妇科危重症超声诊断及声像图分析  

The ultrasound diagnosis of gynecologic severe case and analysis of sonogram echogram

作　　者：张爱青[1] 刘朝晖[1] 郭丽娟[1] 种轶文[1] 张春妤[1] 童春[1] 

机构地区：[1]北京大学第三医院妇产科超声室,100191

出　　处：《中华医学超声杂志（电子版）》2017年第5期359-367,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的研究与分析妇科危重症患者的超声声像图特征。方法选取2014年9月至2015年9月北京大学第三医院妇科收治的妇科危重症患者431例,对其临床、急诊超声影像检查、临床结局及病理检查资料进行研究和分析。结果 431例妇科危重症患者临床均表现为急性腹痛和(或)阴道大量出血;超声检查并经手术或动态观察下保守治疗证实为7类妇科危重症,包括:肿瘤或病灶破裂137例(31.8%),其中黄体破裂67例,异位妊娠破裂59例,肿瘤破裂11例;盆腔炎性病变114例(26.5%);妇科出血性病变67例(15.5%),其中功能失调性子宫出血39例,宫颈癌11例,黏膜下肌瘤7例,子宫内膜癌6例,子宫癌肉瘤4例;早期妊娠相关病变58例(13.5%),其中不全流产32例,难免流产21例,葡萄胎5例;卵巢或囊肿蒂扭转46例(10.6%);生殖道畸形5例(1.2%),其中阴道斜隔4例,宫颈闭锁1例;手术后损伤4例(0.9%),其中子宫穿孔2例,剖宫产后腹壁血肿1例,剖宫产后假性动脉瘤1例。431例妇科危重症患者中非手术治疗101例,急诊手术或对症治疗后手术329例,介入治疗1例。结论妇科危重症疾病种类不同,但多具有典型声像图特征,结合病史和临床症状可作出超声诊断提示。急诊超声在妇科危重症患者的救治中有重要临床应用价值。Objective To analyze the ultrasonic features of gynecological emergency and severe cases. Methods To analyze 431 cases in clinical, ultrasonic images and examination data of gynecological emergency and severe patients in Peking University Third Hospital from September 2014 to September 2015, and to study clinical pathological and ultrasonic imaging examination. Results In 431 severe cases of gynecologic emergency, the clinical symptom were shown as acute abdominal pain or and vaginal bleeding. They were divided into seven types by clinical examination, operation or conservative treatment under dynamic observation. There were 137 cases of fracture disease, accounting for 31.8%, with corpus luteurn rupture in 67 cases, ectopic pregnancy burst in 59 cases and tumor rupture in 11 cases. There were 114 cases of pelvic inflammatory disease, accounting for 26.5%, with hemorrhagic disease of department of gynaecology in 67 cases （15.5%）, dysfunctional uterine bleeding in 39 cases, cervical cancer in 11 cases, submucosal myoma in 7 cases, endometrial carcinoma in 6 cases, in 4 cases. There were 58 cases of early pregnancy related diseases, accounting for 13.5%. Among them, 32 cases were incomplete abortion, and 21 cases were inevitable abortion and 5 cases were hydatidiform mole. Forty-six cases were torsion of pedicle （10.6%）. Five cases were genital tract malformation, accounting for 1.2%, with vaginal septum obliquumevery 4 cases and cervical atresia in one case. There were damages after the operation in 4 cases （0.9%）, uterus perforation in 2 cases, abdominal wall hematoma in 1 case after cesarean section, and false aneurysm in 1 case after cesarean section. In the 431 cases, there was emergency surgery oroperation after symptomatic treatment in 329 cases, interventional treatment in one case and non-operative treatment in 101 cases.Conclusions There are corresponding typical ultrasonographic characteristics in different diseases of emergency and severe gynaecologic cases, combined with clinical symptoms a

关 键 词：超声检查 妇科检查 危重症 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711[医药卫生—诊断学]