实时超声弹性成像对桥本甲状腺炎的应用价值研究

目的：探讨实时超声弹性成像在桥本甲状腺炎（HT）诊断中的应用价值。方法：对175例临床确诊为HT的患者进行常规超声及实时超声弹性成像检查,根据二维声像图特征分为回声不均型、斑片型、弥漫型及结节型,并与30例健康者作对照,分析正常对照组及各型HT弹性图分级及应变率比值。结果：HT弹性图分级四型之间存在差异（P〈0.05）,回声不均型多为0、1级,斑片型以1、2级为主,弥漫型以2、3级为主,结节型以3级为主。回声不均型与正常对照组之间弹性分级、应变率比值差别无统计学意义（P〉0.05）,四型HT之间弹性分级、应变率比值差异有统计学意义（P〈0.05）,且从回声不均型到结节型,分级程度逐次增高,应变率比值依次增大（P〈0.05）。结论：实时超声弹性成像能够估测不同类型HT甲状腺实质硬度的差别,为HT常规超声诊断提供了辅助信息。     

应用经直肠实时超声弹性成像引导前列腺活检

目的探讨经直肠实时超声弹性成像(TRTE)引导前列腺活检的应用价值。方法对91例疑诊前列腺癌拟行前列腺活检的患者,在经直肠彩色超声(TRUS)扫查基础上,应用TRTE明确可疑病灶引导目标活检,同期并行系统活检。结果 TRTE检出可疑病灶42个,其中34个为癌结节,阳性率80.95%(34/42),8个为非癌结节,假阳性率19.05%(8/42),4例前列腺癌弹性图无局灶性改变,假阴性率12.50%(4/32)。目标活检共计97点,前列腺癌检出率77.78%(28/36);系统活检共计642点,前列腺癌检出率31.87%(29/91);两种活检方案比较前列腺癌检出率差异有统计学意义(P<0.01)。结论 TRTE有助于确定活检靶目标,提高超声引导前列腺活检的效能。     

实时超声弹性成像在甲状腺结节诊断中的临床价值

目的探讨实时超声弹性成像在甲状腺结节诊断中的临床应用价值。方法对2009年6~12月期间收入我院血管甲状腺腹壁疝外科并行实时超声弹性成像检查的168例甲状腺结节性疾病患者的临床资料进行回顾性分析,将实时超声弹性成像图按弹性硬度分为0~Ⅳ级(0~Ⅱ级为良性,Ⅲ~Ⅳ级为恶性),并与病理学结果进行比较。结果 168例患者共208个结节:结节性甲状腺肿125个;甲状腺腺瘤36个;甲状腺恶性肿瘤41个,其中39个为甲状腺乳头状癌,1个为甲状腺髓样癌,1个为甲状腺非霍奇金淋巴瘤;其他结节6个,包括弥漫性毒性甲状腺肿1个、灶性淋巴细胞性甲状腺炎3个、亚急性肉芽肿性甲状腺炎2个。弹性分级为0~Ⅱ级的结节148个,Ⅲ~Ⅳ级者60个。根据病理学结果,良性结节占0~Ⅱ级的97.3%(144/148),占Ⅲ~Ⅳ级的38.3%(23/60);恶性结节占0~Ⅱ级的2.7%(4/148),占Ⅲ~Ⅳ级的61.7%(37/60)。实时超声弹性成像的诊断敏感度为90.2%(37/41),特异度为86.2%(144/167),准确度为87.0%(181/208)。结论实时超声弹性成像能反映甲状腺结节的相对硬度,为诊断提供有用信息,有助于鉴别诊断甲状腺结节的良、恶性。     

