Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography(PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age-and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging(DTI), using a 3.0 T magnetic resonance scanner(Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD) and radial diffusivity(RD). The asymmetry index(AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test;compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into threesubgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side(P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls(P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients(P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups(P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

Recurrent orbital space-occupying lesions:a clinicopathologic study of 253 cases

Objective：To analyze the clinical features,histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.Methods：A retrospective study was carried out in 253 consecutive patients with recurrent orbital spaceoccupying lesions treated by surgical excision in the Institute of Orbital Diseases,the General Hospital of the Armed Police Force from January 2009 to December 2010.Results：The patients included 123 males and 130 females aged 2 to 78 years（mean,36.2 years）,and the last recurrence interval after operation ranged from 1 month to 40 years（median,4.75 years）.Of all the cases,159（62.8%）,65（25.7%）,20（7.9%）,8（3.2%） and 1（0.4%） had previously experienced once,twice,three,four and six times of surgeries,respectively.Among them,29（11.5%） cases had recurred 3 times or over,and 37（14.6%） cases got recurrence in 10 or more years postoperatively.Most of the patients with local recurrence presented with various clinical manifestations,while 31（12.3%） cases were symptom-free.Two hundred and thirty-one（91.3%） cases underwent surgical removal of the recurrent orbital lesions,and another 22（8.7%） cases had to receive the exenteration of orbit.Categories of these recurrent orbital lesions after operation were as follows：lacrimal gland tumors,65（25.7%） cases;vasogenic diseases,54（21.3%） cases;neurogenic tumors,42（16.6%） cases;secondary tumors,24（9.5%） cases;orbital inflammation,21（8.3%） cases;myogenic tumors,14（5.5%） cases;fibrous and adipose tumors,12（4.7%） cases;lympho-hematopoietic tumors,7（2.8%） cases;bone or cartilage tumors,7（2.8%） cases;orbital cysts,6（2.4%） cases;and indefinitely differentiated tumor,1（0.4%） case.The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma,hemangiolymphangioma,lacrimal gland adenoid cystic carcinoma,meningioma,inflammatory pseudotumor,neurofibroma,sebaceous gland carcinoma,vascular malformation,rhabdomyosarcoma and hemangioma.Conclusions：The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions.The lacrimal gland epithelial tumor is most prone to relapse after resection,and early and longer-term postoperative follow-up is needed.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.

Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

BACKGROUND ： Functional magnetic resonance imaging （fMRI） studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages. OBJECTIVE： To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex. DESIGN ： A case-controlled observation SETTING： Department of Radiology, Second Affiliated Hospital, Shantou University Medical College .PARTICIPANTS： Twenty-three patients （13 males and 10 females） with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of （47±1） years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumor types were astrocytoma （n =8）, metastatic tumours （n =7）, meningiomas （n =5） and oligodendroglioma （n =3）. The muscle strength was normal in 11 cases （grade 5） and obviously decreased in 12 cases （grade 2-3 in 3 cases and grade 4 in 9 cases）; muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees （5 males and 4 females） of 20-56 years old with an average of （34±1） years were taken as controls. All the patients and healthy subjects were right-handed. METHODS： All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted simple active finger-tapping movements, and for the 3 cases whose clinical symptoms were severe in the patient group, the simple passive finger-tapping movements were used. The manifestations in the activated brain areas were analyzed in the patients with brain tumor of different muscle strength and the controls. The motor deficit and activation of contralateral primary motor cortex （M1） in simple finger-tapping movements were observed in the patient group. MAIN OUTCOME MEASURES： （1） Brain areas activated by finger-tapping movements in each group： （2） Activated volumes in hemisphere by finger-tapping movements between groups. RESULTS： The contralateral M1 area could not be activated in 1 case in the patient group,, all the other 22 patients and 9 healthy subjects were involved in the analysis of results. （1） In the control group, unilateral finger tapping movement activated the contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC. The activation volume was the largest in contralateral primary motor cortex （M1）, smaller in the SMA, and the smallest in PMC. The finger tapping movement in healthy subjects could activate contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC, which had no obvious differences from the manifestations of brain functional area activated by active finger tapping. There was no significant difference in the volume of activated functional areas between right and left hands. In the patient group, the central sulcos around the tumor in the activated M1 area displaced towards dorsal or ventral side, also extended. The distance of displacement in the functional area was determined as compared with the contralateral central sulcus, and the results suggested the M1 displacement, including that there were 10 cases with the M1 displacement larger than 10 mm in the patients with motor deficit, which were obviously more than in those without motor deficit （n =1, P 〈 0.01）, and the activated volume in contralateral M1 area was obvious smaller in the patients with motor deficit than in those without motor deficit （P 〈 0.01）. （2） The M1 activation and changes were observed in contralateral hemisphere in the patient group, and the activated volume was obviously larger than that in the control group （P 〈 0.01）. The activated volumes of M1 and PMC in ipsilateral hemisphere were obviously larger than those in the control group （P 〈 0.05）, but that of SMA had no obvious difference between the two groups （P 〉 0.05）. CONCLUSION： fMRI can be used to observe the activation of the brain motor functional areas of patient with space-occupying lesions in motor area, and evaluate the state of their motor function. The larger the distance of displacement of M1 compressed by tumor, the more obviously the muscle strength decreases in the patients.

