胰腺癌超声诊断及其临床的探讨

本文总结了43例胰腺癌的临床发病特点及超声图象特征,发病年龄为50至69岁占62.8％,男:女=27:16,初发症状以上腹部不适或疼痛为多占46.51％(27/43)黄疸占37.21％(16/43),发病时间1～2月者占58.14％,超声所见为:胰腺体积增大者占97.67％(42/43)显示为胰腺部位低回声团块者占81.40％(35/43)高回声团块9.30％(4/43)混合性回声9.30％,肿块形态不规则者占88.37％(38/43)发病部位以胰头最多,占55.81％(24/43),合并胆管系统明显扩张者占69.77％(30/43)诊断符合率为93％,文中还讨论了胰腺癌超声检查误诊原因。     

肝脏局灶性结节增生的超声诊断

目的探讨超声对肝脏局灶性结节增生的诊断价值。方法采用基波超声对37例肝脏局灶性结节增生（FNH）进行检查,并进行超声造影。结果基波超声37例呈稍低回声或稍高回声,其中4例（10．8％）病灶中心回声不均,可见不规则低回声,血供丰富。超声造影提示动脉期37例（100％）高增强,其中7例（18．9％）可见特征性轮辐状增强。门脉期30例（81．1％）呈高增强,7例（18．9％）呈稍高或等增强。实质期20例（54．1％）呈高增强,17例（45．9％）呈等增强。结论超声对肝脏局灶性结节增生的诊断具有一定特征性,超声造影能提高对FNH的诊断准确性。     

黑龙江地区466例孕妇羊水穿刺产前诊断结果分析

目的:探讨羊水细胞染色体异常核型与各产前诊断之间的关系。方法:466例高危孕妇行羊膜腔穿刺术后羊水细胞培养及染色体核型分析。结果:异常核型66例,异常率14.16%,包括染色体数目异常27例,三体综合征22例(21-三体15例、18-三体6例、13-三体1例),占异常染色体核型的33.33%,占染色体数目异常的81.48%;染色体结构异常39例,主要包括染色体多态性、平衡易位、倒位和衍生等,占染色体异常核型的59.10%。异常核型检出率中血清学筛查高危组(14.44%)要高于高龄妊娠组(10.89%)和有不良孕产史组(11.11%)(P0.05);超声提示胎儿发育异常组(23.26%)要高于血清筛查高危组(P0.05)。结论:血清筛查高危和超声提示胎儿发育异常是黑龙江地区最主要的产前诊断指征,异常核型以21-三体综合征检出率最高。通过对高危孕妇羊水细胞染色体的核型分析可发现部分染色体疾病,从而避免此类出生缺陷儿的出生。     

胎儿重复肾畸形的超声诊断及误诊原因分析

目的:探讨胎儿重复肾畸形的超声诊断的图像特征及误诊原因。方法:回顾分析我院30例经产前超声诊断为重复肾胎儿的超声图像及其临床资料。结果:30例重复肾胎儿中,出生后经手术或临床证实或终止妊娠后经解剖证实的共有27例,出生后经复查双肾正常的胎儿共有3例。27例重复肾胎儿中,单侧、双侧重复肾分别占22、5例,共32侧重复肾,其中合并输尿管扩张、合并输尿管囊肿的分别占14、4侧;合并其他系统气管畸形的胎儿共6侧,其中染色体三体综合征的有4例;出现4例误诊;胎儿重复肾声像图特征:1呈囊肿样改变肾上极占4侧,类圆形无回声区,壁较薄、光滑,与输尿管相通;2肾窦区可见两个不相通的肾盂,分离肾盂占11侧,未与输尿管相通;3肾窦区可见两个不相通肾盂,分离肾盂占14侧,上肾盂或下肾盂相连于输尿管;4 3侧肾窦区见两个不分离的肾盂,肾脏形态拉长,未与输尿管相通。结论:胎儿重复肾的超声声像图特征主要为两个不相通的肾盂;加强在胎儿中晚孕期时做常规多切面扫查,有利于提高对重复肾胎儿的确诊精确率,为临床评估胎儿提供借鉴。     