VTIQ实时剪切波弹性成像在甲状腺微小癌风险评估的价值

目的 应用VTIQ实时剪切波弹性成像技术检测甲状腺微小癌（TMC）病灶组织剪切波速度（SWV）,结合病理分析VTIQ在甲状腺微小癌风险评估的价值。方法 选取经细针穿刺细胞学诊断为TMC,术前行VTIQ检测,获取病灶SWV最大值、最小值及平均值。以术后病理为金标准,拟分为：Ⅰ型,TMC伴被膜浸润、伴颈部淋巴结转移;Ⅱ型,TMC伴被膜浸润、但无转移;Ⅲ型,TMC无被膜浸润、且无转移。将术前测得TMC的SWV值根据术后病理分组绘制ROC曲线,分析各组之间的参考临界值。结果 (1)根据病理结果,50例TMC中,11例为Ⅰ型,10例为Ⅱ型,29例为Ⅲ型。不同类型TMC的SWV最大值、最小值以及平均值均存在差异,具有统计学意义（P﹤0.05）。(2)SWV最大值、最小值以及平均值对鉴别诊断TMC风险的ROC曲线下面积分别约0.952、0.994、0.973,诊断效能最佳为SWV最小值。(3)ROC曲线特性中得出：Ⅰ型与Ⅱ型最佳临界值为SWV最小值3.25 m/s,诊断敏感度、特异度及约登指数分别为91%、90%、81%;Ⅱ型与Ⅲ型最佳临界值为SWV最小值2.76 m/s,诊断敏感度、特异度及约登指...     

超声弹性成像技术对小乳腺癌的诊断价值

目的评价超声弹性成像技术对于小乳腺癌(最大直径≤2cm)的诊断价值。方法收集2012年9月至2014年10月期间收治的72例患者共72个最大直径≤2 cm的乳腺肿块资料。术前均经过常规超声及超声弹性成像检查,常规超声采用BI-RADS分类,超声弹性成像采用改良5分法分别对乳腺肿块的性质进行鉴别诊断。术后或细针细胞穿刺术后病理结果作为金标准,比较单独运用常规超声及两者联合应用这两种方法对小乳腺癌的诊断准确率。采用SPASS18.0统计软件进行分析,率的比较采用χ~2检验,P0.05为差异有统计学意义。结果以病理诊断作为金标准,单独运用常规超声诊断的敏感性、特异性、准确率为55.2%,60.5%,58.3%,而两者联合诊断的敏感性、特异性、准确率79.3%,81.4%,80.6%,两者的差异有统计学意义(χ~2=8.378,P=0.006)。结论超声弹性成像有助于提高小乳腺癌的诊断准确率,具有重要的临床价值。     

经直肠实时组织弹性成像联合超声造影在诊断前列腺良恶性疾病中的应用价值

目的:探讨经直肠实时组织弹性成像(TRTE)联合超声造影(CEUS)在诊断前列腺良恶性疾病中的应用价值。方法:分析经病理证实的88例95个前列腺病灶的超声资料,计算TRTE、CEUS及两者联合诊断前列腺良恶性病变的敏感性、特异性、准确性、阳性预测值和阴性预测值,绘制TRTE、CEUS和两者联合应用的受试者工作特征(ROC)曲线,分别计算三者的曲线下面积(AUC),评估联合应用TRTE和CEUS诊断前列腺良恶性病变的价值。结果:TRTE诊断前列腺病变的敏感性为83.33%,特异性为78.72%,准确性为81.05%,阳性预测值80.00%,阴性预测值82.22%;CEUS诊断前列腺恶性病变对应的敏感性为87.5%,特异性为76.60%,准确性为82.11%,阳性预测值79.25%,阴性预测值85.71%;CEUS联合TRTE诊断前列腺恶性病变对应的敏感性为95.83%,特异性为80.85%,准确性为88.42%,阳性预测值83.63%,阴性预测值95.00%;TRTE的ROC曲线下面积为0.877,CEUS的ROC曲线下面积为0.820,TRTE联合CEUS的ROC曲线下面积为0.894,联合诊断的AUC略高于TRTE和CEUS的AUC,联合诊断的诊断价值稍高。TRTE和CEUS联合诊断的诊断准确性高于单独应用TRTE或CEUS,三者之间行χ2检验,差异有统计学意义(P0.05)。结论:TRTE联合CEUS在诊断前列腺良恶性疾病中具有较高的价值,两者结合可提高疾病的诊断率。     