经静脉超声造影在子宫局灶性病变诊断及评估中的应用现状

常见的子宫局灶性病变(focal uterine lesions,FUL)包括良性病变和恶性病变。恶性FUL早期的诊断与治疗对于提高生存率和改善预后起着至关重要的作用。不同的FUL的病理特点不同,微血管灌注也存在差异。经静脉超声造影(CEUS)技术作为有效的微血管显像方式,为鉴别诊断FUL的良恶性及进一步评估恶性病变提供了更多的信息,为临床医师管理患者方案的选择提供了客观的影像资料。本文就经静脉CEUS在常见FUL中诊断及评估的应用现状做一综述。

经阴道超声联合超声造影诊断子宫肌瘤效率

目的:探讨经阴道超声联合超声造影(CEUS)诊断子宫肌瘤效果.方法:回顾性分析2021年1月-2023年1月本院收治且经手术病理确诊的112例子宫肌瘤患者临床资料,均经阴道超声和CEUS检查,与手术病理结果进行比较,分析经阴道超声、CEUS检查和二项联合诊断子宫肌瘤价值.结果:112例中Ⅰ型72例、Ⅱ型40例,黏膜下肌瘤21例、肌壁间肌瘤62例、浆膜下肌瘤29例,单发肌瘤58例、多发肌瘤54例,共检查出病灶数173个,其中黏膜下肌瘤病灶数25个、肌壁间肌瘤病灶数112个、浆膜下肌瘤病灶数36个.与病理结果比较,经阴道超声联合CEUS诊断子宫肌瘤的准确率为100.0%,高于阴道超声(89.3%)和CEUS(93.8%);漏诊率为0,低于阴道超声(10.7%)和CEUS(6.3%)(均P<0.05).经阴道超声联合CEUS诊断Ⅰ型、Ⅱ型子宫肌瘤的准确率均为100.0%,均高于阴道超声(90.3%、87.5%)和CEUS(94.4%、90.0%);经阴道超声联合CEUS对肌壁间肌瘤诊断率高于经阴道超声、CEUS单独诊断(均P<0.05),3种诊断方式对黏膜下肌瘤、浆膜下肌瘤诊断率无差异(P>0.05);经阴道超声联合CEUS对肌壁间肌瘤的病灶检出率高于经阴道超声、CEUS单独诊断(均P<0.05),3种诊断方式对黏膜下肌瘤、浆膜下肌瘤病灶检出率无差异(P>0.05).结论:经阴道超声联合CEUS提高了诊断子宫肌瘤效率,并可准确判断子宫肌瘤的位置、分型及数目,对肌壁间肌瘤检出率较高.为临床选择治疗方案提供依据.

