未成熟型卵巢畸胎瘤的术前超声诊断分析

目的:探讨利用超声检查与肿瘤标志物测定鉴别卵巢畸胎瘤成熟与否的可能性。方法:收集卵巢成熟畸胎瘤46例,未成熟畸胎瘤16例,比较其二维超声特征、血流RI值及肿瘤标志物水平。结果:卵巢成熟与未成熟畸胎瘤的超声特征、血流阻力指数、肿瘤标志物AFP水平等指标有显著差异。结论:根据畸胎瘤的超声形态特征及AFP水平可初步鉴别畸胎瘤成熟与否。     

卵巢恶性畸胎瘤临床预后分析

目的对卵巢恶性畸胎瘤的临床、病理特点及预后进行分析。方法总结1979年9月至2000年12月在辽宁省肿瘤医院治疗的卵巢恶性畸胎瘤93例,其中卵巢未成熟畸胎瘤80例,卵巢畸胎瘤恶变13例。中位随访60个月。寿命表法统计累积存活率,分析临床、病理与预后的关系。结果卵巢恶性畸胎瘤1年、3年、5年、10年总的存活率分别为88.83%、78.02%、76.75%、73.42%。存活率与临床期别及病理类型有关。结论卵巢恶性畸胎瘤临床期别早,则预后好。卵巢未成熟畸胎瘤较卵巢畸胎瘤恶变预后好。     

阴道超声结合彩色多普勒超声诊断卵巢恶性肿瘤的价值

目的探讨经阴道超声及彩色多普勒超声准确诊断卵巢恶性肿瘤的价值,鉴别卵巢良恶性肿瘤.方法47例有盆腔肿块的患者,术前应用阴道超声对肿块进行评分同时加用彩色多普勒超声检查获得PI和RI值.术后对照病理诊断了解诊断符合率.结果阴道超声对盆腔肿块评分B超积分＞9的19例患者中,病理检查证实为恶性肿瘤17例,诊断符合率为89.5%.B超积分≤9的28例患者中,病理检查证实为良性肿瘤26例,诊断符合率为92.9%.彩色多普勒超声测定肿块周边血流PI＜1.0的例数19例,病理检查证实为恶性肿瘤18例,诊断符合率为94.7%.RI＜0.5的例数19例,病理检查证实为恶性肿瘤19例,诊断符合率为100%.超声评分和血流PI、RI值综合估计肿块良恶性程度B超积分＞9和PI＜1.0、RI＜0.5共18例,病理检查均为恶性肿瘤,诊断符合率为100%.B超积分≤9和PI≥1.0、RI≥0.5共27例,病理检查证实为良性肿瘤26例,诊断符合率96.3%.结论B超积分＞9和PI＜1.0、RI＜0.5是卵巢恶性肿瘤较特异的超声表现,是鉴别卵巢良恶性肿瘤较好的手段.     

彩超和磁共振成像诊断胎盘植入价值的评价

目前胎盘植入产前诊断困难，尚无确切的诊断依据，血清AFP,彩色超声多普勒、磁共振的应用有一定的诊断作用。但血清AFP特异性不强，影响因素多，仅能作为筛查诊断的依据，彩色超声多普勒和磁共振成像（magnetic resonance imaging，MRI）诊断胎盘植入仅见独自报道，尚未见对照评价。现回顾分析我院2002～2007年同时行彩色超声多普勒和磁共振成像的18例疑诊胎盘植入患者的临床资料，探讨彩色超声多普勒和磁共振成像诊断胎盘植入的价值。     

卵巢成熟性畸胎瘤恶变的临床病理学分析

目的：探讨卵巢成熟性畸胎瘤恶变的临床病理特征。方法 回顾性分析本院2009年1月至2020年12月卵巢成熟性畸胎瘤1476例,伴恶变17例,提取并分析临床及病理学资料。结果： 卵巢成熟性畸胎瘤恶变比例1.15%,平均年龄47.2岁（23岁至80岁）,其中肿块最大径9.5± 4.0cm（4.0~17.5cm）,143例处于绝经后,其中7例（4.89%）恶变,1333例为绝经前患者有10例（0.75%）恶变,绝经后恶变比例高于绝经前（P<0.05）。术前6例血清肿瘤标记物升高,2例术前影像学确诊为畸胎瘤恶变。病理检查恶变成分为鳞癌11例,腺癌3例,类癌3例。随访时长13个月至116个月,其中6例复发,4例死亡,其余患者均无病存活。结论： 卵巢成熟性畸胎瘤恶变可发生于任何年龄,但绝经后畸胎瘤恶变比例高,以鳞癌最常见,术前影像学及血清肿瘤标记物诊断价值有限,准确的诊断依赖于病理检查。     

