目的 探讨盆腔区域子宫静脉内平滑肌瘤病(IVL)的超声特征,以提高对该病的超声诊断水平.方法 回顾性分析2016年2月至2020年12月本院收治的4例经手术证实的盆腔区域IVL患者临床、超声及病理资料.结果 患者平均年龄44岁,2例有子宫肌瘤剔除术病史.3例超声提示子宫及附件区实性"蠕虫样"占位,术前提示IVL.1例漏诊病例,超声仅提示子宫肌瘤.术中瘤体呈条索状分布,沿子宫血管生长,与超声所见相符.结论 盆腔区域IVL的超声声像图表现具有一定特征性,对比历史检查如发现"蠕虫样"实性结节可提示IVL可能;超声能显示病变大小、累及范围、内部回声及血流等情况,可作为IVL术前诊断及术后随访的首选影像学方法 .

目的 建立胎儿脐轮部脐静脉流速的正常参考值范围.方法 成功选取1 710例孕22～38+6周的正常胎儿,测量胎儿脐轮部脐静脉流速,按孕周分组,并进行统计学分析.结果 (1)各孕周脐轮部脐静脉流速呈正态分布;(2)各孕周间脐轮部脐静脉流速无统计学差异;(3)各孕周脐轮部脐静脉流速为:第5百分位数:12 cm/s,第50百分位数:30 cm/s,第95百分位数:60 cm/s.结论 初步建立了正常胎儿脐轮部脐静脉流速的参考值范围,可为脐带扭转等导致胎儿脐静脉血流动力学改变的产前超声诊断提供有价值的信息.

目的 运用超声测量并建立不同孕周胎儿子宫前后径的正常值范围,探讨胎儿子宫前后径与孕周的相关性.方法 常规产前超声检查的1 818例24～38周孕妇中选取符合条件的样本库,对其胎儿进行子宫前后径的测量,按孕周分组,进行统计学分析.结果 总共1 745例进行最后的统计分析,子宫前后径与孕周呈正相关,相关系数为r=0.990 (P＜0.001).以孕周为自变量,胎儿子宫前后径为因变量,直线回归分析得出自变量与因变量之间存在的直线关系,将所得方程进行简化,得出简易公式:子宫前后径(mm)=孕周×0.5-8.结论 成功建立了孕24～38周胎儿子宫前后径的直线回归方程,为胎儿外生殖器异常及子宫发育异常的诊断提供有价值的信息.

Objectives To investigate the the value of shear wave (SWV) for early diagnosis of prostate benign and malignant lesion.Methods 60 patients with prostate lesions were examined by SWV,technology and postoperative pathology was measured and compared for differentiating the benign and malignant tumors.Results SWV technology for detection of prostatc malignant lesions and benign lesions were compared between groups,there was significant difference in shear wave velocity (P ＜ 0.001).There was significant difference in shear wave velocity between the prostate benign mass and normal prostate groups (P ＜0.017).With the SWV ＞ 2.87 m/s as diagnostic point for benign and malignant prostate lesions,the positive predictive value and specificity for malignancy was 86.7％ and 66.7％,respective.Conclusions SWV technology will provide more information and basis for early differential diagnosis of prostate benign and malignant lesions.

Objective:Virtual touch tissue quantification(VTTQ) is a new,promising technique for detecting the stiffness of tissues.The aim of this study is to compare the performance of VTTQ and digital rectal examination (DRE) in discrimination between prostate cancer(PCa) and benign prostatic hyperplasia(BPH).Methods:VTTQ was performed in 60 patients with suspected BPH and PCa before the prostate histopathologic examination.The shear wave velocity (SWV) at each nodular lesion was quantified by implementing an acoustic radiation force impulse(ARFI).The performance of VTTQ and DRE in discrimination between PCa and BPH was compared by the pathology.Results:The SWV values (m/s) were significantly greater in PCa and BPH than in normal prostate (2.97±0.42,2.61±0.47 and 2.46±0.52).The area under the receiver operating characteristic curve(AUC) for VTTQ(SWV＞2.87 m/s) to differentiate prostate nodules as benign hyperplasia or malignancy was 0.78,while it was 0.67 for DRE.The diagnostic sensitivity,specificity,PPV,NPV and accuracy were 80.0％,66.7％,74.3％,72.0％,79.2％,respectively for VTTQ (SWV＞2.87 m/s),whereas they were 57.5％,52.3％,62.5％,57.0％,62.1％ respectively for DRE.Conclnsion:VTTQ can effectively detect the stiffness of prostate nodular lesions,which has a significantly higher performance than DRE in discrimination between PCa and BPH.

