二维超声和彩色多普勒超声对浅表软组织肿物的诊断价值

目的探讨二维超声及彩色多普勒超声对浅表软组织肿物的诊断价值.方法应用超声和彩色多普勒血流显像(CDFI)对86例浅表软组织肿物患者术前进行检查,全部病例均经手术及活检证实.结果良性病变41例,恶性病变45例,超声对病变的检出率为100%,准确率为75.58%(65/86),良恶性肿物的最大长径与最大短径比(L/S)及CDFI的血流动力学参数具有差异.结论超声诊断软组织肿块检出率高,可作为诊断此病的首选方法,CDFI超声对良恶性肿块的鉴别诊断有一定的临床价值.     

彩超鉴别诊断乳腺良恶性肿块的价值评估

目的:探讨彩色多普勒超声对乳腺良恶性肿块的鉴别诊断价值.方法:应用二维超声观察肿块的形态、边界、内部回声、有无后方衰减及侧方声影,并应用彩色多普勒血流显像(CDFI)观察肿块内部血流分布情况,并测量血流阻力指数(RI).结果:67例乳腺癌患者中64例超声诊断与病理结果相符,另有3例误诊为良性肿块,诊断符合率为95.5%;29例乳腺良性肿块患者中28例超声诊断与病理结果相符,另有1例误诊为恶性肿块,诊断符合率为96.6%.结论:彩色多普勒超声对乳腺良恶性肿块的检查与病理符合率高,有很好的鉴别诊断价值.     

彩色多普勒血流显像及乳腺内筋膜韧带声像变化对鉴别诊断乳腺小肿块的价值

背景与目的:彩色多普勒血流显像(colorDopplerflowimaging,CDFI)已广泛应用于乳腺肿块的超声诊断,但CDFI结合乳腺内筋膜韧带(浅、深筋膜和Cooper韧带)的声像变化在鉴别诊断乳腺小肿块(直径≤2cm)中应用的文献报道甚少。本研究探讨CDFI结合乳腺筋膜和Cooper韧带的声像改变在鉴别诊断小乳癌的应用价值。方法:对乳腺肿块直径≤2cm的110例患者(经术后病理确诊为良性52例,恶性58例)进行CDFI检查,分析乳腺病灶内部和周边的血流分布及多普勒频谱。根据血流丰富程度分成四个等级,并结合乳腺内筋膜韧带(浅、深筋膜和Cooper韧带)受浸润情况的观察,将诊断结果与病理结果进行对照。结果:超声对乳腺良、恶性小肿块诊断的符合率分别为:90.4%、84.5%。假阳性率为9.6%;假阴性率为15.5%。良恶性肿块的血流分级和收缩期流速峰值(Vmax)、阻力指数(RI)及浅、深筋膜和Cooper韧带的声像变化均有显著性差异。结论:CDFI结合乳腺内筋膜及韧带的声像变化,对乳腺小肿块的诊断和鉴别诊断具有一定的临床应用价值。     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体）,对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法,具有实时、经济、简便易行等优点。     

高频彩色多普勒超声在甲状腺微小癌诊断中的应用

 【摘要】　目的　探讨甲状腺微小癌（TMC）的高频声像图及彩色多普勒血流特征,评估彩色超声对TMC的诊断价值。方法　对经病理证实的67个甲状腺小肿块高频声像图及彩色多普勒血流特征进行回顾性分析,与病理结果对照。结果　TMC的高频声像图具备多种恶性特征,其中肿块内微小钙化是TMC的重要特征,另外脉冲多普勒（PD）频谱阻力指数（RI）≥0.70及彩色多普勒血流显像（CDFI）的血流分级≥T2级亦具有很好的阳性预告意义。结论　使用高频二维超声结合彩色多普勒超声可以较准确诊断TMC。     