“主客交”理论在子宫颈癌前病变中的应用

基于“主客交”理论结合现代医学研究,探讨子宫颈癌前病变的发病机制及中医药应用策略。子宫颈癌前病变的主要病因病机为肝脾肾之“主”失调,加之痰湿热毒之“客”邪内聚、蕴结,终成癥瘕,渐成痼疾,发为宫颈癌前病变并趋向恶性发展。治以“扶正达邪,分离主客”,在疏肝健脾固肾的同时厘清主客强弱,精准辨证。分阶段灵活选用清热、祛湿、解毒、理气、活血、化瘀等“通”法以祛邪通络。

经阴道超声联合CEA、CA125、CA153鉴别诊断子宫腔占位性病变良恶性

目的:探讨经阴道超声联合CEA、CA125、CA153鉴别子宫腔占位性病变良恶性的价值.方法:收集2021年2月-2023年5月本院疑似子宫腔占位性病变患者117例临床资料,根据刮宫或术后病理检查结果分为恶性组及良性组,其中恶性组56例,为子宫内膜癌;良性组61例,为子宫内膜良性息肉.比较两组经阴道超声及血清指标差异,受试者工作特征曲线(ROC)分析各指标鉴别诊断子宫腔占位性病变良恶性效能.结果:超声检查收缩期峰值血流速度两组无差异(P>0.05),恶性组阻力指数小于良性组、内膜厚度大于良性组;恶性组血清癌胚抗原(CEA)、糖类抗原125、CA153水平均高于良性组(均P<0.05).ROC曲线结果显示,经阴道超声、血清CEA、CA125、CA153各指标单独或联合应用鉴别诊断子宫腔占位性病良恶性的AUC分别为0.822、0.713、0.728、0.797及0.915,均有价值,但联合诊断价值最高.结论:经阴道超声、血清CEA、CA125、CA153联合应用对宫腔占位性病变良恶性鉴别诊断效能较高,有较好的临床应用价值.

桂枝茯苓胶囊联合戈舍瑞林对子宫肌瘤患者内分泌功能的影响

目的:探讨桂枝茯苓胶囊联合戈舍瑞林治疗UFE的疗效。方法:将83例UFE患者按照治疗方式不同分为A组(n=41)和B组(n=42)。A组给予注射用戈舍瑞林微球;B组在A组基础上给予桂枝茯苓胶囊。两组均持续治疗3个月。比较两组临床疗效、血液流变学指标、内分泌功能、病灶形态、血清人附睾蛋白4(HE4)、癌抗原125(CA125)、血管紧张素Ⅱ(AngⅡ)、干扰素γ(IFN-γ)水平及生活质量。结果:治疗后,B组总有效率为95.24%,高于A组的78.05%(P<0.05)。治疗后,两组血液流变学、内分泌功能指标、血清HE4、CA125、AngⅡ、IFN-γ水平均降低,且B组低于A组(P<0.05);子宫体积和UFE体积均缩小,且B组小于A组(P<0.05);生活质量各项评分均升高,且B组高于A组(P<0.05)。结论:UFE患者经桂枝茯苓胶囊与戈舍瑞林联合治疗可改善血液流变学高凝状态及内分泌功能,调节相关因子水平,提高治疗效果及患者生活质量。

宫腔镜检查对异常子宫出血诊断的临床意义研究

目的探讨宫腔镜检查对诊断异常子宫出血(AUB)的临床意义。方法选取本院收治的120例AUB患者为研究对象,均进行经阴道超声检查、宫腔镜检查,以病理检查结果为金标准,分析宫腔镜检查对AUB的诊断价值。结果宫腔镜检查诊断AUB的诊断准确率为98.33%,高于经阴道超声检查的92.50%(P<0.05),且宫腔镜检查对AUB的诊断准确率、病因判断正确率及病灶形态显示符合率与病理检查结果比较差异无统计学意义(P>0.05)。结论宫腔镜检查诊断AUB准确率较高,且能为病因的精确判断提供有效参考,同时可清晰显示病灶形态,应用价值确切。