鄂中地区8136例妇女HPV感染导流杂交法亚型检测的临床意义

目的分析鄂中地区人群HPV感染基因型别。方法采集8136例鄂中地区2009年8月至2010年7月武汉市商业职工医院门诊与住院患者宫颈口及颈管脱落上皮细胞,应用导流杂交法进行HPV分型检测。结果HPV阳性感染1437例（17．66％）,其中高危型感染检出1189例（占82．67％）,低危型感染检出141例（占9．74％）,中国人群常见亚型感染检出305例（占21．16％）,多重感染检出369例（26．68％）。单一感染者中高危型833人（57．97％）,低危型感染者72人（5．01％）,中国人群常见亚型感染者163人（11．34％）。根据年龄分层,〈25岁组HPV感染率相对较高,为21．17％（P〈0．05）;HPV高危型感染组中〈25岁比例较高,达17．80％。在1437例HPV阳性感染者中,单一感染者共1068例（74．32％）,二重感染占18．72％。最常见的交叉感染是高危型＋中国人群常见亚型合并感染（8．28％）。结论导流杂交法HPV基因型分型检测可为宫颈疾病流行病学及早筛早治提供重要线索,对于发现HPV感染的高危人群、积极控制HPV感染、具有重要意义。     

彩色多普勒超声在腹股沟区包块诊断中的价值分析

目的探讨彩色多普勒超声在腹股沟区包块诊断中的价值。方法选取2016年1月~2017年6月我院收治的初步诊断为腹股沟区包块患者78例,均行彩色多普勒超声检查,并对超声声像图进行分析。结果经过彩色多普勒超声检查,78例腹股沟区包块初步诊断患者中,腹外疝29例,声像图呈现中高回声或混杂性回声;鞘膜积液23例,声像图呈现无回声;淋巴结包块13例,声像图呈现低弱回声;实质性包块9例,声像图呈现中高或低回声;隐睾4例,声像图呈现中等回声。结论彩色多普勒超声仪对腹股沟区包块的诊断具有重要应用价值,可为患者的治疗提供参考,也可作为患者预后效果的评估指标,值得临床推广应用。     

常规超声及超声造影在肝癌中的诊断及鉴别诊断价值

目的:探讨常规超声及超声造影在肝癌中的诊断及鉴别诊断价值。方法:收集2009年5月至2013年10月在我院进行住院诊治的肝癌患者120例,选择飞利浦IU22进行常规超声检查,选择飞利浦的IU22进行超声造影检查。结果:常规超声检查68例为低回声,20例为强回声,12例为等回声,17例为混合性回声,3例误诊为肝外病变,检出率为97.5%。肝癌组织的AT、TTP、ACT值明显晚于正常肝组织(P0.05),而BI、PI、MTT与BF值对比差异无明显差异(P0.05)。Spearman相关分析显示超声造影灌注参数AT、TTP、ACT与肿瘤分化程度呈正向相关性(P0.05)。结论:常规超声及超声造影在肝癌中的诊断及鉴别都有很好的应用价值,超声造影的应用可反映正常和病变组织的血流灌注情况,从而提高肝癌诊断的准确性。     

高龄患者下肢深静脉血栓超声诊断的Logistic回归分析

目的：应用Logistic回归筛选高龄患者下肢深静脉血栓灰阶及彩色多普勒超声诊断特征。方法：对我院150例主动要求下肢深静脉血栓灰阶及彩色多普勒超声检查的高龄患者,应用超声检查观察血管管径、管腔内回声及血流动力学等特征,进行Logistic回归分析,筛选超声诊断特征,对Logistic回归模型预测诊断绘制受试者工作曲线图（ROC）,评估模型效果。结果：150例超声检查高龄患者,发生下肢深静脉栓塞129例,占86.00%。Logistic回归筛选,血管管径、管腔内回声、管壁内壁、血流信号改变4个变量进入回归模型,Logistic回归模型预测超声检出的ROC曲线下面积为0.903,灵敏度为90.3%,特异度为93.8%。结论：以高龄患者下肢深静脉血栓超声特征建立的Logistic回归模型对该病具有较好的预测诊断价值。     