彩色多普勒超声在甲状腺癌诊断中的应用价值

目的探讨彩色多普勒超声在甲状腺癌诊断中的应用价值。方法回顾性分析2012年1月至2013年12月间收治的65例经病理确诊的甲状腺癌患者的二维与彩色血流图像。结果共发现80枚肿块,肿块大小为5.1mm×6.2mm至66.5mm×48.0mm,平均大小为25.0mm×23.0mm。超声图像显示,肿块边界不规则,且无包膜,周边无任何声晕;部分出现不均匀回声,或者稍低回声,混合性回声。彩色多普勒超声结节显示有血流信号,且表现中心性和穿入性血流,血流信号的多少与患者病灶大小相关,结节越大其血流信号越丰富,且比较复杂。结节血流分级显示,Ⅰ级10例(15.4%),Ⅱ级28例(43.1%),Ⅲ级27例(41.5%)。PSV为10.5cm/s至50.0cm/s,流速为(30.4±3.5)cm/s;RI为0.42~0.99,平均RI为0.71。结论彩色多普勒超声在甲状腺癌诊断中具有重要价值,二维和彩色多普勒超声能够有效提高诊断符合率。     

超声造影对肝脏实性肿块的诊断及治疗的进展

超声诊断问世几十年里,经历了几次飞跃。从A超和M超,到显示实时切面图像的灰阶二维B超,超声诊断有了突破性进展。在二维超声上叠加彩色血流信号以及对血流多普勒信号的分析,大量的心血管性疾病得以明确。近几年,三维成像、造影成像模式的相继出现,超声在临床各个领域中得到了更广泛的应用。我们从超声对肝内肿块诊断的变化,体会到从二维超声到超声造影的巨大技术进步。一、二维超声及彩色多普勒超声(CDFI)诊断肝内病灶随着超声检查的普及,发现肝内实性肿块日益增多,以原发性肝癌(HCC)、肝血管瘤、肝转移瘤多见;肝硬化结节、局灶性增生结…     

乳腺叶状肿瘤良、恶性的二维及彩色超声表现

目的研究乳腺叶状肿瘤良、恶性的二维声像图及彩色多普勒血流（CDFI）特点。方法回顾分析19例经手术病理证实的乳腺叶状肿瘤的二维及彩色多普勒超声所见。结果①叶状肿瘤良性8例、恶性4例、交界性7例。②良性肿瘤二维超声表现为：乳腺肿物较大，呈类圆形或分叶状。形态规则，边界清晰，见包膜回声及侧方声影，内部多为欠均匀的中低回声；恶性肿瘤二维超声表现为：乳腺肿块形态欠规则，边界不清，无包膜或包膜不完整，内部回声不均匀，后方伴声衰减。③多普勒超声表现，良、恶性肿物内及周边彩色多普勒血流信号较丰富，恶性组动脉血流速度和RI高于良性组。结论乳腺叶状肿瘤具有一些特征性的超声声像图表现。肿块局部边界不清、后方声衰减、血流丰富、流速及阻力指数增高提示恶性程度可能性较高。二维超声及CDFI结合病史有利于乳腺叶状肿瘤的良、恶性诊断和鉴别诊断。     

彩色多普勒超声鉴别诊断甲状腺良恶性肿块

目的：探讨彩色多普勒超声在甲状腺肿块中的诊断与鉴别诊断价值。方法：对120例甲状腺肿患者观察二维及彩色多普勒血流（CDFI）的特点,结果：结节性甲状腺肿67例,超声诊断符合率94．0％,甲状腺炎25例,超声诊断符合率92．0％,甲状腺良性肿瘤18例,超声诊断符合率100％,甲状腺恶性肿瘤10例,超声诊断符合率80．0％,结论：甲状腺良性肿块之间及良,恶性肿块在超声声像图及血流上有鉴别意义。     

高频声像图与彩色多普勒显像对乳腺肿瘤的诊断价值

目的评价高频超声及CDFI对乳腺肿瘤的诊断价值。方法回顾性分析67例经手术病理证实乳腺肿瘤的高频超声图像及彩色多普勒血流表现。结果高频超声能清晰显示乳腺肿块大小、形态、内部结构等,CDFI血流分级有差异,但对小乳癌血流信号检出不敏感。结论高频超声及彩色多普勒对乳腺肿瘤有较高的诊断价值,但仍有局限性。     

Full-term gestation and transvaginal delivery after wide resection of an abdominal desmoid tumor during pregnancy