超声弹性成像技术对提高肝肿瘤穿刺活检确诊率的应用价值

目的探讨超声弹性成像技术对提高肝肿瘤穿刺活检确诊率的应用价值。方法将126例肝肿瘤患者(共141个肝脏肿块)随机分为弹性组(70个肿块)和对照组(71个肿块)。对弹性组行超声弹性成像检查,分别对肿块进行弹性评分及应变率比值测定,然后参照弹性图特点行超声引导下肝肿瘤穿刺活检;对照组只采用常规超声引导肝肿瘤穿刺活检。以病理结果为金标准,对比分析两种方法对肝肿瘤的穿刺成功率、取材满意度和确诊率。结果以1针为穿刺成功标准,对照组和弹性组的穿刺成功率分别为29.58%(21/71)、64.29%(45/70),二者差异有统计学意义(χ~2=17.05,P0.01);以≤2针为穿刺成功标准,弹性组穿刺成功率明显高于对照组[95.71%(67/70)vs 85.92%(61/71),χ~2=4.04,P=0.04]。以取出长度约10~22mm的完整组织条或取材量满足病理诊断为取材满意,对照组和弹性组的取材满意度分别为81.20%(108/133)、93.88%(92/98),差异有统计学意义(χ~2=7.80,P=0.01)。弹性组与对照组总确诊率差异有统计学意义[95.71%(67/70)vs 84.51%(60/71),χ~2=4.95,P=0.03]。结论超声弹性成像可敏感反应肿瘤组织的软硬程度、准确分辨肝肿瘤内的液化坏死区,对提高肝肿瘤穿刺活检确诊率具有重要的价值。     

剪切波弹性成像对食管静脉曲张的诊断价值

目的探讨剪切波弹性成像技术(SWE)对食管静脉曲张(EV)严重程度和破裂出血的诊断价值。方法对临床确诊的103例肝硬化患者行超声、内镜及实验室检查,分析性别、年龄、体质量指数(BMI)、肝功能Child-Pugh分级、肝硬度(LS)、LS×脾长径与血小板(PLT)比值指数(LSPS)、血小板与天冬氨酸氨基转移酶比值指数(APRI)、脾硬度(SS)对有无EV、低危和高危EV、有无EV破裂出血的预测价值,并进行相关性分析。结果有EV与无EV肝硬化患者之间,Child-Pugh分级、LSPS、APRI、LS、SS差异均有统计学意义(P均0.05),LS、SS是诊断EV的独立影响因素。LSPS、APRI、LS、SS诊断EV的AUC为0.84、0.79、0.83和0.89。低危和高危EV患者Child-Pugh分级、LS、SS差异有统计学意义(P均0.05);有无EV破裂出血患者SS差异有统计学意义(P0.01),SS为预测高危EV及有无EV破裂出血的独立影响因素。有无EV与Child-Pugh分级相关性较弱(r=0.35,P0.05),与LSPS、APRI、LS相关性中等(r=0.52、0.45、0.51,P均0.05),与SS相关性较强(r=0.61,P0.05)。结论 SWE对肝硬化患者EV严重程度和破裂出血有较高价值,可作为预测EV分级和破裂出血的无创检查技术。SS对EV的诊断价值高于LS。     

超声弹性成像在甲状腺结节鉴别诊断中的价值

目的评价超声弹性成像指标在鉴别甲状腺良、恶性结节中的价值。方法对116个甲状腺结节行灰阶超声和超声弹性成像检查,计算病灶在弹性图/灰阶图的直径变化率和面积比值,与病理结果对照分析甲状腺良、恶性结节的超声弹性指标。结果超声弹性分级4级及以上者在恶性甲状腺结节中所占比例显著高于良性结节(P<0.05);甲状腺恶性结节弹性图/灰阶图直径变化率和面积比值均显著高于良性结节(P<0.05);分析ROC曲线,甲状腺结节灰阶图和弹性图面积比值较直径变化率诊断价值高,诊断准确性亦高(P<0.05)。结论超声弹性成像灰阶图和弹性图直径变化率和面积比值作为甲状腺弹性成像检查的诊断指标,明显提高了甲状腺结节鉴别的诊断价值和诊断准确性。     

剪切波超声弹性成像的原理及临床应用现状

剪切波超声弹性成像(SWE)是一种用于评价活体组织硬度的新技术,具有实时、无创、定量等特点,目前的研究表明其具有良好的临床应用前景。本文旨在对该技术的原理以及临床应用现状进行综述。     

Outcomes of bariatric surgery in patients with obesity and compensated liver cirrhosis

