剖宫产瘢痕部位妊娠误诊1例

剖宫产瘢痕部位妊娠（ CSP ）是指有剖宫产史的孕妇,胚胎着床于子宫下段剖宫产切口瘢痕处,是一种特殊部位的异位妊娠,为剖宫产的远期并发症之一［1］。但由于本病的早期诊断困难,初诊误诊率高,而且瘢痕处肌壁薄弱且纤维组织多,若处理不及时或不恰当,易导致难以控制的阴道大出血或子宫破裂,危及患者生命。将收治的1例剖宫产瘢痕部位妊娠的诊治经过及误诊原因分析如下。     

经阴道彩色多普勒超声对剖宫产切口瘢痕妊娠的诊断价值

剖宫产切口瘢痕妊娠是一种少见特殊类型的异位妊娠,是孕囊着床于子宫下段剖宫产瘢痕处的异位妊娠。随着剖宫产率的升高,发病率有所提高,对子宫瘢痕妊娠（cesarean searpregnancy,CSP）的报道也逐渐增多。剖宫产切口瘢痕妊娠处理不当,容易发生难以控制的大出血。对该病的早期诊断是决定预后的关键。本文就超声诊断剖宫产切口子宫瘢痕妊娠进行分析,探讨其诊断价值。     

经阴道超声对剖宫产切口憩室的诊断价值研究

目的 研究经阴道超声对剖宫产切口憩室的诊断价值.方法 选择有剖宫产史,临床症状为经期延长或经血过多或阴道不规则出血的20例患者行经阴道超声检查.结果 17例患者剖宫产切口处形成憩室,3例为切口处妊娠.结论 经阴道超声检查较碘油造影或宫腔镜简便、便宜、无创,是发现剖宫产切口憩室最佳检查方法.     

剖宫产切口妊娠超声和MRI诊断比较

目的探讨MRI和阴道彩色多普勒超声在诊断剖宫产切口妊娠中的价值。资料与方法回顾性分析经病理确诊的40例剖宫产切口妊娠患者的超声和MRI影像特点,比较二者诊断剖宫产切口妊娠的优势。结果彩色多普勒超声准确诊断36例,诊断正确率为90.0%;MRI准确诊断35例,诊断正确率为87.5%;6例子宫局部破裂,其中4例MRI显示妊娠组织突出于峡部,2例可见新鲜出血信号,而彩色多普勒超声未提示。超声与MRI诊断剖宫产切口妊娠的正确率比较,差异无统计学意义(χ2=5.74,P>0.05)。结论彩色多普勒超声和MRI对切口妊娠的诊断正确率均较高,MRI可更好地显示剖宫产切口妊娠与周边组织的关系。     

三维断层超声显像技术联合超声造影对切口妊娠诊断效能的影响

切口妊娠主要是指妊娠胚囊着床于切口妊娠处,主要是由剖宫产所致,是临床少见异位妊娠,也是剖宫产长期并发症之一,可引起子宫破裂、大出血等并发症,危及生命[1]。近年来,三维断层超声显像(TUI)技术作为医学影像学一门新兴学科,为普通二维超声诊断仪提供三维成像途径,已广泛应用于切口妊娠诊断中[2]。超声造影(CEUS)可反映组织血流灌注信号,增强二维超声影像,有利于明确切口妊娠植入部位、范围即程度,为临床诊断提供参考依据。     

剖宫产切口妊娠25例的超声结果分析

目的：探讨剖宫产术后子宫切口妊娠的超声特点。方法选取2011年1月-2013年1月行剖宫产的产妇共100例，统计40例切口妊娠产妇经腹经阴道彩色多普勒超声诊断结果，分析其超声诊断表现、临床治疗以及病例结果。结果40例切口妊娠产妇的超声诊断和临床诊断结果为：切口混合性包块15例（37.5％），切口内见妊娠囊13例（32.5％），妊娠囊壁局部突入切口内有7例（17.5％），且大部分位于宫腔下段，妊娠囊位于宫腔中央，切口区见子宫脱膜突入5例（12.5％）。结论经腹经阴道彩色多普勒超声诊断剖宫产切口妊娠的精确性和灵敏性非常高，为临床医师确定治疗方案提供重要的依据。     