卵巢生殖细胞肿瘤的临床统计分析

本文报道近十年来本院收治的卵巢生殖细胞肿瘤１７２例，占同期卵巢肿瘤的２５．５％。其中成熟型畸胎瘤１６２例，卵巢甲状腺肿１例，未成熟型畸胎瘤５例，成熟型畸胎瘤恶变２例，无性细胞瘤１例，混合型生殖细胞瘤（卵黄囊瘤合并成熟型畸胎瘤）１例。本组资料显示：成熟型畸胎瘤合并妊娠者对围产儿无明显不良影响，本文并讨论了未成熟型畸胎瘤的治疗原则。     

单纯性卵巢未成熟型畸胎瘤肝脏周围复发的临床特点和诊？…

目的 总结单纯性卵巢未成熟型畸胎瘤肝脏周围复发的临床特点,探讨其正确的诊断和治疗方案。方法 采用回顾性分析方法,对１８例肝脏周围复发的单纯性卵巢未成熟型畸胎瘤患者的临床分期、手术、化学治疗化疗）以及其原发、复发肿瘤的病理,结合随诊结果进行综合分析。结果 本组患者平均发病年龄为２４．８岁;初次手术的患者中,３８．８％（７／１８）的患者行单侧附件切除术,６６．１％（１１／１８）为临床Ⅲ期,４４．４％（     

卵巢未成熟畸胎瘤后生长性畸胎瘤综合征一例并文献复习

生长性畸胎瘤综合征（growing teratoma syndrome,GTS）是一种发生在未成熟畸胎瘤（immature teratoma,IMT）或混合性恶性生殖细胞肿瘤患者中的罕见疾病。其特征是在手术治疗后的辅助化疗期间或化疗结束后的肿瘤标志物正常的情况下,手术残存病灶增大或出现其他部位肿块,术后病理学检查仅存在成熟畸胎瘤组织,无恶性生殖细胞。完全性手术切除是GTS治疗的首选方案,而免疫调节、化疗及射频消融术可阻止疾病进展。GTS诊断明确,但发病率低,容易误诊为恶性肿瘤复发。现报告1例卵巢IMT后GTS病例,复习相关文献,以期提高对该病的认识,丰富临床经验,减少误诊和漏诊。     

经阴道彩色多普勒超声检查对诊断剖宫产子宫瘢痕妊娠的临床意义

目的 探讨经阴道彩色多普勒超声检查对诊断剖宫产子宫瘢痕妊娠的临床意义。方法 选取50例剖宫产子宫瘢痕妊娠患者,分别实施经阴道彩色多普勒超声检查和经腹部彩色多普勒超声检查。对比两种检查方法患者的误诊率、漏诊率、确诊率、超声声像分型及满意度。结果 经阴道彩色多普勒超声的确诊率为98.00%,高于经腹部彩色多普勒超声诊断的82.00%,经阴道彩色多普勒超声诊断的误诊率低于经腹部彩色多普勒超声（P<0.05）。两种诊断方法显示的超声声像分型比较,差异无统计学意义（P>0.05）。经阴道彩色多普勒超声诊断的满意度明显高于经腹部彩色多普勒超声（P<0.05）。结论 采用经阴道彩色多普勒超声诊断剖宫产子宫瘢痕妊娠,具有较高的诊断确诊率,且能清晰显示声像分型,获得患者的认可与满意。     

卵巢成熟畸胎瘤恶变5例临床病理分析

本文对近5年来我院收住的5例卵巢成熟畸胎瘤恶变病例进行回顾性分析,探讨其临床特点及诊断治疗。1临床资料1.1一般资料 我院1997年1月至2001年12月共收治卵巢成熟畸胎瘤503例,其中5例恶变,恶变率为0.99％;恶变年龄49-62岁,平均54.6岁,围绝经期2例,绝经后3     

A critical evaluation of transvaginal Doppler studies, transvaginal sonography, magnetic resonance imaging, and CA 125 in detecting ovarian cancer.

