经阴道联合腹部超声检查在妇科急腹症诊断中的应用价值

刘小平 陈敏

838200新疆鄯善县人民医院妇科

经阴道联合腹部超声检查在妇科急腹症诊断中的应用价值

刘小平 陈敏

838200新疆鄯善县人民医院妇科

目的：探讨在妇科急腹症诊断中经阴道联合腹部超声检查的应用价值。方法：收治经腹部及阴道超声检查的妇产科急腹症患者100例，进行超声检查，观察结果。结果：100例患者经阴道联合腹部超声诊断符合率97.0%。其中子宫穿孔经阴道联合腹部超声诊断9例，与病理诊断均相符，诊断符合率100.0%；不全流产病理诊断和经阴道联合腹部超声诊断均10例，诊断符合率100.0%；黄体破裂病理诊断19例，经阴道联合腹部超声诊断18例，诊断符合率94.7%；急性盆腔炎病理诊断22例，经阴道联合腹部超声诊断21例，诊断符合率95.5%；异位妊娠病理诊断40例，经阴道联合腹部超声诊断39例，诊断符合率97.5%。结论：经阴道联合腹部超声检查诊断妇科急腹症具有简便、无创、快捷、准确率高等特点。

阴道超声检查；腹部超声检查；妇科；急腹症

妇科急腹症具有发病急、病变进展快的特点，是一种急性症状，因女性盆腔器官的某些疾病而引起[1]，其中最常见的临床症状是腹痛[2]，病情严重时对生命产生威胁[3]。为进一步对经阴道联合腹部超声检查在妇科急腹症诊断中的应用价值进行探讨，2015年2月-2017年2月收治经腹部及阴道超声检查的妇产科急腹症患者100例，对其资料进行回顾性分析，现报告如下。

资料与方法

2015年2月-2017年2月收治经腹部及阴道超声检查的妇产科急腹症患者100例，年龄21～55岁，平均(39.3±2.4)岁。急性下腹痛、发热、不规律阴道流血、肛门坠胀等是患者的主要表现。所有患者均经临床证实，并且和手术病理结果进行了对照。

方法：待患者膀胱充盈后进行腹部超声检查，使用意大利百胜公司的mylab 30 cv型号彩色超声诊断仪，经腹部超声探头频率2～5 MHz，再排空膀胱取截石位行阴道超声检查。经阴道超声探头频率4～8 MHz，对子宫、附件及盆腔进扫查，对宫腔子宫大小、形态的检查要特别注意，同时注意观察是否有积液或孕囊，附件区有无包块，如有包块存在，需要了解包块的位置、大小、形态、边界是否清晰，检查内部回声及血流特征。

结 果

经阴道联合腹部超声检查与手术病理结果比较：100例患者经阴道联合腹部超声诊断符合97例，诊断符合率97.0%。其中子宫穿孔经阴道联合腹部超声诊断9例，与病理诊断均相符，诊断符合率100.0%；不全流产病理诊断和经阴道联合腹部超声诊断均10例，诊断符合率100.0%；黄体破裂病理诊断19例，经阴道联合腹部超声诊断为18例，诊断符合率94.7%；急性盆腔炎病理诊断22例，经阴道联合腹部超声诊断21例，诊断符合率95.5%；异位妊娠病理诊断40例，经阴道联合腹部超声诊断39例，诊断符合率97.5%，见表1。

讨 论

妇产科急腹症的经腹部及经阴道超声图像特征：①异位妊娠：典型的输卵管异位妊娠超声表现有轻度增大的子宫，宫腔内没有妊娠囊，但假妊娠囊可出现在部分病例的宫腔内，胚囊或混合型回声包块可在妊娠附件区被探及，形态不规则，边界模糊，壁厚。部分宫外孕包块内有丰富的动、静脉血流信号。结合阴道超声检查，具有较强的分辨率，不受肥胖、肠管及其气体多种因素影响，图像清晰，检查前无需充盈膀胱，诊断效果更好。本组漏诊1例。②卵巢黄体囊肿破裂出血：声像图表现为囊肿形态不完整，同时囊肿的轮廓也不完整，呈塌陷状，破损的现象出现于局部，腹腔有囊液溢出，液性暗区可出现于子宫直肠凹处，后穹隆穿刺抽出液体，呈血性，阴道超声检查、血HCG检测联合后穹隆穿刺是诊断黄体破裂的敏感方法。本组误诊1例(误诊为破裂型宫外孕)。③急性盆腔炎：一系列增厚、迂曲的连续管状回声可在附件区探及，增厚大小不等，边缘增厚、不规则或模糊，椭圆形无回声区可出现在盆腔内。本组漏诊1例。④不全流产：本病比较容易诊断，本组诊断准确率100%。⑤子宫穿孔：本病比较容易诊断，本组诊断准确率100%。