超声弹性成像技术联合宫腔镜对子宫宫腔病变的诊断价值

目的探讨与分析超声弹性成像技术联合宫腔镜对子宫宫腔病变的诊断价值。方法选择2020年4月—2022年12月在淄博市妇幼保健院诊治的87例子宫宫腔病变患者作为研究对象,所有患者都给予超声弹性成像技术联合宫腔镜检查,并给予病理检查并判断诊断价值。结果在87例患者中,病理诊断为子宫内膜癌17例(恶性组);子宫内膜息肉32例,子宫内膜炎18例,子宫黏膜下肌瘤16例,子宫内膜不典型增生4例(良性组)。恶性组的超声弹性成像技术评分明显高于良性组,差异有统计学意义(P<0.05),判断为恶性病变14例,良性病变73例。宫腔镜诊断为子宫内膜癌13例,子宫内膜息肉33例,子宫内膜炎19例,子宫黏膜下肌瘤17例,子宫内膜不典型增生5例,宫腔镜检查总准确率为90.8%(79/87)。超声弹性成像技术联合宫腔镜判断为恶性病变16例,良性病变71例。超声弹性成像技术、宫腔镜、超声弹性成像技术联合宫腔镜鉴别诊断子宫宫腔病变良恶性的敏感性分别为82.3%(14/17)、64.7%(11/17)、94.1%(16/17),特异性分别为100.0%(70/70)、97.1%(68/70)、100.0%(70/70),超声弹性成像技术联合宫腔镜鉴别诊断子宫宫腔病变良恶性的敏感性高于宫腔镜检查,差异有统计学意义(P<0.05),其他方法的诊断敏感性与特异性比较,差异无统计学意义(P>0.05)。结论超声弹性成像技术联合宫腔镜对子宫宫腔病变组织良恶性的判断具有更高的敏感性与特异性,有较好的应用价值。

超声新技术在宫腔占位性病变诊断中的应用进展

子宫宫腔占位是临床妇科中常见的疾病,经阴道二维超声(2D-TVS)检查是这些疾病基础的初查方式。随着超声新技术的不断发展,出现了经阴道三维超声(3D-TVS)、超声弹性成像(UE)以及静脉超声造影(CEUS)等高级声像学诊断技术。本文对3D-TVS、UE及CEUS的基本原理及其在子宫宫腔占位性病变诊断中的应用进展进行综述。

经阴道超声联合弹性成像技术在宫腔病变鉴别中的价值

目的探讨经阴道超声联合弹性成像技术在宫腔病变鉴别中的价值。方法选取2018年1月—2021年1月于河北北方学院附属第二医院妇科就诊的宫腔病变患者126例,使用GE-E10彩色多普勒超声诊断仪进行经阴道超声和经阴道弹性成像检查,探头频率5~9 MHz,以组织病理学检查结果为“金标准”,分别比较经阴道超声、弹性成像及联合检查的结果,同时记录病变宫腔组织的平均弹性值(Emea)、最大弹性值(Emax)、最小弹性值(Emin)、弹性值标准差(Esd),比较良恶性宫腔病变的弹性模量值差异,绘制各弹性模量值诊断宫腔良恶性病变的受试者工作特征曲线(ROC),分析阴道超声联合弹性成像在宫腔良恶性病变鉴别诊断中的应用价值。结果恶性病变组弹性成像的Emea、Emax、Emin及Esd均高于良性病变组,差异具有统计学意义(t=28.573、23.996、2.618、17.412,P均<0.01);经阴道超声检查恶性病变与组织病理学确诊的符合率为54.3%,弹性成像检查为71.4%,联合检查为88.6%;经阴道超声检查良性病变与组织病理学确诊的符合率为82.1%,弹性成像检查为78.6%,联合检查为92.9%。经阴道超声检查诊断良恶性病变AUC为0.538,弹性成像技术AUC为0.661,联合检查AUC为0.788,联合检查AUC高于经阴道超声检查、弹性成像技术(P=0.04)。结论经阴道超声联合超声弹性成像技术可提高宫腔恶性病变的诊断准确率。