目的 探讨经直肠超声造影(CEUS)在前列腺癌诊断中的临床应用价值.方法 回顾性总结分析2014年10月~2015年12月我院住院接受治疗的72例前列腺癌患者接受经直肠CEUS检查的资料.观察二维声像图及前列腺癌超声造影的灌注参数.结果 经注入造影剂后,癌性病变区域造影剂信号分布紊乱,呈快速增强及消退.癌性结节呈快进快出的高增强,部分结节内可见造影信号呈蚓状进入;72例前列腺癌患者共80个结节,均成功进行灰阶CEUS分析.二维图像上,病灶多呈低回声50个,17个结节血流较为丰富,其余5个未见明显血流信号.前列腺癌超声造影的灌注参数:始增时间(18.58±3.91)s,达峰时间(33.59±4.61)s,峰值强度(13.12±3.38)db.结论 经直肠超声造影用于前列腺癌诊断具有重要的应用价值,可以显著提高前列腺癌的诊断准确率.

目的 探讨胎儿先天性椎体畸形的产前超声分型情况,并分析不同诊断切面对不同类型胎儿先天性椎体畸形的优势.方法 回顾性分析经产前超声诊断为胎儿椎体畸形的孕妇36例,总结产前超声分型及不同切面的诊断情况.结果 36例孕妇中,胎儿半椎体畸形25例,分节不全8例,混合型3例.脊柱纵切面诊断前方半椎体4例,后方半椎体6例,前后融合障碍型半椎体3例,以及融合椎畸形8例;结合病变部位横切面或冠状切面诊断左、右侧半椎体8例,蝴蝶椎4例.结论 胎儿先天性椎体畸形的产前超声分型是可行的,针对性脊柱三维成像可为在二维超声诊断基础上的椎体畸形进一步分亚型提供帮助.不同切面对不同类型胎儿先天性椎体畸形的临床诊断有重要指导意义.

Objective:To compare the different vaule of two-dimensional ultrasound contrast hysterosal-pingography(2D-HyCoSy) and three-dimensional ultrasound contrast hysterosalpingography (3D-HyCoSy) for the diagnosis of tubal patency. Method:Choose 53 cases infertile (106 fallopian tubes),at fisrt, imple-menting three-dimensional ultrasound contrast hysterosalpingography,and then implementing two - dimen-sional ultrasound contrast hysterosalpingography, and then compared the situation of 2D-HyCoSy, 3D-Hy-CoSy and laparoscopic methylene blue dye test pass CLP in the diagnosis of tubal patency and 2D-HyCoSy with 3D-HyCoSy in the diagnosis of tubal patency diagnostic value. Result: Application of 3D-HyCoSy technology, tubal patency rate of 90 cases diagnosed, 10 cases of tubal patency part, 6 cases of tubal ob-struction;2D-HyCoSy diagnosis of tubal patency in 55 cases, 24 cases of tubal patency part, blocked fallo-pian tubes 27 cases;CLP diagnosis of tubal patency in 61 cases, partial tubal patency in 25 cases, 20 cases of tubal obstruction, there was significant difference in the three ( P<0.05) . 2D-HyCoSy with 3D-HyCoSy in the diagnosis of tubal patency or not the comparison shows that significant differences exist two groups, with statistical significance (P<0.05). Conclusion: Compare to the two-dimensional ultrasound contrast hysterosalpingography,the diagnostic value of three-dimensional ultrasound contrast hysterosalpingography is higher in the diagnosis of tubal patency,it is the best way to seek the causes of infertility, and has broad ap-plication prospects.

