超声检查在甲状腺疾病诊断中的价值

随着超声医学的发展，超声检查在临床应用日益广泛，尤其在浅表器官的疾病检查中，它不仅能观察病变组织形态、结构、边缘、内部回声等二维表现，而且可了解病变部位的血流分布情况并得到血流频谱参数及测值，通过超声造影新技术反应局部组织血流灌注状态。由于超声检查具有非侵入性、无辐射、可反复检查等优点，它已成为甲状腺疾病诊断中的不可或缺的手段，在甲状腺疾病的诊断和鉴别诊断方面发挥着十分重要的作用。现就超声检查在甲状腺疾病中的诊断价值简述如下。     

彩色多普勒超声在甲状腺癌中的诊断价值

目的评估彩色多普勒超声对甲状腺癌的诊断价值。方法回顾分析2009年1月至2009年12月因甲状腺结节行手术切除的患者资料,共207名患者入组本研究,其中行超声检查207例,行超声＋CT检查144例。所有患者行手术治疗,对比术后病理与术前影像学检查结果。用统计软件SPSS16．0,计数资料用卡方检验对比超声与CT的统计学意义,对比超声与CT的敏感性、特异性、阳性预测值、阴性预测值和准确率,P〈0．05有统计学意义。结果207例甲状腺结节患者术后病理显示151例为良性,56例为恶性。对比术前资料。超声和CT的敏感性分别是80．4％、75．0％,特异性分别是68．2％、47．1％,准确率分别是71．5％、54．9％,阳性预测值分别是48．4％、35．3％,阴性预测值分别是90．4％、83．1％。超声检查在甲状腺肿瘤良恶性结节中的特异性和准确率明显高于CT检查（P〈0．01）,差异均有统计学意义。结论彩色多普勒超声检查是鉴别甲状腺结节良恶性非常有用的方法。形态不规则、钙化、低回声、边界不清、Ⅱ型血流及实性结节是判断结节良恶性的参考指标。存在3个以上超声特征的结节的恶性概率将明显增加。超声检查在良恶性鉴别方面优于CT检查。CT检查对甲状腺癌评估有一定的价值,可协助超声检查。     

多普勒超声在全训部队人员阴囊疾病诊断中的应用

目的探讨多普勒超声在全训部队人员阴囊疾病诊断中的应用价值。方法回顾分析450例阴囊超声检查阳性的全训部队患者(Ⅰ组)的资料,对担负高原运输任务的152名驾驶员(Ⅱ组)进行阴囊多普勒超声检测,并与150名无临床症状的地方男性青年(Ⅲ组)相对比。结果 I组中附睾炎及附睾睾丸炎占43.33%(195/450),精索静脉曲张占22.44%(101/450);Ⅱ组亚临床型精索静脉曲张和睾丸微石症(TM)发生率高于Ⅲ组(P0.001);Ⅱ组与Ⅲ组睾丸及附睾内动脉血流参数比较差异无统计学意义(P0.05)。结论彩色多普勒超声是诊断全训部队人员阴囊疾病的首选检查方法。     

彩色多普勒超声在诊断肝移植术后并发症中的价值

目的探讨彩色多普勒超声在肝移植术后并发症的诊断价值。方法回顾分析彩色多普勒超声对95例肝移植患者术后并发症的诊断结果。结果95例中发现肝动脉血栓形成3例（3.15%）,肝动脉狭窄2例（2.10%）,门静脉血栓形成1例（1.05%）,门静脉狭窄1例（1.05%）,下腔静脉狭窄2例（2.10%）,胆道并发症10例（10.52%）,排异反应7例（7.36%）,浆膜腔积液93例（97.89%）,肝周血肿7例（7.36%）,肿瘤复发5例（29.41%）。结论彩色多普勒超声在肝移植术后并发症诊断中具有重要的实用价值。     

