CA125/HE4和超声影像指标在不同类型盆腔包块的分布特征及恶性风险中的评估价值

目的:观察CA125、HE4及超声恶性风险指标在不同类型盆腔包块的分布特征及恶性预测价值,探讨更优化的卵巢癌风险评估方法。方法:选取2015年1月到2016年6月第三军医大学附属西南医院妇科收治的盆腔包块手术患者305例,依据术后病理结果将患者分为良性组(223例)、交界性肿瘤组(12例)、卵巢癌组(70例)。分析CA125/HE4和超声指标的分布特征并评估其恶性风险预测的灵敏度、特异度。结果:上皮性卵巢癌组中CA125和HE4值显著升高,与非上皮性卵巢癌和良性组比较,差异均有统计学意义(P0.001);非上皮性卵巢癌与良性组比较,差异无统计学意义(P0.05)。卵巢癌组与交界性肿瘤组的CA125值比较,差异无统计学意义(P=0.31),交界性肿瘤的HE4值低于上皮性卵巢癌,差异有统计学意义(P0.05)。良性组子宫内膜异位囊肿CA125升高,HE4无升高,与上皮性卵巢癌比较,差异均有统计学意义(P0.001)。超声指标中,肿块血流、肿块内乳头结构、肿块有实性部分、腹水、肿块直径100mm及多个分隔囊腔六项指标的阴性预测值达78.0%~86.9%。肿块血流、乳头结构、腹水对卵巢癌诊断的特异性均达90%以上。结合血清学和超声指标,建立绝经前卵巢癌风险回归预测模型。结论:CA125和HE4升高分布于上皮性卵巢癌和交界性肿瘤,是其敏感的评估指标。单项CA125升高多分布于卵巢子宫内膜异位囊肿,HE4值是鉴别指标之一。超声六项指标灵敏度低但特异度高,其阴性预测值利于识别恶性风险。本研究的绝经前卵巢癌风险模型有助于卵巢癌的判别,且方法简便。     

腹茧症致不孕2例

例1,患者29岁,因婚后未避孕未孕6 年,发现盆腔包块2 年于2005年7月14日入院.男方精液检查正常.月经史:初潮13岁,经期6 d,周期28 d,末次月经2005年6月26日.既往无下腹部疼痛史,无腹部手术史.入院时查体:外阴、阴道(-),宫颈光滑,无举摆痛,宫体前屈,正常大小,无压痛,左附件区增厚,无压痛,右附件区未扪及异常.入院前7 d院外腹腔镜检查示:盆腔广泛粘连.左输卵管粘连并折叠,双卵巢、右输卵管未显见(粘连包裹),小肠间广泛粘连.入院诊断:原发不孕,盆腔广泛粘连.术中见:肠管被包膜茧状包裹,包膜向下延伸封闭盆腔,不能探及盆腔脏器,仅见左输卵管伞端,沿伞端分离出部分左输卵管后,见左卵巢(大小约4 cm×3 cm×1 cm)表面有包膜包裹,术中考虑此病例为腹茧症所致原发不孕,未继续分离粘连关腹.     

阑尾周围脓肿误诊为右侧卵巢囊肿一例

病例:女,18岁,因右下腹部疼痛一周入院。患者入院前一周无明显诱因出现右下腹疼痛,持续性隐痛,无恶心、呕吐,体温37-38℃之间。在当地诊所抗炎治疗后热退,腹痛减轻。入院当日再次出现右下腹疼痛,B超示盆腔包块,以"盆腔包块性质待查"收住我科。病程中大便排出不畅。月经规则,未婚,否认有性生活史。肛诊:子宫后     