OBJECTIVE: To evaluate whether transvaginal Doppler ultrasound is more valid than transvaginal sonography, magnetic resonance imaging (MRI), and CA 125 in differentiating malignant from benign ovarian tumors. METHODS: Sixty-three patients with ovarian tumors (36 benign and 27 malignant) were studied with transvaginal Doppler ultrasound before surgery. Blood flow velocity waveforms arising from intratumoral and/or tumor surface arteries were assessed by calculating the resistance index. Transvaginal B-mode sonography and MRI imaging examinations were also conducted. Serum CA 125 levels were measured. RESULTS: There was a significant difference between the resistance index value (0.692 +/- 0.188) in benign tumors and the value (0.503 +/- 0.107) in malignant tumors (P < .05). When 0.72 (mean of the malignant tumor resistance index values + 2 standard deviations) was considered as the cutoff value of the resistance index, the sensitivity and specificity of the resistance index in detecting malignant ovarian tumors were 92.6 and 52.8%, respectively. These values did not differ significantly from those with transvaginal sonography diagnosis (sensitivity 85.2%, specificity 69.4%). The resistance index sensitivity was significantly higher than those with MRI diagnosis (66.7%) and CA 125 levels (59.3%) (P < .05); however, the resistance index specificity was significantly lower than those with MRI diagnosis (97.1%) and CA 125 levels (91.7%) (P < .05). CONCLUSION: Our results suggest that transvaginal Doppler ultrasound does not provide more useful diagnostic information than transvaginal sonography, MRI, and CA 125 for the differentiation of malignant from benign ovarian tumors.     

Contrast-enhanced, three-dimensional power Doppler sonography for differentiation of adnexal masses

OBJECTIVE: To investigate the potential usefulness of contrast-enhanced, three-dimensional power Doppler sonography in the differentiation of benign and malignant adnexal lesions. METHODS: A total of 45 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy. All the results were compared with histopathology. RESULTS: There were 12 cases of ovarian malignancy and 33 benign adnexal lesions. Of the 12 ovarian cancers, seven (58. 3%) showed vascular distribution suggestive of malignancy at nonenhanced three-dimensional power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy. One cystadenofibroma demonstrated penetrating vessels at initial scan, whereas two benign lesions (fibroma and cystadenofibroma) were misdiagnosed as malignant at contrast-enhanced, three-dimensional power Doppler sonography. The use of a contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency (95.6%) that was superior to that of nonenhanced three-dimensional power Doppler sonography (86. 7%). CONCLUSION: Contrast-enhanced, three-dimensional power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with three-dimensional morphologic ultrasound assessment, enhanced three-dimensional power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.     

阴道超声对诊断治疗卵巢子宫内膜异位囊肿及子宫腺肌病的价值

目的探讨阴道超声及血清CA125测定对诊断治疗卵巢子宫内膜异位囊肿及子宫腺肌病的价值。方法对卵巢子宫内膜异位囊肿及子宫腺肌病患者631例进行回顾性分析，术前均经阴道超声检查，部分患者进行了血清CA125测定。结果阴道超声检查卵巢子宫内膜异位囊肿符合率98．7％；子宫腺肌病符合率91．7％；卵巢子宫内膜异位囊肿合并子宫腺肌病符合率95．1％。血清CA125检查卵巢子宫内膜异位囊肿，阳性率39．4％；子宫腺肌病阳性率52．2％；卵巢子宫内膜异位囊肿合并子宫腺肌病阳性率59．2％。结论阴道超声可做为较准确诊断卵巢子宫内膜异位囊肿及子宫腺肌病的首选方法。阴道超声下囊肿穿刺是治疗卵巢子宫内膜异位囊肿的简便、有效的方法之一。血清CA125测定可做为卵巢子宫内膜异位囊肿及子宫腺肌病的协助诊断方法，应进一步完善对照组的研究。     

Doppler flow and arterial location in ovarian tumors.