高频彩色多普勒超声在小乳腺癌诊断中的价值

目的探讨高频二维超声及彩色多普勒血流成像(CDFI)诊断小乳腺癌的应用价值。方法回顾性分析经术后病理证实的小乳腺肿块(小于2.0cm)101例,其中小乳癌53例,乳腺良性病变48例。分别就二维超声声像图特征、CDFI等项指标进行对照分析,明确对诊断有肯定价值的诊断指标。结果二维超声检查中,乳腺癌与良性病变在形态、边界、包膜、内部回声、后方回声、纵横比、有无钙化等方面均有显著性差异。CDFI乳腺癌的血流检出率为90.57%,血流信号丰富,以Ⅱ～Ⅲ级为主(占83.02%)。腋窝转移性淋巴结是乳腺癌的间接征象。结论小乳腺癌的二维图像、CDFI及转移性腋窝淋巴结在诊断小乳腺癌上均有特征性表现。综合分析可大大提高小乳腺癌的诊断准确率。     

彩色多普勒在胎盘植入诊断中的应用价值

目的应用彩色多普勒超声观察产前胎盘植入的声像图特征,提高产前诊断和J临床治疗中的应用价值。方法回顾性分析在本院进行诊治、并最终经手术后病理证实为胎盘植入的患者56例,分析其产前胎盘植入的声像图特征,得出对产前胎盘植入的检出率。结果产前胎盘植入的二维声像图以胎盘增厚、胎盘内漩涡形成、胎盘后间隙消失、局部肌层菲薄为主要特征;而加用彩色多普勒后,则可显示出胎盘漩涡内的丰富血流及增多的胎盘基底血管丛。56例胎盘植入患者中,产前超声正确诊断出20例,检出率约为35．7％。结论彩色多普勒超声在胎盘植入的产前诊断中有重要的临床应用价值。     

医源性股动脉假性动脉瘤及动静脉瘘的彩色多普勒超声诊断价值

目的：探讨彩色多普勒超声检查对医源性股动脉假性动脉瘤和动静脉瘘的诊断价值。方法：使用彩色多普勒超声检测26例临床怀疑为股动脉假性动脉瘤或动静脉瘘的病人,主要观察其血管壁的连续性、动静脉间有无异常交通及是否出现异常血流信号等指标。结果：在26例经彩色多普勒超声检查的病人中,20例被正确诊断为假性动脉瘤,6例为动静脉瘘。结论：彩色多普勒超声能明确诊断医源性股动脉假性动脉瘤及动静脉瘘,可作为临床首选的检查方法。     

三维超声在胆囊疾病诊断中的价值

目的:评价三维超声在诊断胆囊病变中的价值.方法:104例胆囊疾病患者,在清晰的二维图像基础上进行三维重建,对比两者诊断价值,评价三维超声在胆囊疾病中的临床应用价值.结果:三维超声可清晰显示胆囊息肉是否带蒂,胆囊腺瘤基底部的宽和窄,胆囊腺肌增生症及胆囊癌病变与胆囊壁的关系,均优二维超声,P<0.05.结论:三维超声成像在胆囊病变诊断中较二维超声提供了更丰富、更准确的信息,有助胆囊疾病的诊断.     

彩色多普勒超声在诊断子宫圆韧带病变中的应用

目的探讨彩色多普勒超声在子宫圆韧带病变诊断和鉴别诊断中的应用价值。 方法回顾性分析2013年1月至2018年12月,首都医科大学附属北京朝阳医院西院105例（113条）超声诊断为圆韧带病变患者的临床资料及超声图像表现,与术后诊断结果对比。 结果临床术后证实圆韧带囊肿共66例（69条）,均合并腹股沟疝,其中68条为斜疝,彩色多普勒超声正确诊断圆韧带囊肿61例（64条）。超声表现圆韧带积液合并圆韧带增粗者2例（2条）,经手术及病理证实为子宫内膜异位症合并斜疝。超声诊断为圆韧带静脉曲张合并斜疝1例（1条）,斜疝术后复查静脉曲张消失。超声诊断的圆韧带囊肿合并疝1例（1条）,手术证实为斜疝合并圆韧带囊性病变（性质不明）。超声正确描述圆韧带区交通性积液21例（24条）,术后均证实为斜疝。 结论彩色多普勒超声在诊断圆韧带病变中具有较高的应用价值,特别是对圆韧带囊肿的诊断率较高。圆韧带病变中圆韧带囊肿发生率相对较高。圆韧带病变和腹股沟斜疝的发生关系密切。     