BackgroundObesity is a major health burden worldwide and is associated with nonalcoholic fatty liver disease, which can lead to cirrhosis. Bariatric surgery is increasingly being used to treat obesity, and the number of patients with obesity and cirrhosis undergoing bariatric surgery is also rising. However, the safety and feasibility of bariatric surgery in patients with obesity and cirrhosis are controversial.ObjectivesIn this meta-analysis, we compared postoperative complications, mortality, and weight loss between patients with and without cirrhosis undergoing bariatric surgery.SettingAn electronic search of Medline, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL).MethodsPatient morbidity and mortality odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were assessed. Intraoperative and overall complications, length of hospital stay, in-hospital mortality, long-term mortality, and total weight loss were recorded.ResultsThe literature search yielded 2977 articles. Eight studies were included in the analysis. Meta-analysis showed that the overall complications (OR: 2.1; 95% CI: 1.47–3.00; P < .0001), postoperative bleeding (OR: 2.22; 95% CI: 1.95–2.54; P < .00001), length of hospital stay (MD: .68; 95% CI: .14–1.19; P = .01), and in-hospital/90-day mortality (OR: 3.59; 95% CI: 2.84–4.54; P < .00001) were significantly higher in patients with compensated cirrhosis than in patients without cirrhosis. Intraoperative complications, operation time, major complications, and long-term mortality were similar between the groups. Total weight loss was also not significantly different between the groups.ConclusionBariatric surgery can be considered only in highly selected patients with obesity and compensated cirrhosis.     

断流术对肝硬化患者术后肝纤维化的影响

目的 探讨脾切除贲周血管离断术对乙肝肝硬化门静脉高压症患者无创性肝纤维化指标及肝功能的影响.方法 20例未经抗病毒治疗的乙肝肝硬化门脉高压患者,Child-PughA级12例,B级8例,分别于断流术前后,采用ELISA法测定血清PDGF、CTGF;电化学发光法测定透明质酸（HA）、三型前胶原（PcⅢ）、层黏连蛋白（LN）、四型胶原（cⅣ）;采用全自动生化分析仪及血细胞计数仪测定总胆红素（TBIL）、转氨酶（AST、ALT）、胆碱酯酶（CHE）、前白蛋白（PA）、WBC及PLT.结果 ①血清PDGF、CTGF及肝纤四项指标较术前明显下降.②总胆红素（TBIL）较术前明显降低;前白蛋白（PA）、胆碱酯酶（CHE）较术前有所升高,差异明显.③白细胞、血小板较术前升高差异有统计学意义.结论 断流术不仅能够减少肝硬化门静脉高压的多种并发症,同时在改善肝功能、凝血功能及延缓肝纤维化的发展上起了重要作用.     

肝硬化合并皮肤软组织感染研究进展

肝硬化患者因其免疫力低下、下肢水肿等原因是皮肤软组织感染的高危人群,常见的皮肤软组织感染部位为下肢,常见的感染类型为蜂窝织炎。与一般人群不同,肝硬化患者合并皮肤软组织感染的病原体以革兰阴性杆菌为主。血清肌酐值和MELD评分为肝硬化患者合并皮肤软组织感染预后不良的预测因素。我国肝硬化患者合并皮肤软组织的病原学与临床特征尚需进一步明确,旨在为优化此类患者的优化管理提供一定的依据。     

Impact of intraoperative ultrasonography in laparoscopic liver surgery

Background Laparoscopic surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver. This mainly includes diagnostic procedures, interstitial therapies, and treatment of liver cysts. However, the authors believe there is room for a laparoscopic approach to the liver in selected cases. Methods A prospective study of laparoscopic liver resections was undertaken with patients who had preoperative diagnoses of benign lesion and hepatocellular carcinoma with compensated cirrhosis. The inclusion criteria required that hepatic involvement be limited and located in the left or peripheral right segments (segments 2–6), and that the tumor be 5 cm or smaller. The location of the tumor and its transection margin were defined by laparoscopic ultrasound (LUS). Results From December 1996, 17 (5%) of 313 liver resections were included in the study. There were 5 benign lesions and 12 hepatocellular carcinomas in cirrhotic patients. The mean age of the study patients was 59 years (range, 29–79 years). The LUS evaluation identified the presence of new hepatocellular carcinoma nodules in two patients (17%). The resections included 1 bisegmentectomy, 8 segmentectomies, 3 subsegmentectomies, and 3 nonanatomic resections. The mean operative time, including laparoscopic ultrasonography, was 156 ± 50 min (median, 150 min; range, 60–250 min), and the perioperative blood loss was 190 ± 97 ml. There was no mortality. Conversion to laparotomy was necessary for two patients. Postoperative complications were experienced by 3 of 15 patients, all of them cirrhotics. One of the patients had a wall hematoma, and the remaining two patients had bleeding from a trocar access requiring a laparoscopic reexploration. The mean hospital stay for the whole series was 6.9 ± 4.9 days (median, 6 days; range, 2–25 days) and 5.6 ±1.4 days (median, 6 days; range, 2–8 days) for the 15 laparoscopic patients. Conclusion Laparoscopic treatment should be considered for selected patients with benign and malignant lesions in the left lobe or frontal segments of the liver. Evaluation by LUS is indispensable to guarantee precise determination of the segmental tumor location and the relationship of the tumor to adjacent vascular or biliary structures, excluding adjacent or adjunctive new lesions. The evolution of laparoscopic hepatectomies probably will depend on the development of new techniques and instrumentations.     

