腹膜假性黏液瘤的超声表现与手术病理对照分析

目的 通过比较腹膜假性黏液瘤(PMP)超声表现与手术探查所见,探讨超声在检查PMP中的诊断价值.方法 对22例手术和/或超声引导下穿刺活检病理证实为PMP患者的声像图表现和外科手术病理结果 进行回顾性分析及比较.结果 22 例中术前超声检查提示PMP 21例,漏诊1例,诊断准确率95.5%.超声分型表现:以腹水表现为主8例,以腹膜增厚表现为主伴腹水14例(7例以蜂窝状增厚为主,7例以肿块型增厚为主).14例以腹膜增厚表现为主的PMP,彩色多普勒血流成像显示稀疏血流信号7例,另7例未见血流信号.17例进行了手术治疗,术中见大网膜呈板状增厚6例,其中4例术前超声显示网膜普遍增厚;手术中见大网膜呈结节状5例,术前超声所见2例;手术见果冻样腹水11例,而术前超声检查15例呈黏液样腹水;术中发现病变原发于阑尾或回盲部6例,而术前超声诊断仅发现1例.结论 超声检查对PMP有较高诊断准确率,应作为首选影像诊断手段;PMP的超声表现为黏液样腹水和大网膜普遍或结节状增厚,具有较高特异性,而对原发病灶显示率较差.

Comparative analysis of ultrasonographic manifestations and surgical pathology in patients with pseudomyxoma peritonei

Objective To investigate the value of ultrasonography in diagnosis of pseudomyxoma peritonei(PMP) by comparing the ultrasonographic manifestations and surgical findings of PMP.Methods The ultrasonographic performance and operation pathology were analyzed retrospectirvely and comparatively in 22 cases of PMP which had been proved by pathology after operation and/or ultrasound-guided puncture.Results Twenty-two patients were underwent preoperative ultrasonography,of which 21 cases were diagnosed as PMP,and 1 case was missed.The diagnostic accuracy was 95.5%.The ultrasonographic feathers were distinguished into two types:type 1 manifested ascites(8/22) and type 2 represent with peritoneum thickening mainly(14/22).Of 14 cases,thickening peritoneum showed honeycomb in 7 cases and tumorous in 7 cases.Seven patients with peritoneum thickening displayed poor blood flow signal and another 7 patients found no blood flow signal by color Doppler flow imaging.17 cases had surgical treatment.Platelike thickening of the great omentum were found in 6 cases,4 of which showed widespread thickening omentum by preoperative ultrasonography.Nodular great omentum were found in 5 cases during operation,while 2 cases were found by preoperative ultrasonography,peptone ascites were found in 11 cases by surgery,while mucoid ascites were found 15 cases by preoperative ultrasonography.An appendix or ileocecal lesion was found in 6 patients,while preoperative ultrasonography found only 1 patient.Conclusion Ultrasonography has a higher diagnostic accuracy in the patients with PMP.It may be used as the first mean to diagnosing PMP.Ultrasonographic features of PMP include mucoid ascites and widespread or nodular omental thickening.However it is poor to display the primary lesions.