广州市花都区789例人乳头瘤病毒感染状况及其基因型研究

目的 对广州市花都区789例疑似人乳头瘤病毒( HPV)感染的妇女进行调查,研究HPV感染状况和基因亚型分布情况.方法 采用荧光定量聚合酶链式反应(Fluorescence quantitative PCR,FQ-PCR)对789例疑似HPV感染患者的宫颈分泌物进行21种人乳头瘤病毒基因亚型的检测.结果 (1)789例标本中,HPV阳性占48.42％(382/789),共检出10种基因型,其中检出单一低危型(HPV6、11、43和44型)279例,占感染者73.04％;单一高危型( HPV16、18、33、52、53、58)68例,占感染者17.80％;多重感染35例,占感染者9.16％.低危型以HPV6、11为主,高危型以HPV16、18为主.HPV6为主要致病基因型,检出率为34.0％ (P ＜0.01);(2)各年龄段间感染率差异无统计学意义(P＞0.05).结论 花都区HPV感染率较高,且多为单一轻危型感染,以HPV6为主要感染亚型,HPV基因型分布有助于确定宫颈癌发生的高危因素及筛查高危人群,对本地区HPV疫苗开发、应用具有重大意义.     

超声胃镜小探头对上消化道黏膜下病变的诊断价值探讨

目的:探讨超声胃镜小探头对上消化道黏膜下病变的诊断价值.方法:使用超声胃镜小探头对我院2010年6月-2011年12月62例经电子胃镜检查的上消化道黏膜下病变患者进行检查,对病变的浸润范围与性质进行分析,结果与术后病理进行对比.结果:良性间质瘤43例,占69.35％,恶性间质瘤6例,占9.68％,异位胰腺5例,占8.06％,囊肿6例,占9.68％,脂肪瘤与静脉曲张各1例,占1.61％.所有结果均经病理检查证实,符合率100％,结果具有代表性(P＜0.05).结论:使用超声胃镜小探头能清楚显示上消化道各层管壁结构,确定上消化道黏膜下病变的性质,提高诊断率,具有极高的临床价值,可作为上消化道黏膜下病变的诊断方法在临床推广应用.     

血清P、β-HCG联合检测预测和治疗先兆流产的临床研究

目的：探讨血清孕酮与B-HCG联合检测在预测早期先兆流产预后及其治疗的临床价值。方法：对340例早期先兆流产患者血清P与B-HCG进行检测,并与追踪到的妊娠结局进行分析。结集：血清P值〉25ng／ml、血β-HCG〉50mIU／ml患者66例占19．4％,经绝对卧床休息,未用药治疗,均胚胎发育正常;血清P值在15．94-25ng／ml、血β-HCG10-50mlU／ml患者170例占50％,经口服黄体酮与HCG针保胎治疗后均胚胎发育正常;血清P值〈15．94ng／ml、血β-HCG〈10mIU／ml患者78例占22．9％,终止妊娠者均可见清除宫内组织物中几乎不见新鲜绒毛并伴有不同程度的陈旧性出血;血清孕酮与β-HCG上升不同步患者26例占7．6%,均最终难免流产。结论：联合检测血清孕酮与β-HCG可以预测先兆流产患者妊娠结局,对于指导治疗具有重要的临床价值,既避免不必要的药物干预及经济负担,又能起到提高保胎治疗的成功率。绒毛膜促性腺激素配伍口服天然黄体酮治疗由黄体功能不全引发的早期先兆流产,均能改善先兆流产患者的预后,且对母儿无不良影响,安全有效。     

The microflora of the reproductive tract in women during intrauterine interventions

The species compositions and persistence factors of the vaginal and cervical microflora of the reproductive tract of women in cases of intrauterine interventions (medical abortion, intrauterine contraception) were studied. Women with inflammatory complications following intrauterine interventions were found to have the same species of bacteria in their vaginal and cervical microflora. In addition, an increase in the values of the persistence factors of vaginal microflora was registered in women practicing intrauterine contraception and a decrease in the persistence potential of vaginal microflora was registered after abortion.     