保留半肝动脉血供联合肝缺血预处理在肝硬化复杂肝切除术中的应用

目的:探讨减轻肝硬化患者复杂肝切除缺血再灌注损伤的措施。方法:回顾性分析46例肝硬化患者复杂肝切除术中保留半肝动脉血供入肝血流阻断+肝缺血预处理(实验组)的临床资料,并与同期全肝入肝血流阻断(Pringle法)肝切除术61例(对照组)作对比研究。结果:实验组平均阻断时间(38.75±6.2)min,对照组(21.67±4.60)min,2组差异有统计学意义(P<0.05)。2组术后3、7和15d血清谷丙转氨酶(ALT)、术后3d血清总胆红素及术中、术后出血量差异无统计学意义(P>0.05)。结论:保留半肝动脉血供入肝血流阻断+肝缺血预处理技术对减少肝硬化患者复杂肝切除术后肝衰竭的发生有重要意义。     

肝硬化病人胰岛素抵抗的研究进展

胰岛素抵抗是指肝脏、骨骼肌、脂肪等组织对胰岛素作用的敏感性下降。肝硬化病人经常会伴随胰岛素抵抗和糖耐量减退。尽管其机制尚不明确，但很多的研究表明肝硬化病人胰岛素抵抗的发生可能与肝硬化时肝脏病理生理的改变、胰岛素与其受体的亲和力降低、拮抗胰岛素的相关激素增加，血内游离脂肪酸增加，血清胰岛素样生长因子水平升高以及调控糖代谢的相关基因表达异常有关。就肝硬化胰岛素抵抗的相关因素作一综述。     

Indication and perioperative management for cardiac surgery in patients with liver cirrhosis

Three patients with noncardiac Child A cirrhosis underwent cardiac surgery. All survived surgery, but 2 died during follow-up periods. A 61-year-old woman who underwent successful double valve replacement died of diabetic coma and severe acidosis due to intestinal necrosis 18 months later. A 57-year-old woman who underwent successful mitral valve replacement died of liver failure induced by heart failure 9 years later. A 45-year-old man who underwent coronary artery bypass grafting is doing well 18 months after discharge. Proper perioperative management, including high-flow cardiopulmonary bypass, pharmacological and mechanical circulatory support, and mechanical respiratory support prevented further, potentially lethal, hepatic dysfunction, leading to good early surgical results. We concluded that patients with Child A cirrhosis could tolerate cardiac surgery. Subsequent surgical results, however, were unsatisfactory, and more careful follow-up is necessary to obtain better late results.     

生化检验项目在肝硬化疾病诊断中的应用价值

目的：探讨生化检验项目在肝硬化疾病诊断中的应用价值。方法选取我院2011年1月～2013年6月收治的50例肝硬化患者与同期50例健康体检人员为研究对象,对其进行各项生化检验项目指标检测,比较分析两组检测结果。结果与对照组相比,观察组丙氨酸转氨酶、总胆红素、谷草转氨酶、碱性磷酸酶、r-谷氨酰转肽酶及直接胆红素数值明显要高;总蛋白、胆碱酯酶及白蛋白数值明显要低,差异均有显著统计学意义（P＜0.05）。此外,肝硬化上述主要生化检验指标数值均在正常值范围之外。结论肝硬化疾病导致肝脏代谢异常,致使其各生化指标与正常人或正常范围值存在明显差异,是判断肝硬化疾病的重要标志。