超声造影时间-强度曲线分析对宫腔占位病变良恶性的诊断价值

目的 探讨超声造影时间-强度曲线分析对宫腔占位病变良恶性的诊断价值。方法 选取2020年1月至2021年12月在丽水市人民医院行超声检查发现的100例宫腔占位病变患者为研究对象,根据宫腔镜术后病理诊断结果分为恶性组48例(其中子宫内膜癌45例,子宫内膜间质肉瘤3例)、良性组52例(均为子宫内膜息肉)。比较两组患者超声造影时间-强度曲线参数,同时分析这些参数对宫腔占位病变良恶性的预测效能。结果 与良性组比较,恶性组对比剂达峰时间较短(P<0.05),峰值强度、曲线上升支斜率均较高(均P<0.05);而两组患者对比剂到达时间比较,差异无统计学意义(P>0.05)。对比剂到达时间、对比剂达峰时间预测宫腔占位病变良恶性的AUC、灵敏度、特异度分别为0.623、0.562、1.000和0.562、0.292、0.923,差异均无统计学意义(均P>0.05);峰值强度、曲线上升支斜率预测宫腔占位病变良恶性的AUC、灵敏度、特异度分别为0.666、0.646、0.712和0.812、0.875、0.673,差异均有统计学意义(均P<0.05)。结论 超声造影时间-强度曲线分析对宫腔占位病变良恶性的鉴别具有一定的诊断价值。

经阴道彩色多普勒超声在绝经后女性妇科宫腔病变诊断中的价值

目的探讨经阴道彩色多普勒超声在绝经后女性妇科宫腔病变诊断中的价值。方法选取60例绝经后女性妇科宫腔病变患者为研究对象,接受经腹部彩色多普勒超声诊断为对照组,接受经阴道彩色多普勒超声诊断为试验组,比较两组的诊断结果、诊断效能及诊断满意度。结果试验组子宫腺肌瘤、子宫肌瘤、宫腔炎症、子宫内膜癌诊断结果优于对照组(P<0.05);试验组妇科病变诊断准确率、敏感度、特异度均高于对照组,差异有统计学意义(P<0.05);试验组诊断满意度为96.67%,高于对照组的86.67%(P<0.05)。结论在绝经后女性妇科宫腔病变诊断中,应用经阴道彩色多普勒超声检查,不仅能够取得较高的诊断准确率,还能有效鉴别妇科宫腔病变类型,且患者诊断满意度高,具有较大的临床推广价值。

子宫内膜采集器SAP-1在常见宫腔占位性病变诊断中的应用价值

目的探讨子宫内膜采集器(SAP-1)在子宫内膜息肉和黏膜下肌瘤诊断中的作用。方法选取2018年8月至2021年12月在澳门镜湖医院妇产科住院行宫腔镜检查的298例患者作为研究对象,术中先应用SAP-1采集子宫内膜,后行宫腔镜下诊刮术或电切术收集标本,以后者的病理诊断结果为金标准,分析SAP-1取材的诊断效能。结果应用SAP-1取材的标本满意率为91.6%,稍低于宫腔镜下取材的95.3%,两种方法比较,差异无统计学意义(P>0.05)。患者的子宫内膜病变以子宫内膜息肉(占48.7%)和黏膜下肌瘤(占7.4%)为主,132例子宫内膜息肉患者中,SAP-1取材检出16例;20例黏膜下肌瘤患者中,SAP-1取材未检出。结论当影像学检查提示子宫内膜息肉或黏膜下肌瘤等宫腔内实性占位病变时,SAP-1不适合用于标本采集,建议行宫腔镜检查明确诊断。