A 29-year-old female was diagnosed with a symptomatic, extra-abdominal desmoid tumor during the first trimester of pregnancy. Computerized tomography (CT) and transabdominal ultrasound (US) noted a mass within the left rectus sheath measuring up to 15 cm in greatest diameter, with mild compression of the uterus. Preoperative diagnosis was confirmed by core-needle biopsy of the lesion. At 20-weeks gestation, wide local resection of the tumor with disease-free margins, as well as abdominal wall reconstruction with polytetrafluoroethylene (PTFE) mesh was successfully undertaken. Histological examination of the tumor ex vivo confirmed that the lesion was a desmoid tumor consisting of spindle cells with dense infiltrating collagenous fibers. Subsequent to her resection, the patient completed a full-term pregnancy without complication, and proceeded with a complication-free transvaginal delivery at 39 weeks. This case illustrates the probable contribution of estrogens towards desmoid tumor development, the durability of abdominal wall reconstruction when subjected to the extraordinary strain of both a gravid uterus and labor, as well as the safety and efficacy of aggressive surgical therapy during pregnancy.     

The therapeutic procedure for desmoids in patients with diffuse polyposis of the large intestine]

Desmoid was diagnosed in 54 out of 632 patients who had been operated on for diffuse polyposis. The age of patients with desmoid ranged from 18-61 years. Twenty of them had desmoid in the anterior abdominal wall whereas 30--in the small intestine mesentery or retroperitoneal space. Dissection was carried out in 14 out of 18 patients with anterior abdominal wall desmoid. Recurrence was registered in 6 patients. Dissection was attempted in 12 out of 26 patients with intraabdominal desmoid but radical procedure could be performed in 5 only. In a group of 4 patients with synchronous desmoid of both sites, both tumors were removed in one patient only whereas in the other 3--only anterior abdominal wall tumor could be dissected.     

腹壁韧带样瘤84例临床分析

[目的]探讨腹壁韧带样瘤的临床特点和治疗方法。[方法]回顾分析1988年1月～2007年12月收治的84例腹壁韧带样瘤患者的临床资料，其中首次治疗69例，外院治疗后复发15例，全组病例均经手术治疗，5例手术后有残留者给予术后放疗。[结果]全组84例病例中．79例患者行广泛切除术，5例姑息性切除，留有肉眼肿瘤残留。行广泛切除术者中，73例病理切缘阴性，6例病理切缘阳性，其中69例首次治疗患者中，64例获得病理切缘阴性．外院治疗后复发病例15例中，5例姑息性切除者皆留有肉眼肿瘤残留；9例病理切缘阴性。切缘阴性局部复发率6．8％．切缘阳性复发率为33％。术后残留病例经放疗后，2例肿瘤消退，1例消退后3年复发再手术，2例稳定。[结论]手术是治疗腹壁韧带样瘤的首要治疗方法，首次治疗的正确性和获得病理切缘阴性对控制局部复发非常重要，放疗是对手术不彻底的有效补充治疗手段。     

Abdominal wall desmoid tumor--analysis of 42 patients

Forty two patients with abdominal wall desmoid tumor, including one Gardner's syndrome, are reported. All patients were female except one. The tumor occurred in various sites in the abdominal wall, 66% in the lower abdominal wall. The fascia, sheath and muscle layer were chiefly involved and a very large tumor could invade peritoneum and viscera. This tumor shows aggressive growth and is prone to recurrence. Surgery is the treatment of choice. Local recurrence rate was 5.5%. Abdominal wall desmoid tumor associated colonic polyposis is named Gardner's syndrome. The authors emphasize that a local extended resection should be performed with a safety margin at least 2-3 cm beyond the tumor. Peritoneum, if involved, should be resected together with the primary focus.     

腹壁韧带样纤维瘤53例病例分析

 目的　探讨腹壁韧带样纤维瘤的临床特点和治疗 ;方法　回顾分析 1964～ 1997年间外科收治的 53例腹壁韧带样纤维瘤 ;结果　 53例腹壁韧带样纤维瘤行广泛切除术 32例 ,根治切除术 19例 ,姑息切除术 2例 ,术后合并放射治疗 1例 ,全组病例复发率 2 0 8%,本院治疗者复发率 3 8%( 2 53) ;结论　腹壁韧带样纤维瘤呈侵袭性生长的特性 ,治疗应按低度恶性软组织肿瘤处理。治疗首选外科手术 ,配合放疗、化疗和内分泌治疗可提高疗效。     

Identification of somatic APC mutations in recurrent desmoid tumors in a patient with familial adenomatous polyposis to determine actual recurrence of the original tumor or de novo occurrence

