阴道超声联合宫腔镜对子宫内膜息肉的诊断分析

目的:分析阴道超声联合宫腔镜对子宫内膜息肉的诊断价值.方法:回顾性分析2018年1月至2020年7月德兴市中医院超声科接收的146例子宫内膜病变患者的临床资料,以子宫内膜活检为"金标准",比较阴道超声、宫腔镜以及联合检查诊断子宫内膜息肉的准确度差异,并统计检查过程中患者出现的不良反应.结果:经子宫内膜活检80例患者确诊为子宫内膜息肉.阴道超声诊断子宫内膜息肉的敏感度为78.75％,特异度为87.88％,准确度为82.87％.宫腔镜检查诊断子宫内膜息肉的敏感度为90.00％,特异度为93.94％,准确度为91.78％.联合检查诊断子宫内膜息肉的敏感度为97.50％,特异度为98.48％,准确度为97.94％.阴道超声不良反应发生率明显低于宫腔镜检查和联合检查(P<0.05).结论:阴道超声联合宫腔镜能应用于子宫内膜息肉的早期诊断,具有较高临床诊断价值.     

阴道超声与宫腔镜在诊断围绝经期子宫异常出血中的应用

目的探讨阴道超声和宫腔镜检查诊断围绝经期子宫异常出血的临床应用价值。方法收集患者180例,以病理检查结果作为＂金标准＂,比较阴道超声和宫腔镜检查的灵敏度及阳性预测的价值。结果在子宫内膜过度增生、子宫内膜癌、未见明显占位性病变（正常子宫内膜、子宫内膜炎、萎缩性子宫内膜）的诊断中,阴道超声检查的灵敏度分别为77.3%、57.1%、82.2%,宫腔镜检查的灵敏度分别为97.7%、92.9%、95.6%,两组之间的差异有统计学意义（P〈0.05）。在子宫内膜息肉、子宫内膜过度增生的诊断中,阴道超声检查的阳性预测价值为79.7%和75.6%,宫腔镜检查的阳性预测价值为96.2%和93.5%,两组之间的差异有统计学意义（P〈0.05）。结论阴道超声可以作为围绝经期妇女临床筛检的常规方法 ,宫腔镜检查可以作为在阴道超声发现宫腔异常情况或不能明确时进一步检查的重要手段。     

阴道超声在子宫内膜病变诊断中的应用价值

目的：评估阴道超声在子宫内膜病变诊断中的应用价值。方法选择于2010年11月~2013年10月在我院接受治疗的子宫内膜病变患者80例,患者分别通过腹壁超声和阴道超声检查,比较两种诊断方法的诊断符合率。结果腹壁超声共检测出子宫内膜病变46例,诊断符合率为57.5%,阴道超声共检测出子宫内膜病变74例,诊断符合率为92.5%,两种检测方法的诊断符合率比较差异显著(P<0.05),具有统计学意义。结论阴道超声在子宫内膜病变诊断中具有较高的临床应用价值,不仅具有较高的诊断符合且临床应用的安全可靠性好,值得在临床诊断中普及应用。     

子宫内膜息肉经阴道三维超声特点及诊断价值分析

目的 探讨经阴道三维超声对子宫内膜息肉(EP)的诊断价值,并分析其影像学特点.方法 回顾性分析2019年3月～2020年6月我院收治的116例疑似EP患者的临床资料,均接受阴道二维超声及三维超声检查.以病理检查结果为金标准,评估二维超声和三维超声对EP的诊断价值,比较两者在灵敏度、特异度、准确性的差异性,记录EP患者的...     

超声诊断子宫内膜病变的应用价值

目的：研究子宫内膜病变经阴道超声诊断的应用效果。方法选择2014年4~7月我院妇产科收治的子宫内膜病变患者76例,将其经阴道超声检查跟病理诊断结果给予比较分析。结果与患者术后的病理诊断对比,经阴道超声诊断的总符合率是81.6%。经阴道超声诊断显示,子宫内膜良性病变血流显示率明显低于子宫内膜癌血流显示率(<0.01),且动脉阻力指数(RI)明显小于子宫内膜癌(P<0.05)。结论子宫内膜病变运用经阴道超声诊断的准确率比较高,可以清晰地显示出病变血流信号,临床诊断应用价值较高,值得进一步推广与应用。     