腹腔镜下子宫动脉临时阻断联合病灶切除术治疗外生型剖宫产瘢痕妊娠的临床研究

目的 分析腹腔镜下子宫动脉临时阻断联合病灶切除术在外生型剖宫产瘢痕妊娠(CSP)的临床应用价值。方法 收集江西省人民医院、上饶卫校附属医院、上饶市人民医院、景德镇第一人民医院、九江市妇幼保健院2016年7月至2018年6月收治的外生型CSP患者资料(104例)。根据手术方式不同,将其分为腹腔镜下子宫动脉临时阻断联合病灶切除术组(A组),腹腔镜下病灶切除术组(B组),子宫动脉栓塞联合腹腔镜下病灶切除术组(C组)。组间疗效的评价指标包括手术时间、术中出血量及围手术期输血率、术后疼痛评分、血β-人绒毛膜促性腺激素(β-HCG)恢复正常时间、住院时间、术后1~2年间的妊娠情况。结果 三组血β-HCG恢复正常时间及住院时间差异无统计学意义(P> 0.05);A组的手术时间长于C组(P <0.05),但与B组差异无统计学意义(P> 0.05);A组的术中出血量及围手术期输血率低于B组(P <0.05),与C组差异无统计学意义(P> 0.05);A组的术后24及48 h疼痛VAS评分与B组差异无统计学意义(P> 0.05),但低于C组(P <0.05)。A组的妊娠率和活产率高于C组,差异有统计学意义(P <0.05),与B组差异无统计学意义(P> 0.05)。结论 腹腔镜子宫动脉临时阻断联合病灶切除术能有效降低CSP患者的出血风险、减轻患者术后疼痛。对于有再生育期望的女性,也能极大程度保护其生育功能,具有临床应用价值。

腹腔镜下全子宫切除术对良性病变患者围术期指标、凝血功能及卵巢储备指标影响

目的:分析腹腔镜下全子宫切除术对子宫良性病变患者围术期指标、血清脂联素(APN)及术后恢复的影响。方法:选取2020年9月—2022年9月在本院接受医治的170例子宫良性病变患者,依据手术治疗方式分为对照组(85例)和观察组(85例),分别接受经腹全子宫切除手术、腹腔镜全子宫切除手术。术后均常规抗感染治疗,比较两组围术期指标,检测手术前后患者凝血功能指标及卵巢储备功能指标。结果:观察组肛门排气时间(2.05±0.68d)、排便时间(2.64±0.86d)、住院时间(7.56±1.05d)均短于对照组(2.58±0.82d、3.08±0.93d、10.42±3.81d),术中出血量(204.41±15.81ml)少于对照组(248.47±20.25ml),术后并发症(5.9%)低于对照组(21.2%)(均P<0.05)。术后24 h两组凝血酶原时间、活化部分凝血活酶时间、血小板水平均较术前降低,对照组低于观察组(P<0.05),术后纤维蛋白原、D-二聚体水平均较术前升高,但观察组低于对照组,两组术后2个月血清卵泡刺激素、黄体生成素、抗苗勒管激素、抑制素B均降低,但观察组高于对照组,雌二醇水平升高,且观察组高于对照组(均P<0.05)。结论:腹腔镜下全子宫切除术可缩短患者术后恢复时间,减少术中出血量,对卵巢储备功能不良影响较小。

剖宫产瘢痕妊娠Ⅱ、Ⅲ型两种治疗方法效果比较

目的:分析经阴道妊娠病灶切除术和子宫动脉栓塞术(UAE)联合刮宫术治疗剖宫产瘢痕妊娠(CSP)II、III型临床疗效。方法:选取2017年3月—2023年1月本院收治的Ⅱ型、Ⅲ型CSP患者77例,随机分为两组,分别给予经阴道妊娠病灶切除术(经阴道组,36例),UAE联合刮宫术(UAE组,41例)。比较两组治疗成功率、住院费用及时间、人绒毛膜促性腺激素(hCG)恢复至正常时间、术中出血量、术后首次月经复潮时间、并发症、术后疼痛等。结果:经阴道组治疗成功率(100.0%)、术中出血量(24.4±13.9ml)、住院时间(7.3±1.7d)与UAE组(97.6%、22.4±8.6ml、7.0±2.1d)无差异(P>0.05),住院费用(10808.3±2310.7元)、血清hCG下降至正常时间(16.0±3.6d)、月经恢复时间(30.3±2.1d)、并发症发生率(0)、患者术后疼痛评分(4.72±1.67分)均低于UAE组(16888.7±4004.5元、18.4±3.0d、32.8±4.6d、9.8%、7.89±1.41分)(均P<0.05)。结论:两种方法治疗效果相当,但经阴道妊娠病灶切除术术后恢复指标更佳,并发症更低。