彩色多普勒超声对乳腺良、恶性肿物血管分布的研究

目的探索彩色多普勒超声在乳腺良、恶性肿物诊断中血管分布的差异,寻求较为准确的诊断方法与标准。方法选取2011年1月～2013年1月我院外科以乳腺肿物入院的100例患者作为观察对象,其中46例患者确诊为恶性肿物,为实验组;54例确诊为良性肿物,为对照组。比较两组患者肿物形态,包括肿物大小、边缘、血管与肿物位置关系等,以及肿物内血管分布情况,包括血管数目、血液流速、动脉阻力指数等,以及两组患者超声检出率以及病灶情况。结果两组患者乳腺肿物大小以及超声检出率均无显著统计学差异（P均〉0.05）。实验组乳腺肿物边缘粗糙、血管生长入肿瘤内部比率高于对照组,差异均有统计学意义（P均〈0.05）。实验组血管数目较对照组多,血流速度较对照组快,动脉阻力指数较对照组低,差异均有统计学意义（P均〈0.05）。两组患者在病灶情况对比上,差异均有统计学意义（P均〈0.05）。结论彩色多普勒超声可以清晰显示血流分布,同时监测血管流速等,在乳腺良恶性肿瘤的鉴别中特异性较高,值得临床推广应用。     

超声引导下乳腺肿块Mammotome微创旋切术及其临床应用

目的探讨超声引导下微创旋切手术对乳房肿块的诊断与治疗。方法对109例136处乳腺肿块进行了超声引导下旋切术,评价其诊治效果。结果109例136处乳腺肿块中,96例123处乳腺肿块临床诊断为乳腺纤维腺瘤,均被Mammotome微创旋切切除,13例经Mammotome微创旋切术进行活检术。所有操作均成功,皮肤伤口仅3mm,无并发症。结论超声引导下乳腺肿块旋切术操作方便易学,对乳腺小纤维腺瘤切除彻底,皮肤疤痕微小;对可疑病灶能及时明确诊断,合理治疗。     

彩色多普勒超声对乳腺良恶性肿块诊断的临床价值

目的探讨乳腺良恶性肿块的超声声像图特征及其鉴别诊断。方法回顾性分析我院2010年6月~2014年6月收治的乳腺肿块28例的临床资料,并对乳腺肿块的超声声像图特征及血流动力学指标血流搏动指数（PI）、阻力指数（RI）、血流最大速度（Vmax）进行分析。结果 28例乳腺肿块中,经彩色多普勒超声诊断证实良性肿块22例,恶性肿块6例。乳腺良性肿块的超声表现为形态规则,包膜完整,内部回声均匀。乳头、乳晕下实质性小结节呈中高回声,内部不均,边界清晰,邻近大导管可伴有扩张。肿块周边或内部可见彩色血流。恶性肿块边界不清,边缘呈多角形或蟹足样,形态不规则,内部呈低回声,无包膜,肿块呈细点状、斑片状、团状、条状、线状等形态,主要为以细点状多见的钙化灶。CDFI显示肿块周围及内部可见多条动、静脉彩色血流信号,多有动脉穿入肿块内并有弯曲或分支。乳腺良性肿块组患者的PI、RI、Vmax分别明显低于恶性肿块组,差异具有统计学意义（P〈0.05）。乳腺良性肿块组血流分级以0~Ⅰ级为主,恶性肿块组的血流分级以Ⅲ级为主。结论应用彩色多普勒超声诊断乳腺良、恶性肿块诊断准确率高,且操作简便,患者无痛苦,更易接受,值得广泛推广和应用。     

高频彩色多普勒超声对乳腺肿块诊断及定位的临床应用价值

目的探讨高频彩色多普勒超声对乳腺肿块诊断及定位的临床应用价值。方法选取2011年6月-2012年12月,在广州市越秀区妇幼保健院接受治疗的162例乳腺肿块患者。采用高频彩色多普勒超声对其乳腺肿块进行诊断和定位,并对其临床情况进行了回顾性分析。结果 106例为良性,56例为恶性,和病理学检测结果对比,相符率为94.3%,恶性肿块的相符率为92.9%。良性肿块二维图像显示圆形或椭圆形,回声低、边界清楚,有完整的包膜,形态较为规则;恶性肿块的二维图像多表现为低回声肿块,且形态不规则、纵横比增大,无包膜,边界模糊、呈锯齿状或蟹足状,肿块内部回声不均、多存在微钙化灶。结论有效结合二维图像及彩色多普勒检查,能够提高乳腺肿块的诊断及定位效率。     

The clinical impact of aberrant internal carotid arteries in children

Objective

Variations in the course of the internal carotid artery are not rare and likely to be a congenital anomaly. The purpose of this study is to highlight the clinical impact of aberrant internal carotid arteries in children for surgical and interventional procedures in the head and neck.

Methods

Retrospective study of the vessel course in patients under the age of 18 years over a period of 4.5 years. Vessels were classified according to the anatomic classification by Weibel and Fields and related to a previously proposed clinicoradiological risk classification system. Clinical implications are pointed out.

