肠梗阻的临床进展

将近5年来有关肠梗阻的新诊治方法作一综述，结论如下：①B超、CT和76％泛影葡胺口服造影等对肠梗阻诊断有重要临床价值。②腹腔镜小肠梗阻手术是最能体现微创技术优越性的手术之一。③EPII应以非手术疗法为主。     

Staging-laparoscopy

Summary. The so-called extended diagnostic laparoscopy (EDL) facilitates the comprehensive exploration of the abdominal cavity, thus improving the precision of the pretherapeutic tumor staging in gastrointestinal malignancies. EDL comprises visual inspection with a specific preparation of all relevant sites, laparoscopic sonography and retrieval of samples for biopsy and cytology. Additional relevant therapeutic information was obtained through EDL in 40.5 % of gastric cancer patients. EDL could be of similar importance for diagnosing esophageal, hepatobiliary and pancreatic malignancies.      

Basic study on velocity-flow urodynamics using Doppler sonography: Simultaneous detection of cavitation and Doppler signals in an artificial urethral model

BACKGROUND: We have developed velocity-flow urodynamics using Doppler sonography based on the hypothesis that microbubbles formed in the urethra are responsible for Doppler signals. In order to confirm this hypothesis derived from Bernoulli's principle, we investigated the simultaneous detection of cavitation noise and Doppler signals in an experimental system. METHODS: An experimental circuit was built in which a stenosis was created using a glass or silicon tube with tap water used as the sample fluid. Doppler signals, pressure before and after the stenosis, flow rate, flow velocity and cavitation noise were measured. Direct detection of cavitation with a high-speed charged-coupled device (CCD) camera was conducted in the glass tube. The relationship between cross-sectional area and flow velocity in terms of the detection of Doppler signals was analyzed in the silicon tube study. RESULTS: In the glass tube study, a high-speed CCD camera clearly detected masses of microbubbles associated with cavitation. The range of flow rates creating cavitation completely corresponded with those producing Doppler signals detected by ultrasonography. A similar correlation was observed in the silicon tube study, which showed that a low flow velocity of 41.5 cm/sec through a stenosis with a cross-sectional area of 20 mm(2) created Doppler signals at a flow rate of 8.3 mL/sec. CONCLUSION: The results of the present study confirmed that microbubbles created in flowing urine are responsible for Doppler signals. Measurement of velocity-flow urodynamics has great potential to become a non-invasive and reliable alternative to conventional pressure- flow urodynamic studies.     

Primary and secondary malignancies of the penis: ultrasound features

Cancer of the penis is a rare neoplasm in developed countries but worldwide represents a significant health problem. In this study, the ultrasonographic features of primary and secondary malignant lesions of the penis are described. Squamous cell carcinoma usually presents as a hypoechoic lesion with heterogeneous appearance. Invasions of the corpora cavernosa and the corpus spongiosum are appreciable. B-cell lymphoma presents as a well-vascularized mass, a plaque, or ulcers in the penile skin. Penile metastases result from hematogenous or lymphatic spreading of distant tumors or, more frequently, as penile infiltration by tumors from adjacent organs. Diffuse corporeal or nodular involvement can result. 1Award-winning poster at the 10th European Symposium on Urogenital Radiology; Uppsala, Sweden, September 4•7, 2003.     

非典型输卵管妊娠的临床与超声

输卵管妊娠是一种常见的妇科急腹症 ,对妇女造成极大的危害 ,诊断不及时甚至可危及生命。近 2 0年来全世界异位妊娠的发病率均有显著增加 ,发生率增长了 2～ 3倍。我国部分地区统计异位妊娠与正常妊娠之比为 1∶ 4 3～ 1∶ 5 0 [1～ 5] ,其原因如下 :(1)诊断方法先进 ,手段增多 ,检出率提高 ;(2 )盆腔炎症未彻底治疗 ;(3)性病的蔓延流行等高危因素。为了提高对异位妊娠的诊断水平 ,特别是非典型输卵管妊娠 ,有必要再复习一下异位妊娠的成因、病理、临床及超声声像图的各种表现。1　病　因病因是多方面的 ,如生殖细胞精子畸形、核型分类异常、染色体异常、卵发育停滞、受精卵发育不良、着床部位异常。盆腔炎造成输卵管周围粘连影响输卵管蠕动 ,伞端粘连影响捕捉孕卵功能 ,使输卵管半阻塞、狭窄乃至阻塞 ,纤毛粘连成瘢痕。性传播性疾病 ,特别是沙眼衣原体与异位妊娠的关系 ,Martin,Chow等人研究结果表明异位妊娠患者与沙眼衣原体感染有关 [6 ,7] 。输卵管本身的因素 ,如手术、炎症 ,造成肌层增生、狭窄等。宫内避孕器可降低输卵管妊娠 95 % ,研究表明带避孕器者好发于输卵管伞端。人工流产可增加宫...     