子宫内膜异位症的超声诊断

目的探讨子宫内膜异位症的超声诊断价值。方法收集2012年1月~2013年12月在我院经过腹腔镜手术确诊患有子宫内膜异位症的93名患者超声影像特征,对比分析内在性子宫内膜异位症与外在性子宫内膜异位症的影响特征差异;结果 1子宫内膜异位症超声征象主要表现为:包块外形包块规则(占63%)、包块边界不清晰(占77.2%)、包块回声为无回声(占68.5%)或低回声(占27.2%)、内部无回声(占72.8%);无血流信号(占80.4%);2内在性子宫内膜异位症患者具有妊娠分娩史的占86.1%高于外在性子宫内膜异位症的66.1%;包块边界不清晰率88.9%高于外在性组的69.6%,组间差异显著;3超声诊断准确率达91.4%;结论超声对子宫内膜异位症的诊断便捷、准确率高、费用合理,但尚存在不符合特异征象的影像表现,需同时结合临床病史及其他指标进行联合诊断。     

腹腔镜联合人工授精治疗子宫内膜异位症不孕的临床观察

目的探讨子宫内膜异位症（EMs）不孕患者腹腔镜术后行夫精人工授精妊娠率的影响因素。方法回顾性分析164例腹腔镜术后的EMs不孕患者进行的318个人工授精周期的临床资料。以年龄、不孕年限、腹腔镜术后时间、用药情况、周期数、是否促排卵、r-AFS分期、IUI时机分别进行妊娠率的比较。结果 EMs不孕患者术后人工授精的周期妊娠率为13.21%。年龄≤35岁的周期妊娠率高于35岁以上者（χ2=6.687,P〈0.05）,不孕年限≤5年的妊娠率高于5年以上者（χ2=5.430,P〈0.05）,腹腔镜术后1年内行人工授精的妊娠率高于1年以上者（χ2=6.005,P〈0.05）,Ⅰ～Ⅱ期患者的妊娠率高于Ⅲ～Ⅳ期患者（χ2=8.264,P〈0.05）,加用促排卵治疗的妊娠率高于自然周期者（χ2=4.569,P〈0.05）,3周期内人工授精的妊娠率高于3周期以上者（χ2=4.031,P〈0.05）,双次IUI者妊娠率高于单次者（χ2=4.371,P〈0.05）,差异均有统计学意义。而术后是否使用GnRH-a则与妊娠率无关。结论 EMs不孕患者腹腔镜术后行人工授精治疗的最佳时间是术后1年内3周期内有较高的妊娠率,建议同时加用促排卵治疗。     

不孕女性子宫内膜LIF基因表达研究

白血病抑制因子(leukaemiainhibitoryfactor,LIF)是一种具有多种生物学功能活性的细胞因子。随着对其深入研究,发现LIF在胚泡着床中起着十分重要的作用。对小鼠的研究表明,在妊娠第4天(即胚泡着床期)的子宫内膜中,LIF出现突发性的强烈表达,这提示子宫内膜LIF基因表达可能与胚泡着床密切相关[1],此外,无LIF基因表达的转基因小鼠能发育至成体,但不能发育,原因是胚泡不能在子宫中着床[2],这更有力地证明了LIF与胚泡着床密切相关。临床上有相当一部分不孕患者病因不明,这些患者中是否有部分患者的病因与其子宫内膜LIF基因表达缺陷相关,…     

阴道超声和宫腔镜对绝经后阴道出血的诊断价值

目的绝经后阴道出血(PMB)是老年妇女常见症状。及时地对PMB进行病因诊断很重要。本研究旨在通过比较阴道超声(TVS)和宫腔镜(HSC)对PMB的诊断,分析其优缺点。方法取2001年1月~2005年10月在我院妇产科住院的PMB患者117例进行TVS检查,测量其子宫内膜厚度,随后进行HSC检查并行内膜活检。将TVS和HSC检查结果与病理检查进行分析比较。结果萎缩性子宫内膜厚度3.26~4.39 mm,病变组的内膜厚度与萎缩性子宫内膜均有显著的统计学差异,以子宫内膜厚度6mm作为阴道超声判断绝经后子宫内膜有无病理改变的临界值,其敏感度为96.53%,特异度为91.53%,阳性预测值为90.32%,阴性预测值为96.32%。结论TVS和HSC对诊断PMB的敏感性都很高,但HSC的特异性高于TVS。PMB患者应常规进行TVS检查,如子宫内膜厚度超过6 mm,应行HSC检查。     

Uterine findings by transvaginal sonography during percutaneous estrogen treatment in postmenopausal women

Objectives: To evaluate the effect of hormone replacement treatment (HRT) with percutaneous estradiol and cyclical peroral medroxyprogesterone acetate (MPA) every month or every third month on the uterus and endometrium of postmenopausal women. Methods: Uterine size and endometrial thickness were measured by transvaginal sonography in 159 postmenopausal women before HRT, and after 6 and 12 months on HRT during 9–12 days of the MPA administration periods. Results: During HRT, uterine size and endometrial thickness increased. The percentage increase in uterine diameter varied between 3.8% and 19.6%, and endometrial thickness varied between 28.7% and 76.4%, being greater in the group receiving MPA every third month than in the groups receiving MPA every month. Myomas grew during the first 6 months on HRT but increased no further during the next 6 months on HRT. Conclusions: The increases in uterine size, myomas and endometrial thickness during HRT were moderate and not problematic and occurred mainly during the first 6 months on HRT.     