红藤加减汤联合西药治疗盆腔炎随机平行对照研究

[目的]观察红藤加减汤联合西药治疗盆腔炎疗效。[方法]使用随机平行对照方法,将88例住院患者按病志号抽签随机分为两组。对照组44例头孢硫咪150mg+5%葡萄糖250m L,2次/d,静滴;替硝唑,100m L/次,2次/d,静滴。治疗组44例红藤加减汤(甘草5g,桃仁10g,白芷、赤芍、牡丹皮、丹参、金银花各15g,红藤、蒲公英各30g;严重湿热加苍术10g;腰膝酸软加牛膝、杜仲各15g;下腹疼痛剧烈加川芎、延胡索各10g;严重盆腔瘀血加红花、桃仁各10g),1剂/d,水煎200m L,早晚口服;西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、盆腔包块、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组痊愈13例,显效15例,有效13例,无效3例,总有效率93.18%;对照组痊愈8例,显效11例,有效12例,无效13例,总有效率70.45%;治疗组疗效优于对照组(P0.05)。[结论]红藤加减汤联合西药治疗盆腔炎,疗效满意,无严重不良反应,值得推广。     

辨证分型联合中极、气海中药离子导入治疗反复性盆腔炎随机平行对照研究

[目的]观察辨证分型联合中极、气海中药离子导入治疗反复性盆腔炎疗效。[方法]使用随机平行对照方法,将76例住院患者按病志号抽签方法简单随机分两组。对照组38例替硝唑,0.4g/次,1次/d,静滴;头孢呋辛4.0g+250m L5%葡萄糖,静滴,1次/d。治疗组38例辨证分型:气虚(芪藤汤化裁,黄芪、银花藤各20g,党参、生晒参、白术、茯苓、蒲黄各15g,香附10g,鸡内金、赤白芍各12g,丹参20g);血瘀(少腹逐瘀汤加减,延胡索、当归、川芎各20g,桃仁、赤芍、乳香、没药、丹皮、五灵脂各10g,土茯苓、徐长卿、生薏仁、红藤、败酱草各30g);湿盛(川芎、赤芍、香附、黄柏各10g,玄胡20g,黄芪、党参、红藤、败酱草、生薏仁、丹参、土茯苓各30g);1剂/d,水煎750m L/d,3次/d,口服;药渣再行第4次浓煎60min,过滤去渣,浓缩至20m L制成导入液,取纱布垫浸,并置中极、气海,用5~10m A直流电导入,以患者耐受情况为度,25min/次,1次/d。连续治疗15d为1疗程。观测临床症状、盆腔积液、盆腔包块、不良反应。连续治疗6疗程,判定疗效。[结果]临床疗效治疗组优于对照组(P0.05)。[结论]辨证分型联合中极、气海中药离子导入治疗反复性盆腔炎,疗效满意,无严重不良反应,值得推广。     

2014年读片窗(6)

<正>患者,女性,47岁,发现盆腔包块10 d入院,神清,浅表淋巴结未触及肿大。腹平软,肝脾肋下未触及,全腹无明显压痛,双下肢不肿。妇检:宫颈轻度炎症,可见纳氏囊肿,右侧附件区子宫上方触及一质硬包块,直径约12 cm,活动度欠佳,压痛(±)。实验室检查:血CA125:153.60 U/mL(正常0~35 U/mL),血β-HCG<0.10 uIU/mL、AFP:2.70 IU/mL、CEA:0.86ng/mL、CA199:15.38 U/mL,在正常范围。胃镜:浅表性胃炎,十二指肠球炎。     

巨大子宫阔韧带平滑肌瘤2例

例1,女,38岁,已婚,因自觉腹围增大近1年,加重1周于2011年5月6日入我院.体格检查:腹膨隆,腹部可及巨大包块,上界达剑突下6 cm,两侧达盆壁,囊性感,边界尚清,活动,无压痛.妇科检查:外阴及阴道未见异常;宫颈难以暴露;宫体及附件可及一孕8个月子宫大小的包块,境界清楚,活动,无压痛.彩超示:盆腔实性包块.盆腔CT示:右侧腹腔至盆腔附件区占位,考虑:(1)子宫或右侧附件来源恶性肿瘤并动静脉瘘可能;(2)腹腔恶性肿瘤(间叶组织来源)可能;(3)建议行腹主动脉血管成像检查.腹主动脉血管成像检查考虑:下腹部、盆腔区占位性病变,动脉期其内可见多数动脉血管影,提示病变富含动脉供血.     