MRI和超声对剖宫产术后子宫瘢痕妊娠的术前诊断效能差异

目的 探讨超声及MRI对剖宫产后瘢痕妊娠的诊断价值.方法 回顾性分析2011年6月至2012年4月,经手术后病理证实的15例剖宫产后瘢痕妊娠患者的超声及MRI资料,判断超声及MRI对瘢痕妊娠诊断效能.结果 15例患者超声检查中13例诊断宫旁囊性或囊实性病变,考虑瘢痕妊娠(13/15).其中2例误诊,1例超声诊断为妊娠滋养细胞肿瘤,1例诊断为宫颈妊娠.15例患者同时行MRI检查,在切口处均发现孕囊,考虑瘢痕妊娠15例(15/15).结论 MRI作为瘢痕妊娠的辅助性检查方法,对诊断该病具有一定特异性,但仍需要结合剖宫产病史及超声检查.     

子宫切口瘢痕部妊娠6例临床诊断与治疗

目的探讨子宫下段剖宫产术后子宫切口瘢痕部妊娠的临床表现、诊断和治疗。方法对6例剖宫产术后子宫切口瘢痕妊娠患者临床资料进行回顾性分析。结果 6例中4例经甲氨喋呤和米非司酮杀胚后清宫治愈,2例药物治疗失败后,其中1例双侧子宫动脉栓塞术联合化疗;1例经双侧子宫动脉栓塞术联合化疗血β-HCG下降不满意行经腹子宫切口妊娠病灶切除术。结论充分认识剖宫产术后子宫切口瘢痕部妊娠的临床特征,早期明确诊断,及时药物治疗、适时清宫,可选择子宫动脉栓塞术,辅以合适的手术治疗措施,切忌盲目刮宫。     

彩色多普勒超声检查剖宫产术后子宫切口妊娠的临床价值

目的探讨超声在剖宫产术后子宫切口妊娠(caesarean scar pregnancy,CSP)诊断中的临床应用价值。方法对收治的CSP孕妇采用超声进行检查,观察子宫、双侧附件区及盆腔,观察孕囊着床位置和子宫切口位置的相关性,并与具有剖宫产史且再次正常妊娠的孕妇进行超声结果的对比分析。结果 CSP组54例孕妇经彩色多普勒超声检查所见妊娠物均位于子宫前壁下段剖宫产切口处,其中孕囊型切口妊娠20例,不均质团块型切口妊娠23例,结节型切口妊娠11例。CSP组大部分孕妇无明显回声,对CSP组和对照组的超声声像图特征进行对比统计发现CSP组中宫腔内有异常回声的例数明显少于对照组,而有子宫切口假腔的例数则明显高于对照组;另外,CSP组的切口肌层厚度、孕囊与切口距离均明显低于对照组,且差异具有统计学意义。CSP组孕妇的血流指数(0.52±0.08)明显低于对照组血流指数(0.68±0.12),且差异具有统计学意义(t=3.81,P0.05)。结论彩色多普勒超声检查无创、简单易行,对CSP的诊断准确可靠。     

剖宫产瘢痕部位妊娠病因及诊疗研究进展

剖宫产瘢痕部位妊娠是指于前次剖宫产术后子宫切口瘢痕处发生的妊娠,是一种特殊类型的异位妊娠。近年来,随着剖宫产率的上升,瘢痕部位妊娠发生率也在随之升高。目前,有关剖宫产瘢痕部位妊娠的形成机制尚不明确,多数学者倾向于"窦道形成学说",认为其发生与子宫内膜层和肌层连续被破坏,局部子宫肌层窦道形成有关。另有研究表明,多次剖宫产史、子宫下段厚度及剖宫产缝合技术等因素,也可能影响剖宫产瘢痕部位妊娠的发生。本病诊断主要依靠超声检     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.