目的 探讨产前超声诊断胎儿先天性脊柱裂及其预后评估的临床价值.方法 回顾分析产前超声诊断胎儿脊膜膨出6例、脊髓脊膜膨出16例、脊髓外翻3例、隐性脊柱裂9例及30例正常胎儿脊柱的相关超声资料,总结其声图像特征,并与产后超声、MRI或尸检结果对照.结果 ①脊膜膨出声像为:a.背部包块:均见囊性包块向外膨出;b.脊髓圆锥位置:均正常;c.后颅窝池:均正常存在.②脊髓脊膜膨出:a.背部包块:均见混合囊性包块向外膨出;b.脊髓圆锥位置:腰骶部脊柱裂均显示圆锥低位,颈部脊柱裂显示圆锥位置正常;c.后颅窝池:14例消失,2例明显变小.③脊髓外翻声像为:a.背部包块:均未显示包块外膨;b.脊髓圆锥位置:均显示圆锥低位;c.后颅窝池:均消失.④隐性脊柱裂声像为:a.背部包块:均未显示包块外膨;b.脊髓圆锥位置:均显示圆锥低位;c.后颅窝池:均正常存在.⑤预后:脊髓圆锥低位和后颅窝池消失提示脊柱裂预后不良.结论 产前超声能为胎儿先天性脊柱裂的产前诊断及预后评估提供有价值的信息.

To compare transabdominal and transvaginal color Doppler ultrasonography in the diagnosis and treatment of ectopic pregnancy application value to improve further the diagnosis of ectopic pregnancy.Methods:Randomly selected from June 2012 to July 2013 in our hospital obstetrics and gynecology clinic,76 cases with pathologically diagnosed patients with ectopic pregnancy were taken transabdominal and transvaginal color Doppler ultrasound,and then compare the color multi-Doppler findings and clinical pathology results and the consistent rate of diagnosis.Results:76 cases by transabdominal diagnosed as ectopic pregnancy diagnosed 60 cases of postoperative pathology,diagnosis consistent rate was 78.95%,including 55 cases of ectopic pregnancy,cervical pregnancy in one case,one case of rudimentary uterine horn pregnancy,one case of abdominal pregnancy,one case of uterine horn pregnancy,one case of ovarian pregnancy,misdiagnosed was 16 cases and the misdiagnosis rate was 21.05%.76 cases by transvaginal diagnosed as ectopic pregnancy diagnosed 74 cases of postoperative pathology,the diagnosis consistent was 97.37%,including 60 cases of ectopic pregnancy,cervical pregnancy in four cases,two cases of rudimentary uterine horn pregnancy,four cases of abdominal pregnancy,one uterine horn pregnancy,three cases of ovarian pregnancy,misdiagnosed was two cases,the misdiagnosis rate was 2.63%.The diagnosis consistent rate of ectopic pregnancy by transvaginal group was significantly superior to transabdominal group,the difference was statistically significant (P<0.05).Conclusion:Clinical application of transvaginal color Doppler ultrasound can significantly improve the diagnosis consistent rate of ectopic pregnancy,and convenient,worthy of clinical application.

目的 比较实时三维超声编码造影技术(3D-CCI-HyCoSy)与X线下碘油造影(HSG)评价不孕症患者输卵管通畅性的临床价值.方法 对拟在我院进行腹腔镜通染液试验的123例不孕患者于术前随机分两组进行超声造影和碘油造影检查.59例患者行3D-CCI-HyCoSy,64例行HSG,两组均以腹腔镜通染液试验(CLP)结果为金标准,评价输卵管通畅性.结果 3D-CCI-HyCoSy vs HSG评价输卵管通畅性的灵敏度、特异度、阳性预测值、阴性预测值为94.6％、93.5％、92.9％、95.1％ vs 84.3％、86.8％、81.1％、89.1％.3D-CCI-HyCoSy vs HSG的ROC曲线下面积为0.940 vs 0.864,两者差异具有统计学意义(P＜0.05).结论 3D-CCI-HyCoSy在不孕症患者输卵管通畅性的评价方面有着明显优势,在一定程度上可替代X线下输卵管碘油造影.

