阴道超声联合腹部超声在诊断妇科急腹症中的应用价值

Application Value of Vagina Combined with Abdominal Ultrasound in Diagnosis of Gynecological Acute Abdomen

目的探究妇科急腹症采用阴道超声联合腹部超声的诊断价值。方法选取2017年4月至2019年6月本院收治的77例妇科急腹症患者,全部患者均进行超声检查,并对腹部超声检查、阴道超声检查、联合检查结果以及超声影像特点进行分析。结果腹部超声检查准确率90.91%,漏诊率9.09%;阴道超声检查准确率97.40%,漏诊率2.60%;阴道与腹部超声联合检查准确率100.00%;阴道超声与腹部超声联合检查的准确率均高于腹部超声、阴道超声(P<0.05)。超声影像特点:(1)异位妊娠:子宫较饱满,宫腔内对娠囊与胚芽不能检测到,附件区发现有囊性混合型回声肿块。(2)卵巢黄体破裂:子宫大小比较正常,附近区域发现不均匀囊性包块,囊壁呈内陷状态,边界不够清楚,存在规律的黄体囊肿,边界一般清楚,内夹存在纤细的光条与弱光点,存在少量弱回声光斑。(3)子宫穿孔:发现子宫后壁浆膜层持续中断,肌层内发现条状高回声,穿孔位置存在大网膜嵌入,腹腔内存在少许积血。(4)卵巢囊肿蒂扭转:盆腔内发现有一囊性、囊实性或者实性包块,形态不规则,边界比较清晰,没有显著血流信号出现。(5)出血性输卵管炎:存在附件包块与腹腔积液,输卵管每个部位都有增粗表现,宫旁发现无形反射强度不同的宫旁高回声团块。结论妇科急腹症采用阴道超声联合腹部超声的诊断价值显著,可减少漏诊或误诊的情况出现。

Objective To explore the diagnostic value of transvaginal ultrasound combined with abdominal ultrasound in gynecologic acute abdomen.Methods From April 2017 to June 2019,77 patients with gynecologic acute abdomen admitted to our hospital were selected.All patients underwent ultrasound examination,and the results of abdominal ultrasound examination,vaginal ultrasound examination,combined examination and ultrasound image characteristics were analyzed.Results The accuracy rate of abdominal ultrasound examination was 90.91%,and the missed diagnosis rate was 9.09%.The accuracy rate of transvaginal ultrasound examination was 97.40%,and the missed diagnosis rate was 2.60%.The accuracy rate of combined vaginal and abdominal ultrasound examination was 100.00%.The accuracy rate of combined examination of vaginal and abdominal ultrasound was higher than that of abdominal ultrasound and vaginal ultrasound(P<0.05).Ultrasonic imaging features:(1)Ectopic pregnancy:the uterus is plump,the gestational sac and embryo cannot be detected in the uterine cavity,and cystic mixed echo mass is found in the adnexal region.(2)Rupture of ovarian corpus luteum:the uterus is relatively normal in size.Uneven cystic mass is found in the nearby area.The capsule wall is in an invaginated state.The boundary is not clear enough.Regular corpus luteum cyst exists.The boundary is generally clear.Fine light bars and weak light spots are sandwiched inside,and a small amount of weak echo light spots exist.(3)Uterine perforation:continuous interruption of serosal layer of posterior wall of uterus,stripe hyperecho in muscular layer,insertion of greater omentum in perforation position,and a little hematocele in abdominal cavity were found.(4)Torsion of ovarian cyst pedicle:a cystic,cystic solid or solid mass was found in the pelvic cavity,with irregular shape,clear boundary and no significant blood flow signal.(5)Hemorrhagic salpingitis:adnexal masses and ascites were found,thickening appeared in every part of the fallopian tube,and parauterine hyperechoic masses with different invisible reflection intensity were found beside the uterus.Conclusion Vaginal ultrasound combined with abdominal ultrasound is of significant diagnostic value in gynecologic acute abdomen,which can reduce the occurrence of missed diagnosis or misdiagnosis.