OBJECTIVES: This prospective study investigated the clinical evaluation of transvaginal color Doppler ultrasonography in the diagnosis of ovarian tumors. METHODS: Transvaginal ultrasonography (morphological assessment, DePriest's index) and color Doppler analysis were performed for 31 malignant and 64 benign tumors ovarian tumors. Serum tumor markers such as CA125, CA72-4, and STN were measured. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were as follows: DePriest's index, 90.3%, 73.4%, 62.2%, 94.0%, 78.9%; CA125, 70.4%, 87.7%, 73.1%, 86.2%, 82.1%; minimum pulsatile index combined with detection of location of arterial blood flow, 83.9%, 98.4%, 96.3%, 92.6%, 93.7%, respectively. In cases where arterial blood flow was recognized, malignant tumors had significantly fewer diastolic notches, while benign tumors had many diastolic notches. The difference in the presence of diastolic notch between malignant and benign tumors was significant (P<0.0004). CONCLUSIONS: For diagnosis of ovarian tumors, transvaginal color Doppler analysis combined with detection of arterial location is more useful than other procedures.     

The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler

OBJECTIVE: The objective was to determine the diagnostic accuracy of three-dimensional (3D) sonography and 3D power Doppler imaging, used together with standard 2D transvaginal grayscale and color/power Doppler modalities, for preoperative sonographic assessment of suspected ovarian lesions. METHODS: Five-year retrospective analysis was performed by our experts on ultrasonography and surgery on the reports from 43 referred patients with suspected stage I ovarian cancer. All patients were evaluated during the week prior to surgery at our department. Preoperative sonographic assessment included careful examination of ovarian volume, morphology, and vascularity by four complementary sonographic methods. Scoring systems combining morphological and Doppler parameters were adopted for 2D and 3D sonographic examinations. Final diagnosis was confirmed by a histopathologist. RESULTS: Out of the 43 stage I ovarian cancers, 42 cases were successfully detected preoperatively by four complementary sonographic methods. Only 30 (69.8%) and 37 (86.1%) cases of stage I ovarian cancer were detected by 2D grayscale and combined 2D grayscale and color Doppler sonography, respectively. Morphological analysis obtained by 3D sonography alone detected 32 of 43 ovarian malignancies, reaching a diagnostic rate of 74.4%. Qualitative analysis of tumor vascularity architecture by 3D power Doppler significantly improved the sonographic management process and successfully detected 41 cases of stage I ovarian cancer (95.4%). When morphological features obtained by 3D sonography were added to 3D power Doppler findings, we achieved an even higher diagnostic accuracy of 97.7%. We found a statistically significant difference (P 相似文献   

The effectiveness of spectral and color Doppler in predicting ovarian torsion. A prospective study

We evaluated the effectiveness of color and spectral Doppler examination of the ovarian vasculature flow, using transvaginal sonography (TVS) in 65 women prior to laparoscopy due to suspected ovarian torsion. There were 15 cases of ovarian torsion. In all of them, a pathology was detected by the color and spectral Doppler examination. Of the 50 patients without torsion at laparoscopy, one had abnormal Doppler studies. Color and spectral Doppler can demonstrate the presence or absence of arterial and venous flow in cases of suspected torsion of the ovary.     

Seven tumor markers in benign and malignant germ cell tumors of the ovary

Seven tumor markers were analyzed clinically in 135 patients with germ cell tumors of the ovary who were treated in Tokai Ovarian Tumor Study Group, an association comprising Nagoya University and its affiliated hospitals, between January 1979 and September 1990. Positive rate of AFP was 100% (36/36) in yolk sac tumor, 61.9% (13/21) in immature teratoma, and 11.8% (2/17) in dysgerminoma, but there were no positive cases of mature cystic teratoma with malignant transformation (0/7) and mature cystic teratoma (0/31). Positive rate of CA125 was over 50% in all tumor types except mature cystic teratoma, which showed a positive rate of 23.7%. CA125 was useful for the screening of malignant germ cell tumors. CA19-9 showed a high positive rate in teratomatous tumors, which were immature teratoma, mature cystic teratoma with malignant transformation, and mature cystic teratoma. Dysgerminoma and yolk sac tumor, especially dysgerminoma, had a high positive rate of LDH. TPA and CEA were not considered useful tumor markers for germ cell tumors of the ovary.     