Induction of abortion by intra- and extra-amniotic prostaglandin F2 administration

PGF2 alpha was administered intrauterine in 115 patients during the 11th to 20th week of pregnancy for abortion induction. An intra-amniotic method was used in 61 cases, an extra-amniotic one in 54 cases. Average total dose administered was 35.1 (range 5 to 65 mg) in the amniotic group and 6358 mcg (range 1500 to 14000 mcg) in the extra-amniotic group. The intra-amniotic group had an abortion rate of 92% and a 74% rate of side effects, mainly gastrointestinal irritation. Corresponding figures for the extra-amniotic group were 72% and 54% respectively. In the extra-amniotic group, doses of 4750 mcg or more increased the abortion rate up to 80% and side effects up to 64%. There were no serious complications. The intra-amniotic approach of prostaglandin induction is suitable for second trimester therapeutic abortions. The extra-amniotic approach is useful in cases of fetus mortuus and hydatiform mole.     

The efficacy and acceptability of the "prostaglandin impact" in inducing complete abortion during the second week after the missed menstrual period

Clinical research was undertaken using PGF2a (prostaglandin) to induce abortion in 22 pregnant women at 12 +/- 1 days following their missed menstrual period. The PG was administered in a 5 mg single intrauterine dose through the cervix for a 10-minute period. The PG administration caused increased uterine contraction within 20 minutes and raised intrauterine pressure which was sustained for 2 hours. During the initiation of the intrauterine pressure, bleeding started and progesterone and estradiol levels decreased and continued to do so. In those patients who had been sedated, side effects were minimal. At 24 hours following the PG administration, progesterone had been withdrawn at a rate of 44%, bleeding was continuing, and cervical dilatation was at approximately 1 cm. Complete abortion was achieved in 20 out of the 22 women. It is believed that the abortion was effected through the action of endogenous PG, due to the withdrawal effect on progesterone of the exogenously-administered PG.     

Alpha-fetoprotein in Abortion

The clinical value of maternal serum alpha-fetoprotein (AFP) as a guide to the outcome of threatened abortion was assessed. After the thirteenth week of gestation, abortion occurred more frequently (10/12) in women with abnormal serum AFP levels than in those (2/12) whose AFP concentrations were within the normal range. Low levels were present in women with blighted ovum and high concentrations were associated with intrauterine fetal death. In legal first and second trimester abortions, the circulating maternal AFP levels in postabortion samples were often higher than before abortion, irrespective of whether abortion was performed instrumentally or induced with prostaglandins. Maternal serum AFP levels provide a new means for prediction of the outcome of threatened abortion.     

产复康冲剂治疗药物流产后阴道出血的临床观察

目的：观察产复康冲剂在药物流产后服用,阴道出血时间及出血量的变化,方法与结果：实验组（产复康组）及对照组各120名,结果两组流产率无差异（P＞0．05）。完全流产组二者周内出血停止者实验组多于对照组P＜0．01。三周出血不止者实验组少于对照组,P＜0．01。尽管大于月经量出血的平均天数实验组略长,但点滴出血时间较对照组短P＜0．01。结论：产复康冲剂补气养血,排淤生新,加快恶露排净达到尽快止血目的,是治疗药物流后异常阴道出血的方法之一。     

The kinetics of extraamniotically injected prostaglandins to induce midtrimester abortion

In an attempt to improve the extraamniotic administration of prostaglandins in effecting abortion, the movement of injected prostaglandins in a high or low viscosity medium has been observed by radiological studies and radioimmunoassay of PGE and PGFα in amniotic fluid and maternal plasma in association with intrauterine tocographic responses.Results obtained suggest that the immediate response by the uterus is a reflection of the speed of absorption of prostaglandins from the chorio-decidual space and that this influences the outcome in inducing abortion within 24 hours. By giving the prostaglandins in a viscous medium a slower release of prostaglandins was produced in most cases, which probably accounts for the greater efficacy obtained using single injections of prostaglandins in this vehicle compared with normal saline.     