彩色多普勒超声在介入穿刺性血管损伤诊断中的价值

目的用彩色多普勒超声观察穿刺性血管损伤的声像图特征。方法26例周围血管穿刺后出现局部肿块、血管杂音,用彩色多普勒超声显示肿块的形态、回声、与周围血管的关系,观察肿块内、破口处、肢体动脉和静脉内的血流信号。结果3例单纯性血肿,彩色血流成像肿块内无血流信号;19例假性动脉瘤,肿块内有低速的动脉血流信号,动脉与肿块的破口处有五彩镶嵌的彩色血流信号和收缩期高速湍流血流频谱;4例动静脉瘘,在瘘口处可见有一股五彩镶嵌的彩色血流信号和连续性高速分流频谱。结论彩色多普勒超声能为穿刺性血管损伤提供准确的诊断。     

下肢静脉超声检出肌肉骨骼系统病变的临床价值

目的探讨下肢静脉超声检出肌肉骨骼系统病变的临床价值。方法回顾性收集因临床疑诊或需除外下肢深静脉血栓接受下肢静脉超声检查的8 288例患者的资料,分析下肢静脉超声检查对于肌肉骨骼系统病变的检出率及合并深静脉血栓等超声表现。结果下肢静脉超声检出肌肉骨骼系统病变134例,以腘窝囊肿(90/134,67.16%)最常见,其后依次为血肿(31/134,23.13%)、肌肉撕裂(5/134,3.73%)、脓肿(2/134,1.49%)、肿瘤(2/134,1.49%)、肌层囊肿(2/134,1.49%)、腘窝术后积液(1/134,0.75%)及膝关节滑膜增生(1/134,0.75%)。不同肌肉骨骼系统病变超声表现各异。腘窝未破裂囊肿最大径大于破裂囊肿(F=5.266,P=0.024)。134例中20例合并下肢深静脉血栓,其中肌肉撕裂患者最易合并血栓(1/5,20.00%)。结论下肢静脉超声检查可在判别有无深静脉血栓的同时检出肌肉骨骼系统病变,有助于修正或补充临床诊断及治疗方案,具有较高临床价值。     

Current diagnosis and management of urachal remnants

Purpose

The purposes of this study are to review our experience with patients who were found to have urachal remnants. We discuss their diagnosis and management and we also evaluate post-operative complications in our cohort of patients with this entity.

Methods

We performed a retrospective review of all patients diagnosed with a urachal remnant (UR) between January 2006 and December 2010. Patient variables included age, gender, presenting symptoms and signs, diagnostic modality, and type of urachal remnant. Operative management, post-operative complications, and non-operative follow-up were abstracted.

Results

We identified 103 pediatric patients with either a urachal cyst (n = 38), urachal diverticulum (n = 13), urachal sinus (n = 11), patent urachus (n = 21), or a non-specific atretic urachal remnant (n = 20). Seventy-eight patients had symptomatic URs. Thirty-four symptomatic patients underwent surgical excision of the UR and 44 symptomatic patients were observed. Eighteen URs were incidentally diagnosed in asymptomatic patients, none of whom underwent surgical excision. In 7 patients symptoms could not be determined from the records. No patients with non-specific atretic remnants were operated upon. Nineteen of the observed patients were reimaged subsequently. In fifteen (78.9%) of these patients, the URs had resolved spontaneously. None of the patients who were observed required subsequent excision of the UR. Post-operative complications occurred in 14.7% of patients in whom URs were excised.