Objective: To evaluate the use of ultrasound assessment to predict the risk of intrauterine fetal demise(IUFD) in monochorionic(MC) twins with selective intrauterine growth restriction(sIUGR).Methods: The data of 71 MC twins pregnancies diagnosed with sIUGR before 28 weeks of gestation were reviewed.All patients were under expectant management during the observation period.The ultrasonic findings such as growth parameters,oligohydramnios,polyhydramnios,and Doppler spectrums of umbilical artery(UA),ductus venosus(DV) and middle cerebral artery(MCA) were analyzed.The relationships between these ultrasound findings and IUFD of sIUGR were evaluated using multiple logistic regression analysis.Results: There were several factors associated with IUFD in MC twins with sIUGR,including absent or reversed a-wave of DV;absent or reversed end-diastolic flow in the UA(P0.05).While the normal UA Doppler,abnormal MCA Doppler,polyhydramnios and oligohydramnios were not associated with IUFD in MC twins with sIUGR(P0.05).Multiple logistic regression analysis revealed that the absent or reversed a-wave of DV(odds ratio,OR=51.392;P0.05) was a significant risk factor for IUFD.Conclusion: The absent or reversed end-diastolic flow of UA and absent or reversed a-wave of DV showed the worst prognosis.Absent or reversed a-wave of DV should be recognized as an important indicator for IUFD in MC twins with sIUGR to clinically determine the time of delivery.

Objective: To evaluate the value of prenatalultrasonic diagnosis of chorionicity in twin pregnancy.Methods: The chorionicity confirmed by postnatal pathology in172 twin pregnancy in our hospital were reviewed and the ultrasonic characters were analysised.Results: When the first ultrasonic diagnosis of gestational week ≤7 gestational weeks,chorionicity can be diagnosed by gestational sac count via 100% accuracy,however,it is difficult to confirm amniotic sac.When the first diagnosis of gestational week is during 8~10 gestational weeks,chorionic sac and amniotic sac can be counted via 100% accuracy.When the first diagnosis of gestational week is during 11~14,14~28,or larger than 28 gestational weeks,chorionicity can be diagnosed by placenta count,twin-peak-sign,T-sign,partitive membrane's existence and thickness.For those different gestational weeks,the accuracy is 100%,83.8%,51.9% respectively(corresponding P>0.05,P>0.05,P<0.05).Conclusion: The 8~10 and 11~14 gestational weeks are the best time to determine the chorionicity of twin pregnancy with ultrasonography.

目的 探讨产前彩色多普勒超声诊断胎儿右室流出道梗阻的临床价值.方法 回顾分析32例产前超声诊断胎儿右室流出道梗阻的超声资料,总结其声图像特征.结果 (1)单纯肺动脉瓣狭窄时常于肺动脉瓣口局部显示五彩镶嵌血流信号,频谱多普勒显示其峰值流速常大于1.8 m/s;(2)动脉导管早闭时常于动脉导管处显示五彩镶嵌血流信号,频谱多普勒显示峰值流速常大于1.8 m/s,且为双期同向血流频谱；(3)法洛四联症及右室双出口伴肺动脉狭窄时常于肺动脉主干内显示其血流信号稍鲜艳,但频谱多普勒显示峰值流速常小于1.8 m/s,严重狭窄时肺动脉主干内血流信号暗淡,甚至其动脉导管内出现反向血流信号及频谱；(4)肺动脉瓣闭锁时常于动脉导管及肺动脉内显示反向血流信号及反向频谱,频谱多普勒显示峰值流速常小于1.8m/s.结论 彩色多普勒血流显像及频谱形态分析能为胎儿右室流出道梗阻的产前诊断提供有价值的信息.

血管环(vascular ring)是较少见的先天性主动脉弓及分支血管畸形，由Wolman于1939年首先报道，约占先天性心脏病的1％～2％[1]。血管环包绕气管和食管，可能压迫气管与食管产生呼吸困难或吞咽困难等临床症状。最常见的完全血管环包括双主动脉弓(double aortic arch，DAA)和右位主动脉弓(right aortic arch,RAA)、左位动脉导管(left ductus arteriosus,LDA)并迷走左锁骨下动脉(aberrant left subclavian artery,ALSA)。

目的 探讨宫外孕与妊娠黄体的经阴道彩色多普勒血流显像及频谱形态特征,以提高超声对宫外孕的诊断符合率.方法 对126例宫外孕及132例宫内或宫外孕伴黄体囊肿进行经阴道彩色多普勒超声检测,检测结果与其临床病理进行对照分析.结果 (1)宫外孕血流常显示为宫外孕病变处某局部富血流信号,血流均不来源于卵巢,而妊娠黄体血流则常显示黄体周边环状血流信号,血流均来源于卵巢内;(2)宫外孕的多普勒血流频谱可表现为多种形态:包括极低阻力型血流频谱、低阻力型血流频谱、高阻力型频谱、无舒张期血流频谱及舒张期反向血流频谱;而妊娠黄体则常表现为低阻力型及高阻力型血流频谱.结论 经阴道彩色多普勒血流显像及频谱形态特征能为宫外孕与妊娠黄体的鉴别诊断提供有价值的信息.