Results

Nine patients with a total of 14 aberrations (4 tortuosities, 7 kinkings and 3 coilings) were included. All aberrations were incidental intraoperative or radiological findings; no patient suffered from distinct symptoms. The minimum distance to the pharyngeal wall ranged from 0.8 to 9.0 mm with a mean of 3.8 mm. Anatomic classification and clinical risk of injury did not correlate.

Conclusions

Routine pharyngeal surgery and interventional procedures are usually performed without any preoperative imaging. However, variations in the course of the internal carotid artery may considerably increase the risk of vessel injury and should always be anticipated.     

二维及彩色多普勒超声诊断乳腺包块的临床价值

目的：探讨二维及彩色多普勒超声诊断乳腺包块的临床价值。方法应用高频探头对85例各种原因引起的乳腺包块进行检查,所有病例均经手术及病理证实,并与超声诊断对照分析。结果85例乳腺包块经病理证实良性者32例,二维＋多普勒超声准确诊断30例,诊断符合率为93．8％;恶性者53例,二维＋多普勒超声准确诊断50例,诊断符合率为94．3％,且无论良性或恶性,二维＋多普勒超声诊断符合率均较单纯二维声像图诊断率高。结论二维声像图结合彩色多普勒检查可大大提高诊断的正确率,对乳腺疾病的早期发现及良恶性鉴别具有重要意义。     

Management of ovarian cysts during pregnancy

Ovarian cysts are common in pregnancy, more so with the increase in routine antenatal use of ultrasonography. The majority of ovarian cysts in pregnancy are benign and resolve spontaneously. It is rare to diagnose malignant ovarian tumours during pregnancy. Imaging with ultrasonography is the first line investigation of choice and the use of International Ovarian Tumor Analysis (IOTA) group rules of ultrasonographic appearances of ovarian lesions can help identify benign and malignant lesions more accurately. MRI is also safe to use in pregnancy to better delineate ovarian lesions. Simple cysts <6 cm can be safely managed conservatively, with surgery reserved for larger, symptomatic cysts or those suspicious of malignancy. Ovarian cysts can be managed laparoscopically between 14 and 16 weeks gestation but require advanced laparoscopic skills. Image guided aspiration of benign ovarian cysts remains an option but is associated with high recurrence rates and risk of spillage, a disadvantageous outcome in cases subsequently shown to be malignant.     

介入超声用于颈部肿块诊治的体会

目的：总结介入超声用于颈部肿块诊治的经验与教训及其在临床诊治中的实用价值。方法：108例颈部肿块病人在彩超引导下,作自动活检诊断与穿刺治疗术。结果：80例实性肿块的自动活检病理结果准确率为95％（76／80）;28例炎性液性肿块的诊断率和治愈率均为100％。结论：介入超声用于颈部肿块诊治的关键在于彩超定位的准确性,具有安全、可靠、快捷的优点,应作为临床诊治颈部肿块的首选方法。     

Efficacy of ‘two-man’ FNAB technique in the assessment of patients with non-thyroid neck masses

Objective: To show the superiority of ‘two-man’ FNAB technique comparing to the standard FNAB technique, in order to identify the cause of non-thyroid neck masses. Methods: Over an 18 months period, a consecutive paired study was conducted in the tertiary referral Venizelion General Hospital. Forty-four cytologic examinations were performed in patients with non-thyroid head and neck masses. The samples were taken from the same side using both techniques the standard FNAB technique and the ‘two-man’ FNAB technique (for which two persons carried out the procedure). The slides were seen by the pathologist and were defined as diagnostic, suggestive or inconclusive. The diagnosis was confirmed in any case by definite histology after surgical treatment or open biopsy. Results: From 44 samples taken with the ‘two-man’ technique, 34 were diagnostic (all true) verified by histopathology, seven suggestive (five true and two false) and three inconclusive (6.82%). The correct diagnosis was confirmed in 39 cases (88.64%). From 44 samples of standard technique, 22 were diagnostic (all true), 12 suggestive (five true and seven false) and 10 inconclusive (22.72%). The correct diagnosis was confirmed in 27 cases (61.36%). The accuracy of diagnosis with the standard FNAB technique was 0.79 (SE=0.07), while with the ‘two-man’ FNAB technique was 0.95 (SE=0.03), a significant statistical difference (Fischer exact test, P=0.041). Conclusions: ‘Two-man’ FNAB technique proved to be as safe and patient friendly as the standard FNAB, but more accurate and may be easier to perform than this. The ‘two-man’ FNAB technique could become the preferred method for fine-needle cytology, particularly for difficult to reach areas of the head and neck.     

Three-dimensional ultrasound and three-dimensional power Doppler in the assessment of adnexal masses

Three-dimensional ultrasound is a new, emerging technology that provides additional information for the evaluation of ovarian tumors. Multiplanar and volume-rendering display methods combined with the ability to rotate volume data into standard orientations are essential components of the current and future success of three-dimensional ultrasound.

Increasing knowledge about three-dimensional ultrasound, as well as improved handling allow application of this method to the field of gynecological oncology. The recent development of real-time three-dimensional ultrasound imaging will further advance the clinical applications, particularly in the assessment of pelvic tumors. The introduction of the three-dimensional power Doppler systems may improve the information available on ovarian tumor vascularity and speed up the entire patient management process.