Three-dimensional ultrasound and power doppler improve the diagnosis of ovarian lesions

OBJECTIVE: The aim of this study was to determine whether three-dimensional power Doppler can improve the ability to differentiate benign from malignant ovarian masses. METHODS: Transvaginal color Doppler and three-dimensional power Doppler were performed on 120 patients with ovarian lesions. All patients underwent both ultrasound examinations during the day prior to laparotomy or laparoscopy. Scoring systems combining morphological and Doppler parameters were adopted for two- and three-dimensional ultrasound examinations. RESULTS: In each of 11 ovarian malignancies, preoperative diagnosis by three-dimensional power Doppler was confirmed by histopathology. Transvaginal color Doppler missed 1 case of serous cystadenocarcinoma, while 3 benign lesions were considered false positive. In 1 case of cystadenofibroma both transvaginal color Doppler and three-dimensional power Doppler were falsely positive. Qualitative analysis of the tumor vascularity architecture added to morphological parameters had a sensitivity and specificity of 100 and 99.08%, respectively. CONCLUSIONS: Better results achieved by three-dimensional ultrasound can be explained by improved recognition of the ovarian mass anatomy, characterization of the surface features, detection of the tumor infiltration, and precise depiction of the size and volume. Three-dimensional power Doppler imaging can detect structural abnormalities of malignant tumor vessels, such as arteriovenous shunts, microaneurysms, tumoral lakes, disproportional calibration, coiling, and dichotomous branching. Three-dimensional power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian masses.     

Assessment of ovarian tumors using transvaginal color Doppler ultrasonography

In our study we used transvaginal color Doppler ultrasonography in a token of 127 women presenting with unilateral ovarian tumor. The characteristics of the tumors were analyzed, the presence of vascularization was checked and the resistance index (RI) was calculated. Consequently, based on a concrete scoring system, we attempted to discriminate these tumors as benign or malignant. It was proven that 24 of 127 ovarian tumors were malignant. Transvaginal color Doppler correctly identified 21 of the 24 malignant tumors, as well as 94 of the 103 benign tumors. In nine other cases we had false-positive results. The sensitivity and the specificity of the method was 87.5% and 91.2%, while the positive and negative predictive values were 70% and 96.9%, respectively.     

LPA、CA125与经阴道彩色多普勒超声联合诊断卵巢上皮癌的临床价值

目的:探讨血浆溶血磷脂酸(LPA)在卵巢上皮癌患者血浆中的表达水平,及其与血清CA125和经阴道彩色多普勒超声(TV-CDUS)联合应用诊断卵巢上皮癌的临床价值。方法:术前检测卵巢上皮癌48例,卵巢良性肿瘤30例的LPA、CA125,以20例健康者作为对照,卵巢肿瘤患者同时经阴道超声评分和TV-CDUS检查。结果:卵巢癌患者LPA水平明显高于卵巢良性肿瘤组和健康对照组,差异有统计学意义(P0.05),LPA水平在良性肿瘤组与健康对照组之间无显著差异(P0.05)。单独应用LPA、CA125、TV-CDUS检测诊断卵巢癌的敏感性和特异性分别为87.5%、79.16%、81.25%和80%、70%、86%,各组间敏感性和特异性比较,无显著差异(P0.05)。LPA、CA125、TV-CDUS 3项联合检测诊断卵巢癌的敏感性和特异性为95.80%和94%,与单独应用CA125检测特异性比较,差异有统计学意义(P0.05)。LPA诊断卵巢癌的敏感性和特异性与卵巢癌分期和病理类型无关(P0.05),CA125诊断卵巢癌的敏感性和特异性与卵巢癌的分期和病理类型有关(P0.05)。结论:卵巢上皮癌患者血浆LPA水平明显升高,有望成为卵巢上皮癌诊断的敏感指标,联合检测血浆LPA、血清CA125与TV-CDUS有助于术前卵巢癌的诊断。