Objective To evaluate of color Doppler flow imaging(CDFI) and spectral flow Doppler in the differential diagnosis of uterine myoma and uterine adenomyoma.Methods Sixty-eight cases with uterine myoma and thirty-three cases with uterine adenomyoma underwent color Doppler ultrasonography in comparison with their pathological or clinical results.Results ①In the group of uterinemyoma,color blood flow were often detected within peripheral area of focal uterine lesions,but in the group of uterine adenomyoma,color blood flow were often detected as same as normal muscle tissue of uterus;②In the group of uterinemyoma,peak wave of contractive period and resistant index(RI) in peripheral area of focal uterine lesions often appeared higher than central area of focal uterine lesions(P0.05);but in the group of uterine adenomyoma,peak wave of contractive period and resistant index(RI) in peripheral area of focal uterine lesions often appeared as same as central area of focal uterine lesions(P0.05).Conclusion Color Doppler flow imaging and spectral flow Doppler are important index in differential diagnosis of uterinemyoma and uterine adenomyoma.

目的:观察推按运经仪点穴配合传统中药利胆治疗非结石性慢性胆囊炎的临床疗效。方法:将320例非结石性慢性胆囊炎患者随机分为两组,对照组160例,采用传统中药利胆治疗;治疗组160例,在传统中药利胆治疗基础上给予推按运经仪点穴进行治疗。结果:治疗组与对照组总有效率分别为98.1%、86.9%(P<0.05);治疗组治疗后B超检查正常胆囊增加率及中、重度胆囊炎减少率明显高于对照组治疗后,两组比较有显著性差异(P<0.05)。结论:推按运经仪点穴配合传统中药利胆治疗非结石性慢性胆囊炎可显著改善患者的主要症状和B超影像学,疗效明显优于单用传统中药利胆治疗,是一种更为有效的治疗非结石性慢性胆囊炎的方法。

Objective To compare the performance of three-dimensional color power angiography with pathology in the visualization of intraplacental vessel trees.Methods Total 32 normal singleton pregnant women with 20～39 weeks gestation were examined with 3-D color power angiography to observe the branches of the intraplacental villous vascular trees, which were observed with electron micrographs after dilivery.Rusults The branches of the intraplacental villous vascular trees observed by 3-D color power angiography were the same as the pathology. The presentation rate of the first, second and third stem villous vessels by 3-D color power angiography was 100% and 100% and 90%. There was no visualization of the small villous vessels.Conclusion The intraplacental villous vessels could be visualized on 3-D color power angiography, which may be used to evaluate the placental function of high-risk pregnancy.

Objective: To assess the accuracy and reproducibility of real-time three-dimensional echocardiography (RT-3DE) for measuring the volumes of models with different shape and size ire vitro. Methods: The "pyramidal volume" 3D data were collected by RT-3DE system in 17 different shape and size air balloons. The volumes of balloons were outlined and calculated by the volumetric analysis software of RT-3DE system offline using the largest coronal plane method, meanwhile these volumes were also measured by two-dimensional echocardiography. The true liquid volumes of the balloons were measured by the measuring glass at last. Results: There was good correlation between RT-3DE measured volumes, two-dimensional measured volumes and true liquid volumes in the elliptical ballqon(r=0.99, P0.0001; r=0.99, P0.0001). The correlation between RT-3DE measured volumes and true liquid volumes was better than that between two-dimensional measured volumes and true liquid volumes in the abnormal shape balloon(r=0.94, P0.0001; r=0.82, P0.001). Intraobserver variability and inter-observer variability for the RT-3DE were less than those for the 2D measurement. Conclusion: RT-3DE technique could provide more accurate and more reproducible measurement in the abnormal shape volume than the 2D measurement. It could be indicated that more accurate estimations of LV volume and ejection fraction could be achieved with RT-3DE technique in patients with wall motion abnormalities or known LV aneurysms.