Transcranial doppler ultrasonography for the evaluation of shunt malfunction in pediatric patients

Previous studies have demonstrated a high correlation between hydrocephalus and the resistive index (RI), as determined by transcranial Doppler ultrasonography. Measurements of RI, calculated by dividing the difference between the peak systolic velocity and the enddiastolic velocity by the peak systolic velocity, were attempted in 55 pediatric patients during evaluations for ventriculoperitoneal shunt malfunctions; values were obtained in 52. Indications of shunt malfunction included both clinical and radiographic evidence of increased intracranial pressure. Eleven patients, determined to have functional shunts both by clincal criteria and subsequent outcome, had RIs of 47±5 (average±1 standard deviation). Shunt malfunctions were confirmed in 41 patients. Prior to shunt revisions, these 41 patients has RIs of 71±10%; following revision, the RIs fell to 53±12%. Nine patients had had pre-malfunction RIs of 48±11% obtained during routine follow-ups; when they subsequently had shunt malfunctions, their RIs had significantly increased. Four of the 41 patients with shunt malfunctions had essentially normal RIs (52±7%), but had fluid tracking along the shunt; in these, RIs were essentially unaffected by shunt revision. For comparison, 119 pediatric patients with clinically functional ventriculoperitoneal shunts had RIs of 50±9%. The data, statistically significant with a P value of <0.001, showed a correlation between elevated RIs and shunt malfunction; thus, transcranial Doppler ultrasonography is a practical, non-invasive technique useful in the diagnosis of ventriculoperitoneal shunt malfunction.Presented at the Annual Meeting of the Pediatric Section of the American Association of Neurological Surgeons, Washington D.C., November 1989     

Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

We report on our experience with routine abdominal ultrasonography in 120 children (aged 3–15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. Conclusion The diagnostic value of abdominal ultra‐sonography in unselected children with recurrent abdominal pain is low. However, the direct visualization of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain. Received: 19 March 1996 / Accepted: 29 January 1997     

电阻抗扫描成像和高频超声诊断小乳腺癌的对照研究

目的：评价电阻抗扫描成像(electrical impedance scanning，EIS)和高频超声对小乳腺癌的诊断价值．方法：乳腺肿块(直径≤2cm)54例病理证实，行EIS和高频超声检查，时间间隔不超过3d．结果：乳腺癌23例，EIS诊断小乳腺癌17例，敏感性73．9％，特异性80．6％，准确性77．8％，阳性预测值73．9％，阴性预测值80．6％；高频超声诊断小乳腺癌20例，敏感性87．0％，特异性87．1％，准确性87．0％，阳性预测值83．3％，阴性预测值90．0％．二联合诊断，敏感性95．6％，特异性90．3％，准确性92．6％，阳性预测值88．0％，阴性预测值96．6％．结论：EIS对小乳腺癌的诊断有较大实用价值，且与高频超声结合应用，可以提高小乳腺癌的诊断准确奎．     

超声引导经皮肝穿刺射频治疗肝癌

目的　探讨经皮肝穿刺射频治疗肝癌的有效性、安全性和肿瘤局部的控制情况。　方法　采用RF2 0 0 0射频治疗仪在超声引导下将射频电极放置于肝肿瘤内进行治疗。　结果　 (1) 30例肝癌患者 (肿瘤病灶直径 <5 cm及 >5 cm各 2 3个 )经过治疗 ,肿瘤完全缓解和部分缓解率占 5 4 .3% (2 5 /46 )。半年生存率为 93.3% ,1年生存率为 75 %。 (2 ) 2例出现肿瘤细胞针道种植转移 ,其他未见严重并发症。　结论　射频治疗肝癌是一种安全、有效的方法。对于肿瘤直径 <5 cm的肝癌治疗效果较佳 ;对于肿瘤直径 >5 cm者 ,应配合其他局部介入的综合治疗