Induction of abortion by intra- and extra-amniotic prostaglandin F2α administration

Legal abortion was induced by intrauterine administration of prostaglandin F_2α in 115 patients during the 11th – 20th week of pregnancy. An intra-amniotic method was used in 61 of the cases, an extra-amniotic one in 54 cases. The average total dose administered was 35.1 mg (range 5 – 65 mg) in the intra-amniotic group, and 6358 μg (range 1500 – 14000 μg) in the extra-amniotic group. Abortion rate was 92 % in the intra-amniotic material and 72 % in the extra-amniotic material, and side-effects, mainly gastrointestinal irritation, were noted in 74 % of the intra-amniotic cases and 54 % of the extra-amniotic ones. If total doses of 4750 μg or more were administered in the extra-amniotic cases, abortion rate went up to 80 %, but the frequency of side-effects simultaneously increased to 64 %. No serious complications occurred. Intrauterine prostaglandin induction is well suited therapeutic abortions in the second trimester, and the intra-amniotic technique is more practicable than the extra-amniotic one. The latter is applicable in cases where the puncture of the amniotic cavity is difficult to achieve, e.g. in cases of fetus mortuus and hydatiform mole.     

Intrauterine injection of 15(S)-15-methyl-prostaglandin F2alpha for termination of early pregnancy in out-patient.

15-me-PGF2alpha was administered as single intrauterine injection for interruption of very early pregnancy in 30 out-patients. After 2 weeks, abortion was complete in 60% induced with 125 or 200 mug and 80% induced with 300 mug. After 3 weeks, abortion was complete in 90% induced with 125 mug, in 70% induced with 200 mug and in 100% induced with 300 mug. One failure occurred in patients treated with 200 mug and 2 curettages were performed because of incompleteness of abortion. No serious complications occurred. Compared with our previous results it appears that 15-me-PGF2alpha is as effective as natural PGF2alpha in inducing abortions during very early pregnancy but causes somewhat fewer side-effects.     

Menstrual induction with PGF2 alpha and PGE2.

The "prostaglandin impact" (PGI), a massive intrauterine dose of PG, converts the refractory pregnant uterus into a reactive organ by provoking a regulatory imbalance. This regulatory conversion releases the endogenous mechanism of menstruation or abortion. During initial studies, PGI successfully provoked menstrual induction (MI) in 22 and subsequently in 65 volunteers. These results were confirmed and complemented by 2 independent trials in 14 and 36 gravidas respectively. The best clinical outcome was obtained in 20 volunteers, when a "PG-Pellet" (a mini-suppositorium) was inserted in utero, containing only 2.5 mg PGF2alpha. These 157 trials in sedated volunteers had the common features of over 90% efficiency, transient and medically acceptable side effects and infrequent complications. The present study of 542 volunteers focused upon the collection of clinical data regarding efficacy, side effects and complications of MI. All patients had committee approval for legal abortion, during the 2nd week of their missed menstrual period. They volunteered to participate because of their preference for pharmacological rather than surgical pregnancy termination. The clinical outcome of the 542 MI with 5 mg PGF2alpha (428 cases) and 1.5 mg PGE2 (114 cases) was identical. On the average, 95% of the gravidas had complete evacuation of the uterus with the clinical symptoms of delayed menstruation rather than abortion; they experienced spontaneous menstruation in 34 days after having received a single dose of PG.