经阴道与经腹部超声检查早期诊断宫颈机能不全的对照分析

目的探讨经阴道超声检查在早期诊断宫颈机能不全中的应用价值.方法对同一组(108例)习惯性流产的孕妇于中孕时分别应用经阴道与经腹部超声进行检查,并做对照分析.结果经阴道超声检查对宫颈的显示率和对宫颈机能不全的早期诊断率明显高于经腹超声检查.结论经阴道超声检查是早期诊断宫颈机能不全的一种安全、准确的方法.     

Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding

Objectives: To assess the cost-effectiveness of transvaginal sonography (TVS) in the diagnostic work-up of women with postmenopausal bleeding. Methods: We performed a decision analysis in which we estimated life expectancy and cost of four strategies for the evaluation of postmenopausal bleeding: TVS (I), TVS and office endometrial biopsy (II), TVS and hysteroscopy (III), and endometrial biopsy (IV). In strategies incorporating TVS, calculations were performed for three different cut-off values between 3 and 9 mm double layer. Expectant management, i.e. no diagnosis or treatment was considered to be the reference strategy to which the other four strategies were compared. Data were obtained from the published literature. In extensive sensitivity analyses, we varied patient's age, discount rate, prevalence of endometrial carcinoma and atypical hyperplasia, and costs. Results: The strategy with endometrial biopsy and the strategy with TVS followed by endometrial biopsy in case of an increased endometrial thickness were the most cost-effective strategies. The strategy starting with endometrial biopsy was the most cost-effective when the prevalence of endometrial carcinoma was ≥15.3%, whereas the strategy with TVS and endometrial biopsy was the most cost-effective for women in which the prevalence of endometrial carcinoma was lower. In these strategies, a cut-off level for abnormality of 9 mm resulted in lowest cost per life-year gained. Conclusions: TVS is of use in women with postmenopausal bleeding and a probability of endometrial carcinoma below 15%.     

阴道超声结合尿LH试纸预测排卵在不孕症中的临床应用

目的 探讨阴道超声（TVB）结合尿LH（黄体生成素）试纸预测不孕妇女的卵泡发育、排卵时间及促／超排卵时机掌握的临床意义。方法 阴道超声结合尿LH试纸测定108个自然月经周期（A组），75个CC周期（B组）、42个HMG周期（C组）的卵泡生长、尿LH峰、排卵、子宫内膜情况。比较3组卵泡生长速度、优势卵泡数、排卵时间、过早LH峰和LUF（黄素化未破裂卵泡）发生率、尿LH试纸预测排卵的准确性。结果 比较3组卵泡生长速度，B组与C组明显快于A组（P〈0．01）。优势卵泡数：B组与C组的优势卵泡数均高于A组（P〈0．01）。尿LH试纸测定阳性结果的排卵率91．26％（188／206）。C组排卵日子宫内膜厚度高于A组和B组（P〈0．001）。C组LUF周期发生率16、67％，高于A组和B组（P〈0．01）。B组与C组周期过早LH峰发生率12．8％。尿LH峰后100％在48h内排卵。结论 阴道超声联合尿LH试纸测定对监测卵泡生长及预测排卵是一个简单易行、准确可靠的方法。连续的尿LH试纸测定更能动态的反映卵泡生长并准确预测排卵时间。     

卵泡晚期均质子宫内膜的容受性研究

目的探讨卵泡晚期超声下均质回声子宫内膜的容受性。方法收集卵泡晚期超声下均质子宫内膜妇女14例（实验组）,分别于排卵前和黄体中期取子宫内膜组织,测定白血病抑制因子（LIF）、整合素αvβ3、基质金属蛋白酶-9（MMP9）及血管内皮生长因子（VEGF）水平,其结果与14例卵泡晚期三线征回声内膜妇女（对照组）相比较。结果卵泡晚期对照组和实验组子宫内膜腺体VEGF水平分别为1.39±0.46和0.96±0.37,差别有显著性（P=0.010）。对照组平均LIF、整合素αv、β3水平分别为2.59±0.61、2.60±0.73和2.83±0.57,均高于实验组的1.58±.99、1.85±0.72和1.92±0.91,差别有统计学意义（P=0.003、P=0.011和P=0.004）。结论卵泡晚期均质内膜妇女的子宫内膜容受性低于三线征内膜妇女。     

