study from 2016 to 2019 using electronic records to identify singleton pregnancies with a high index of suspicion of placenta accreta spectrum disorder. Patients were categorized by the anesthetic technique they received: general, neuraxial, or neuraxial with conversion to general anesthesia following delivery. Postoperative maternal opioid administration (oral morphine in mg equivalents) and risk of neonatal respiratory distress were compared using linear mixed models.ResultsThirty-nine records were analyzed. Mean-adjusted oral morphine mg equivalents were 192 for patients receiving general anesthesia vs. 90 for neuraxial anesthesia only (P=0.009) and 104 for neuraxial with conversion to general anesthesia (P=0.052). Neonates delivered under general anesthesia had a 3.5 times relative risk (95% CI 1.3 to 9.8, P=0.017) of respiratory distress compared with those exposed to neuraxial anesthesia alone.ConclusionPatients receiving general anesthesia alone were administered more opioids than those undergoing neuraxial anesthesia or neuraxial with conversion to general anesthesia. This finding was maintained when accounting for whether or not the patient underwent hysterectomy. Deciding on anesthetic management requires consideration of patient comorbidities, severity of placenta accreta spectrum pathology, and surgical requirements.     

超声诊断孕早中期胎盘植入

目的观察孕早中期超声诊断胎盘植入的价值。方法回顾性分析经引产手术证实的10例孕早中期胎盘植入的临床资料,观察孕早中期胎盘植入的超声声像图特点。结果 10例中,9例有剖宫产手术史。术前超声诊断胎盘植入6例,主要表现为胎盘低置,胎盘与子宫肌层间界限不清,胎盘后血流信号丰富、肌层变薄。术前超声漏诊4例。引产后48h复查超声,10例均见宫内胎盘植入残留表现。结论胎盘与子宫肌层间界限不清、胎盘后血流信号丰富及肌层变薄等二维超声图像特点对诊断孕早中期胎盘植入具有高度临床价值。     

CT灌注成像评价经导管动脉化疗栓塞术治疗原发性肝癌的疗效

目的探讨320排CT灌注成像（CTPI）评价TACE治疗原发性肝癌（PHC）疗效的价值。方法对91例中晚期PHC患者于TACE治疗前后行CTPI,对比DSA结果,观察TACE前后肿瘤与正常肝组织的血流灌注参数的变化,评价TACE疗效。结果CTPI诊断结果与DSA结果相符,诊断符合率为100％,TACE后肿瘤组织的肝血流量（BF）、肝血容量（BV）、肝动脉灌注量（HAP）、肝动脉灌注指数（HPI）均较术前降低（P均〈0．05）,而平均通过时间（MTT）、毛细血管表面通透性（Ps）、门静脉灌注量（PVP）与术前比较差异均无统计学意义（P均〉0．05）;59例瘤灶碘油沉积不均,灌注图显示存在血流灌注,其残瘤组织的BF、BV、HAP、HPI、PS值均高于正常肝组织（P均〈0．05）,而MTT、PVP均低于正常肝组织（P均〈0．05）。结论CTPI能全面、直观、定量地反映TAcE前后PHC血流动力学变化,对TACE疗效作出客观、准确评价。