Conclusion

Review of our patients diagnosed with URs indicates there is a subset of patients in whom spontaneous resolution could be expected. Complications are not uncommon after surgical excision.     

超声在不同分型急性结肠憩室炎诊断中的价值

目的 观察超声诊断单纯型及复杂型急性结肠憩室炎的价值。方法 回顾性分析17例急性结肠憩室炎患者的临床、超声及CT资料,分析超声诊断急性结肠憩室炎的价值。结果 17例中,11例接受超声检查,其中单纯型8例、复杂型3例。7例单纯型超声表现为局部结肠肠壁增厚,结肠边缘见囊袋状凸起,边界清,憩室周围可见高回声包绕;1例病灶位于升结肠,结肠边缘见囊袋状凸起,憩室内见高密度粪石,肠壁增厚伴周围脂肪密度升高,超声漏诊后经CT检出。3例复杂型超声均表现为憩室周围低回声包块,与周围肠管、膀胱分界不清。超声结合临床准确诊断10例(90.91%,10/11)急性结肠憩室炎,包括7例(7/8,87.50%)单纯型和3例(3/3,100%)复杂型。结论 超声有助于诊断急性结肠憩室炎,尤其复杂型急性结肠憩室炎。     

Progress of endoscopic ultrasonography and intraductal ultrasonography in the diagnosis of malignant biliary diseases

In recent years, ultrasound technology has made remarkable strides, and the application of these latest advances to endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS) is crucially important. EUS equipped with electronic scanners (both radial and convex types) has been developed, and now EUS with the function of tissue harmonic imaging (THI) and color/power Doppler is applicable clinically. THI facilitates the acquisition of ultrasound images clearer than those of fundamental imaging, and color/power Doppler sonography demonstrates the precise hemodynamics with the use of a contrast agent. In addition, the progress of image processing technology has realized three-dimensional (3D) images in EUS and IDUS. Reconstruction of 3D images enables us to diagnose more objectively. Here we describe the roles of these new ultrasound technologies in the diagnosis of biliary malignancies.     

Remnants of urachus in infants and children —The problems of diagnosis and treatment—

A total 17 cases of remnants of urachus were examined between 1981 and 1989, including 2 cases of patent urachus, 5 of urachal cyst, 9 of urachal sinus, and 1 of urachal diverticulum. A long urachal sinus was considered to be caused by the self-destruction of a cyst. While patent urachus was diagnosed in neonates with urine discharge from the umbilicus, cysts or sinuses accompanied by infection were more often found in older children. Imaging of the burrows was diagnostic in 8 out of 11 cases, ultrasound examination in 9 out of 12, and CT examination in all of 3 cases. Since this condition is frequently accompanied by malformations of the urinary system, attention must be paid to locating the accompanying anomalies. Although primary extraction was performed in 13 cases, the primary treatment of cases with highly infected cysts should be drainage, followed by secondary extraction. Furthermore, caution must be exercised to avoid hemorrhage in cases with dilation of the umbilical artery.     

超声内镜检查与胰腺疾病内镜治疗

超声内镜检查原理与腹部超声相似,其区别只是将微型高频超声探头安装在内镜顶端,进行实时超声扫描.胰腺是腹膜后器官,由于EUS插入胃和十二指肠肠腔内扫查,可清晰显示胰腺结构.随着EUS的广泛应用和内镜附件发展,EUS在胰腺疾病微创治疗中的地位越来越高.EUS-FNA与注射技术、EUS-CPN、EUS介导放射粒子植入术和内镜超声引导下胰腺假性囊肿穿刺引流等治疗技术会逐步推广应用,成为继ERCP内镜治疗后胰腺疾病微创治疗的重要方法.     