Impact of high levels of progesterone on alpha(1)-integrin distribution in the endometrium of patients with unexplained infertility

Irregular or low expression of integrins, which are cell adhesion molecules, may be associated with infertility. We conducted a prospective controlled study evaluating the effects of supraphysiological levels of estrogen and progesterone created by human menopausal gonadotropins (HMG) and progesterone support on alpha(1)-integrin immunolocalisation in the endometrium. Three groups were enrolled in the study. The first group of patients (group 1) had unexplained infertility and had been treated with HMG and progesterone (n=27). The second group of patients (group 2) was an untreated fertile group (n=24). The third group (group 3) consisted of patients who had unexplained infertility and had received no treatment (n=11). Endometrial biopsy specimens were taken from individuals from each group during the ovulation induction period. alpha(1)-integrin immunohistochemistry was performed. Serum estradiol and progesterone levels were also measured in parallel with histological dating of endometrial biopsies. Group 1 showed no statistical difference from group 2 in alpha(1)-integrin or histological dating. Group 3 showed less alpha(1)-integrin in the glandular epithelium in the secretory phase. We observed that alpha(1)-integrin was specific to the secretory phase. Its localization was denser in group 2 when compared with group 3, which supports the conclusion that alpha(1)-integrin may be a useful marker for luteal phase quality. Moreover, the supraphysiological estrogen and progesterone levels created by HMG and progesterone support may affect the alpha(1)-integrin in the endometrium in the secretory phase in the case of unexplained infertile patients.     

Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium

Endometrial carcinoma is the most common genital cancer in women. While patients usually present with vaginal bleeding, in 10–20% this characteristic symptom is absent. Endometrial thickness (double layer) is measured by transvaginal sonography and thickening indicates an increased risk of malignancy or other pathology (hyperplasia or polyps). Objective: We sought to correlate hysteroscopic and pathological findings in asymptomatic postmenopausal women with sonographically thickened endometrium (>6 mm). Study design: A prospective observational study in a university hospital of 304 postmenopausal women referred between 1996 and 2006 because of a sonographically thickened endometrium in the absence of abnormal bleeding, who underwent continuous flow hysteroscopy (4.5 mm Storz hysteroscope) and fractionated curettage of the uterine cervix and corpus (D & C) in addition to vaginal sonography (5 MHz probe). Results: The mean age of the women was 64.8 (range 57.7–71.9) years. Average endometrial thickness measured by ultrasound was 12 mm ± 6.7 mm. Hysteroscopy suggested the presence of endometrial polyps in 226 women (74.3%), simple endometrial hyperplasia in 34 (11.2%), atrophic endometrium in 18 (5.9%), complex endometrial hyperplasia in 2 (0.7%), atypical hyperplasia in 3 (1%) and leiomyoma in 9 (3.0%). In 12 women (3.9%), the hysteroscopic appearance suggested malignancy and histology revealed endometrial adenocarcinoma. All hysteroscopic results were confirmed by histological examination. Conclusion: Hysteroscopy represents an easy, safe and effective method for the investigation of asymptomatic women with a thickened endometrium found with transvaginal ultrasound. The commonest pathology was endometrial polyps.     

多囊卵巢综合征合并不孕症妇女致不孕因素检查结果分析

目的对多囊卵巢综合征（Polycystic ovary syndrome,PCOS）合并不孕症妇女进行血清免疫性不孕抗体与输卵管检测,分析其与非多囊卵巢综合征不孕患者上述指标的异同。方法采用酶联免疫吸附测定法（enzyme linked immunosor-bent assay,ELISA）对166名PCOS不孕妇女与169名非PCOS不孕妇女进行抗精子抗体（Anti-sperm antibody,AsAb）,抗子宫内膜抗体（Anti-endometria antibody,AEMAb）,抗卵巢抗体（Anti-ovary antibody,AOVAb）与抗人绒毛膜促性腺激素抗体（Anti-hCG antibody,AhCGAb）的检测,采用子宫输卵管碘油造影术（Hysterosalpingography,HSG）对输卵管通畅程度进行检测,并进行统计学分析。结果非PCOS不孕症妇女的AsAb,AEMAb,AOVAb,AhCGAb阳性率分别为30.2%,34.3%,42.6%,21.3%,而PCOS妇女分别为31.9%,29.5%,44.6%,21.7%两组无差别。前来就诊的PCOS不孕症妇女输卵管双侧不通或者通而不畅率达到75.9%,和对照不孕妇女（80.5%）相比无明显差异。结论PCOS不孕症妇女与对照不孕妇女一样存在不孕相关抗体以及输卵管阻塞等致不孕因素,提示PCOS不孕症妇女的诊治工作应该是综合的。