注意事项：①要密切结合病史和临床检验结果等资料进行诊断；②超声医生要多总结经验，对于不典型的患者，要反复检查，检查过程要仔细，不留死角[4]；③经阴道扫查时，阴道探头应与宫颈外口和穹隆部紧贴，向左右两侧及前后方分别摆动，尽量使图像清晰，以使诊断准确性提高。

本组资料结果显示，100例患者经阴道联合腹部超声诊断符合97例，诊断符合率97.0%。其中子宫穿孔经阴道联合腹部超声诊断9例，与病理诊断均相符，诊断符合率100.0%；不全流产病理诊断和经阴道联合腹部超声诊断均10例，诊断符合率100.0%；黄体破裂病理诊断19例，经阴道联合腹部超声诊断18例，诊断符合率94.7%；急性盆腔炎病理诊断22例，经阴道联合腹部超声诊断为21例，诊断符合率95.5%；异位妊娠病理诊断40例，经阴道联合腹部超声诊断39例，诊断符合率为97.5%。由此可见，经阴道联合腹部超声检查诊断妇科急腹症具有简便、无创、快捷、准确率高等特点，值得临床推广。

表1 经阴道联合腹部超声检查与手术病理结果比较(n)

[1] 邓妙珍,梁超雄.经腹部联合经阴道超声在妇产科急腹症中的应用价值分析[J].代诊断与治疗,2015,26(1):198-200.

[2] 谢雪琴.经阴道超声检查在异位妊娠诊断中的应用价值[J].临床超声医学杂志,2007,19(7):433-444.

[3] 徐景华,嵇志坚.经腹联合经阴道超声应用于妇产科急腹症的临床应用价值[J].现代诊断与治疗,2013,24(20):4721-4722.

[4] 高魏贞.妇科急腹症经阴道联合腹部超声诊断及鉴别诊断价值分析[J].现代诊断与治疗,2015,26(4):900-901.

The value of transvaginal ultrasonography combined with abdominal ultrasoundin the diagnosis of gynecologic acute abdomen

Liu Xiaoping,Chen Min
Department of Gynaecology,the People's Hospital of Shanshan County,Xinjiang 838200

Objective:To investigate the value of transvaginal ultrasonography combined with abdominal ultrasoundin the diagnosis of gynecologic acute abdomen.Methods:100 cases of gynecologic acute abdomen examined by transvaginal ultrasonography combined with abdominal ultrasoundin were selected.All patients were examined by ultrasonography and the results were observed.Results:100 cases were diagnosed by transvaginal ultrasound and abdominal ultrasound,and the coincidence rate was 97%.Among them,9 cases were diagnosed by transvaginal ultrasound combined with abdominal ultrasound,and all consistent with pathological diagnosis and the diagnostic accuracy rate was up to 100%;10 cases of incomplete abortion diagnosed by pathologic diagnosis were all diagnosed by transvaginal and abdominal ultrasound at the same time,and the diagnostic accordance rate was 100%;19 cases were diagnosed as corpus luteum rupture with pathologic diagnosis,18 cases were diagnosed by transvaginal and abdominal ultrasound,and the diagnostic accordance rate was 94.7%;22 cases of acute pelvic inflammatory disease were diagnosed by pathologic diagnosis,21 cases were diagnosed by transvaginal and abdominal ultrasound,and the diagnostic accordance rate was 95.5%;40 cases of ectopic pregnancy were diagnosed by pathologic diagnosis,39 cases were diagnosed by transvaginal and abdominal ultrasound,and the diagnostic accordance rate was 97.5%.Conclusion:Transvaginal ultrasound combined with abdominal ultrasonography in the diagnosis of gynecological acute abdomen is simple,noninvasive,fast and accurate.

Transvaginal ultrasonography;Abdominal ultrasonography;Gynecology;acute abdomen

10.3969/j.issn.1007-614x.2017.16.79