A 25-year-old female with familial adenomatous polyposis (FAP) presented with an abdominal tumor just below the scar due to a colectomy performed 15 months previously. This tumor (tumor A) measured 7 cm in diameter, was diagnosed as a desmoid tumor of the abdominal wall, and was excised. Despite the subsequent administration of sulindac (300 mg daily for 1 year), a desmoid tumor recurred at the same site. Excision was performed again when the tumor was 8 cm in diameter, and examination revealed it to consist of a large tumor (B) and a small tumor (C) that bulged out from tumor B. Germ-line APC analysis showed a C deletion at codon 1460 resulting in a stop codon. Two somatic mutations were observed in tumor A: a TCAA deletion at codon 1068 and a deletion of a codon at bp 1192–2097. In tumor B, a somatic mutation was found at codon 1041 changing CAA to TAA. We could not detect any somatic mutations in tumor C. We conclude that somatic mutation analysis of the APC gene can be used to identify whether a recurrent desmoid tumor in a patient with FAP is a new primary tumor or a recurrence from microscopic remnants of the original tumor.     

原发性胆囊癌的影像学诊断

目的　比较超声 ,CT ,PTC和ERCP对原发性胆囊癌的诊断价值。方法　 74例胆囊癌病人术前分别进行了超声 ,CT ,PTC和ERCP检查 ,对这些影像学检查进行回顾性研究分析。结果　超声 ,CT和ERCP对胆囊癌的正确诊断率分别为 80 .3 % ,88.5 5和 2 5 % .7例直径 >3cm的胆囊癌中有 6例CDFI阳性。 4例伴有黄疸的病人行PTC检查的目的主要是为了PTBD减黄。结论　超声是诊断胆囊癌首选的影像学检查方法 ,CDFI在确定胆囊恶性肿瘤时很有帮助。疑似胆囊癌或有转移和进行临床分期时 ,CT较超声更有用。胆囊癌伴有黄疸的病人 ,PTC和ERCP主要以治疗为目的     

The use of indomethacin, sulindac, and tamoxifen for the treatment of desmoid tumors associated with familial polyposis

Seven familial polyposis patients with desmoid tumors were treated with indomethacin, sulindac, or tamoxifen either as single agents or in combination. Serial computed tomographic (CT) scan examination was employed for objective measurement of tumor size since physical examination alone was an inaccurate means to evaluate intraabdominal and retroperitoneal desmoids. Only one patient with minimal tumor burden demonstrated a favorable response with complete resolution of an abdominal wall desmoid.     

胃恶性间质瘤的诊断与治疗

目的:探讨胃恶性间质瘤的术前诊断方法及有效的治疗手段。方法:回顾性分析我院1995年~2005年间收治的9例胃恶性间质瘤患者的临床表现、理化检查、治疗方法及结果。结果:胃恶性间质瘤患者多表现为反复的消化道出血、腹痛、腹部不适及腹部包块,纤维胃镜、超声内镜、消化道钡透、腹部CT检查有助于手术前诊断。本组患者肿瘤最大直径为5.5cm~21cm,平均为11.8cm,根治性手术7例、姑息性减瘤手术2例,根治性手术患者中2例术后复发接受二次手术,4例无瘤生存5年以上,姑息性手术2例患者均于术后6个月内死亡。免疫组化检查CD117阳性9例(100%)、CD34阳性7例(77.8%)、Vimentin阳性7例(77.8%)S-100阳性5例(55.6%),Actin阳性4例(44.5%)。结论:免疫组化检查可确诊胃恶性间质瘤,根治性手术减少手术后复发及远处转移。     

硬纤维瘤的临床特点--附100例病例报告

目的：探讨硬纤维瘤的临床特点和治疗方法。方法：回顾分析我院１９６４－１９９７年间外科收的１００例硬纤维瘤,包括腹壁硬纤维瘤５３例,腹壁外硬纤维瘤４７例。结果：全组１００例硬纤维瘤行广泛切除术６８例,根治切除术２７例,术后合并放疗１２例,全组病例复发率３６％,本院治疗复发率１０．８％,１例病人死于肿瘤肺转移。结论：硬纤维瘤呈侵袭性生长,复发率高,治疗应按低度恶性软组织肿瘤处理。外科手术是主要的治疗方