阴囊超声显像在无精子症病因诊断中的应用价值

目的:探讨阴囊超声显像在无精子症病因诊断中的应用价值。方法:对96例无精子症患者行阴囊超声检查,将声像图与最终诊断结果进行对比分析。结果:依据声像特征96例患者中35例提示为梗阻性无精子症,61例提示为非梗阻性无精子症,诊断准确率为97.0%。梗阻病例中44.4%的患者可依据声像特征对梗阻病因及部位作出提示,与最终诊断完全符合;非梗阻病例中46.7%的患者可依据声像特征对病因及部位作出提示,诊断准确率为75.0%。其余病例可对病因作出方向性提示,缩小进一步检查的范围。结论:应用阴囊超声显像可对无精子症病因做出诊断或方向性提示,是无精子症患者重要的检查手段。     

超声内镜在胃癌术前诊断中的应用分析

目的探讨超声内镜(EUS)在胃癌术前TN分期中的应用经验。方法术后病理检查证实为胃癌而且使用超声内镜进行了术前TN分期的患者352例,对其资料进行回顾性分析。结果 EUS胃癌术前T分期总正确率为81.25%,其中T1为85.58%,T2为73.91%,T3为82.14%,T4为83.33%,与术后病理结果比较具有高度一致性(Kappa系数为0.75)。EUS对胃癌术前N分期总的正确率为52.84%,其中N0为85.56%,N1为56.69%,N2为28.09%,N3为26.09%,与术后病理结果比较具有一般一致性(Kappa系数为0.33)。将病变部位分为贲门、胃底、胃体、胃窦、幽门,不同部位之间的检测正确率比较,差异无统计学意义(P0.05)。结论EUS在胃癌术前诊断中具有临床意义,其中T分期可为合理制定治疗方案提供依据,N分期准确性有待提高。     

超声联合空芯针穿刺活检在原发性乳腺癌腋窝淋巴结转移中的诊断价值

目的研究术前超声引导下淋巴结空芯针穿刺(US-CNB)在检测乳腺癌患者腋窝淋巴结转移中的诊断价值。方法回顾性研究2016年1月至2017年7月在我院行超声检查及超声引导下空芯针穿刺活检,并有腋窝淋巴结术后病理诊断的所有乳腺癌病人。计算US-CNB的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、准确性,同时统计Kappa值以明确一致性情况。分析US-CNB结果与N和T分期的关系。结果以术后病理结果为金标准,US-CNB诊断淋巴结转移的敏感性为91.8%(90/98),特异性为58.3%(21/36),PPV为85.7%(90/105),NPV为72.4%(21/29),误诊率为41.7%(15/36),漏诊率为8.2%(8/98),约登指数为50.1%,准确性82.8%(111/134),ROC曲线下面积为0.751。比较US-CNB与术后病理的一致性,Kappa=0.535。排除新辅助化疗患者14例,特异性、PPV和误诊率分别为95.5%(21/22)、98.9%(90/91)以及4.5%,约登指数87.3%,准确性92.5%(111/120),ROC曲线下面积为0.936(P0.0001),比较排除后US-CNB与术后病理的一致性,Kappa=0.777。随着T和N分期的增加,US-CNB的敏感性增加。结论乳腺癌患者术前腋窝淋巴结空芯针穿刺可作为诊断腋窝淋巴结转移的可靠方法,与术后病理有较高的一致性。淋巴结穿刺结果阳性可能与乳腺癌较高肿瘤负荷相关。     

A case of spontaneous rupture perforation of leiomyosarcoma in the urachus of a young boy

A case of spontaneous rupture of the urachal leiomyosarcoma in a 12-year-old boy is presented. This is of interest because massive hemoperitoneum due to spontaneous rupture of the urachal leiomyosarcoma is remarkably rare. We diagnosed based on histopathological features. Partial cystectomy and adjuvant chemo-radiation therapy was done with no sign of local recurrence or metastasis until 6 months after the operation.