超声造影诊断卵泡膜细胞瘤1例

患者女,24岁,因自行发现盆腔包块1个月,下腹部持续性疼痛2d就诊。妇科检查：外阴未产型,子宫前位,正常大小,左侧附件可触及一大小为11cm包块,表面光滑,质硬。实验室CA125检查：227．3μmol/L。超声检查：双侧卵巢清晰,形态大小如常。盆腔正中偏左侧,可见一异常回声区,边界清晰,大小为114mm×108mm×68mm,与双侧卵巢、子宫分界清晰（图1）,其内未见彩色血流信号。     

原发性卵巢平滑肌瘤一例报道并文献复习

一、病例摘要患者,37岁。体检发现盆腔肿物1年,以“子宫肌瘤”收入院。患者糖尿病史5年余,平素月经规律。妇科检查：外阴及阴道无异常,宫颈光滑,子宫前位,如孕18周大小,质中,不活动,双侧附件区触及不满意。彩超检查显示：宫体大小6．9cm×4．3cm×5．4cm,子宫内膜厚0．2cm,子宫左侧可见一个14．3cm×13．5cm×8．9cm低回声包块,与子宫底部紧相邻,其内见较丰富的血流信号,双侧卵巢显示不清。考虑盆腔包块来源待定,子宫肌瘤待除外。行剖腹探查术,术中见：子宫正常大小,右附件正常,左卵巢肿物,遂行左卵巢肿物剥除术＋左输卵管切除术。     

126例青春期女性盆腔包块的病因及诊治分析

Objective To explore the clinical characteristics,causes,diagnosis and treatment of pelvic mass in adolescents caused by gynecologic diseases. Methods One hundred and twenty-six adolescents with gynecologic diseases presented as pelvic mass were retrospectively reviewed. Results The average age of all patients was 17. 6 years,ranging from 10. 0 to 19. 0 years. Ectopic pregnancy was found in 38 patients(30. 2%) ,the average age of the patients was 18.6 ±0.5 years, ranging from 17.0 to 19.0 years. Ovarian neoplasm was found in 35 patients (27. 8%) ,the average age of the patients was 17. 1 ± 2. 1 years, ranging from 10. 0 to 19. 0 years. Twenty cases (57. l%)had germ cell tumor, eighteen with mature teratomas, one with endodermal sinus tumor and one with immature teratoma. Thirteen cases(37. 2%)had epithelial ovarian tumors;eight with serous cystadenomas,three with mucinous cystadenoma, one with mucinous cystadenoma complicated with serous cystadenoma and one with borderline mucinous cystadenoma. Two cases had simple cyst of the ovary (5. 7%) . Congenital abnormality of reproductive tract was found in 14 patients (11. 1%), the average age was 14. 7 ±2. 2 years, ranging from 13.0 to 19. 0 years. Seven had imperforate hymens, two had rudimentary horn of uterus,four had atresia of vagina,one had atresia of vagina complicated with rudimentary horn of uterus,and one had oblique septum of vagina. Corpus luteum rupture was found in 11 patients (8. 7%) , the average age was 18. 1 ± 1. 9 years, ranging from 13. 0 to 19. 0 years. 116 patients underwent operative treatment and 10 patients underwent conservative therapy. Conclusions According to the stage of adolescents, main causes of pelvic mass in adolescents are different Main causes of pelvic mass in early adolescents are tumorous disease. Congenital abnormalities of reproductive tract are usually in middle adolescents. The gonads develop closely mature in late adolescent period; main causes of pelvic mass are ectopic pregnancy, ovarian neoplasm and physiologic ovarian cyst Surgery is the main therapy of pelvic mass in adolescents.